An Anthropological Study of Open Dialogue in the NHS (APOD) v1
Research type
Research Study
Full title
Transformation in Mental Healthcare: An Anthropological Study of Open Dialogue (OD) in the UK's National Health Service
IRAS ID
272400
Contact name
David Mosse
Contact email
Sponsor organisation
SOAS University of London
Clinicaltrials.gov Identifier
ES/T008245/1, ESRC grant under review
Duration of Study in the UK
3 years, 5 months, 1 days
Research summary
Research Summary
This is an in-depth ethnographic study of the Peer-Supported Open Dialogue (POD) model of psychiatric care. Open Dialogue, developed in Finland, is a service delivery model with a collaborative approach that explicitly targets social networks. Its non-diagnostic approach uses dialogical techniques with clients and their networks to engage with the social conditions and meaning of distress. Appropriate pharmaceutical, psychological or social interventions are deployed in shared decision-making with social networks and healthcare professionals. It aims at improving outcomes for people in crisis and suffering from severe mental Illness.The study is undertaken as a complement to the NIHR-funded multicentre cluster RCT UCL-led ODDESSI (Open Dialogue-Development and Evaluation of a Social Network Intervention for Severe Mental Illness). The trial will tell us whether on average people in crisis receiving POD do better across the NHS Trust sites; but it will not explain why or how POD works.
The ethnographic study running alongside the 3-year trial investigates mechanisms of POD. It involves a team including anthropologists, those with lived experience as service-users, and mental-health professionals. It incorporates a PhD project focused on peer roles in POD. The study involves a partnership between SOAS Anthropology and Barnet, Enfield and Haringey Mental Health NHS Trust. The focus is on the Haringey site of ODDESSI, the team delivering POD, its clients and their communities. The research will investigate what happens in practice with regard to Open Dialogue’s dialogical therapeutic model, its social network approach, and the institutional reorganisation of mental health services that it entails. The study will discover factors of context that influence POD practice and outcomes, especially those relevant in a socially diverse inner-city area. It will help interpret findings of the trial, tailor the implementation of the POD model and inform its translation from initial trial sites into new settings.
Summary of Results
1. New methods: this multi-site study (APOD) has developed and implemented a new approach to ethnographic research in mental healthcare. This involves the combination of three elements: (1) researchers training in the therapeutic approach (Open Dialogue) and becoming practitioner-ethnographer members of NHS Community Mental Health Teams; (2) working as a team with mental health professionals who are given ethnographic research training and collaborating in fieldwork and data generation and processing; (3) including those with lived experience of mental health services as core researchers in the team. Finally, the anthropological study is undertaken alongside but independent of a large multi-site randomised controlled trial of the approach being researched. Details published https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fwww.frontiersin.org%252Fjournals%252Fpsychology%252Farticles%252F10.3389%252Ffpsyg.2023.1111588%252Ffull%2FNBTI%2FgxPAAQ%2FAQ%2Fc62e9b44-5806-4d73-b2cd-21c0461ac12e%2F2%2F9SCaBGXs5m&data=05%7C02%7CWales.REC5%40Wales.nhs.uk%7C17f6ae15c3be4110fd0708ddf9b41e57%7Cbb5628b8e3284082a856433c9edc8fae%7C0%7C0%7C638941274216003133%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=W%2BfuR2D1UohojXy1rjiZlXWPKh%2B7ALwayt1qzdC8ZYs%3D&reserved=02. New knowledge: The study has documented in rich detail the experience of implementing Peer-Supported Open Dialogue for clients and practitioners, and the processes involved. It has identified the impact of changing the relationship between clinicians and patients (and a different approach to psychiatric diagnosis and medication) on the therapeutic process and recovery, and evidenced this in the voices of these actors themselves. It has thrown light on the experience and effect of 'peer' work in mental health teams, and established the value of peer support workers in building trusting therapeutic relationships in the interstices of community and healthcare institution. These relationships strengthened engagement with Open Dialogue and services more broadly. The study evidences the nature and importance of team processes, especially the effects of new reflective spaces for therapeutic teams. It has identified a key opportunity for organisational innovation through Open Dialogue but also organisational constraints in implementation given features of the existing healthcare system.
3. New research resources and collaborations: The study has mobilised resources through new collaborations with NHS Trusts to support ethnographic research within mental health services with the appointment of researchers in NHS teams. The experience of APOD fed into the development of a large Research England bid (Expanding Excellence in England- E3) securing a £7.8 million 5-year investment for a sustainable Centre for Anthropology and Mental Health Research in Action (CAMHRA). This expands the kind of work initiated under the APOD project and is developing existing and new research partnerships and collaborations with NHS, public health and other mental health organizations
4. Important new research questions opened up: The study has thrown light on the challenges faced by mental health staff and the need to pose new anthropological questions about organisational culture and the phenomenon of mental health staff 'burnout'. These are under investigation with follow-up PhD research. Further PhD project on 'Transforming Dementia Care using an Open Dialogue approach. An ethnographic study in the NHS'
Impact: The methodology and findings of this study will be of relevance to mental healthcare organisations, most immediately NHS Trust seeking to establish Open Dialogue or dialogical approaches to crisis and psychiatric care. Further outputs on this will be produced in tandem with the results of the ODDESSI RCT trial due in December 2025. The outcomes and engagements contribute to policymaking debates in professional organisations (e.g., Royal College of Psychiatrists), and voluntary sector organisations (including those concerned with suicide prevention). The outcomes involve work with overseas mental health organisations adopting Open Dialogue approaches.
REC name
Wales REC 5
REC reference
20/WA/0037
Date of REC Opinion
14 Apr 2020
REC opinion
Further Information Favourable Opinion