A new model of care for people with psychosis is currently being trialled in a number of countries. Called Open Dialogue, it aims to empower patients and families
Citation: Martin F (2017) A model to empower patients and their families in mental health care. Nursing Times [online]; 113: 2, 58.
Author: Fiona Martin is lecturer (education), School of Nursing and Midwifery, Queen’s University, Belfast.
- Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)
There is a quiet revolution happening in mental health care, in particular in the response to the management of psychosis and crisis. Many patients and their families feel they are not being listened to or invited to be part of the decisions made about their care and treatment (Department of Health, 2015; Schizophrenia Commission, 2012). They are no longer content with the traditional system, in which the professional is the sole expert, as it fails to acknowledge the expertise of the patient and family.
Mental health services need a new approach that puts patients and their families/networks at its heart. Open Dialogue – a fairly new care model developed in Finland (opendialogueapproach.co.uk) – may offer a significant advance in addressing these issues and is being piloted in several countries including the UK (Seikkula et al, 2015).
What is Open Dialogue?
The name Open Dialogue was first used in Finnish Western Lapland in 1995. In the model, patients, their families/support networks and staff participate as equals in all treatment meetings relating to the patient to generate, through dialogue, new and shared understandings of patients’ personal experiences and the impact of psychosis.
The model aims for continuity of care, and meeting preferably in the patient’s own home. This arrangement increases a sense of psychological security for the patient and family, and allows for easier recognition of resources within the family.
In 2015 I undertook a Florence Nightingale Travel Scholarship and visited Tornio, Finland, the recognised home of Open Dialogue. The Open Dialogue literature described a positively evaluated model, in which patients and their families/support networks were at the heart of every decision made about them. I then spent a week in England at a residential Open Dialogue training event where four trusts are preparing to be part of the first multi-site Open Dialogue pilot in the UK.
After the training event I visited the US (Massachusetts, Vermont and New York), where Open Dialogue principles were being integrated into mental health systems. The Parachute Project in New York City has attracted international interest and state funding. It is the first time Open Dialogue has been used in a major urban environment.
There is an opportunity to incorporate Open Dialogue principles in the UK. There should be greater awareness of the model as it is still largely unknown, especially among mental health nurses. Information should be disseminated to all stakeholders, patient and family/carer groups, and professional and community groups. In addition curricula design for pre- and post-registration nursing should consider including elements of Open Dialogue.
I would recommend that regions identify teams/services interested in piloting Open Dialogue in conjunction with higher education institutions and the international Open Dialogue Network. Educating and training staff is critical and it is vital that a system of evaluation is established for the pilot project.
The overall message from my visits is that patients and families are no longer content with the traditional system, which includes a lack of recognition for their expertise. Open Dialogue attests to the importance of ensuring all voices are heard and responded to.
Implications for practice
- Nurses need to authentically respect patient and family expertise about their experiences of illness
- The nurse-patient relationship, although central, should be seen within the context of the family/support network
- Nurses must be supported to develop professional confidence in this shared decision-making model
- This article reports on a travel scholarship provided by The Florence Nightingale Foundation. The scholarships give nurses and midwives an opportunity to study practice elsewhere in the UK and/or overseas. They are awarded for the study of projects that will benefit both patients and the profession more widely in the UK.
Schizophrenia Commission (2012) The Abandoned Illness.
Seikkula J et al (2015) The comprehensive Open-Dialogue approach in Western Lapland: 11. Long-term stability of acute psychosis outcomes in advanced community care. Psychosis; 3: 3, 192-204.