This document summarizes a symposium on open dialogue approaches to improving mental health services. It discusses open dialogue as a form of communication, a therapeutic approach, and a process for service delivery, organizational development, and community development. Trialogue meetings and a mental health trialogue network in Ireland are presented as examples of open dialogue processes that bring various stakeholders together and increase understanding of mental health issues. Survey results suggest those participating in trialogue meetings gain greater awareness and understanding of mental health, services, and how to address stigma in their communities.

1. 5th Symposium on Open Dialogue
Approaches to Mental Health
Services Improvements
`One Vision Many Voices`
 Open Dialogue
 The experience of Trialogue
 Mental Health Trialogue Network Ireland
 The experience of Open Dialogue
Processes for an Irish Mental Health
Service
 Trialogue meeting

2. Open Dialogue
 As a form of open communication
 As a therapeutic approach
 Service Delivery
 As a process to aid organisational
development
 As a process for community development

3. Open Dialogue as communication
“where it is perceived as a joint action that joins
people together in a temporary mutual world
experience. Participants have to be willing to
engage in this dialogue or a situation needs to
be created where it can ensue” (Bakhtin 1981)
 Subject to subject (with,not to!)
 Co-creating and naming their world
 Don’t have to abandon beliefs or values

4. Open Dialogue as therapeutic
 ….Dialogue with and about the client’s
narrative, through listening and clarifying
their story. Through generation of a mutual
understanding an inevitable change is
instigated by the expert client………(Anderson and
Goolishian 1992 )

6. Underpinning service delivery &
Organisational Development….
 Western Finland
 Open Dialogue Network based practice for people referred to
services with ‘psychosis’
 Open Network Meetings
 Birmingham – Acute Inpatient Care
 Open Dialogue Groups
 Dublin Acute Inpatient Care
 Leadership Programme change management model –
DCU/HSE
 Patients and Clients Council Bamford Monitoring group
Northern Ireland

7. As a process for community
development

8. Just to be clear……….

9. Characteristics of Open Dialogue
Processes and Participation
 The dialogue is based on give and  An argument can be rejected only after
take as opposed to one way an investigation (and not for instance, on
communication the grounds that it arises from a source
 All people concerned by the issue with limited legitimacy)
under investigation should have the  All arguments to enter the dialogue must
opportunity to participate be represented by the actors
 Participants are obliged to help other (participants) present
participants be active in the dialogue  All participants are obliged to accept that
 All participants have the same status other participants may have better
within the dialogue arena arguments than their own
 Experience is the point of departure  Among discussion issues can be the
for participation roles occupied by participants with no
 At least some of the experience the one exempt from such a discussion
participant has when entering the  The dialogue should be able to integrate
dialogue is seen as relevant a growing degree of disagreement
 It must be possible for all participants  The dialogue should continuously
to have an understanding for the generate decisions that provide a
topics under discussion platform for joint action
(Gustavsen, 2001)

10. Examples of non open dialogue
approaches
 Some community group practices
 Associations & voluntary groups
 Institutional norms & cultures
 Routine protocol & practice
 Hierarchical decision making
 Interviewing to fit the boxes (monologue)
 Ward rounds
 Service access protocols
 Management committees
 Enforced democracy (majority/loudest rules)

12.  The creation of a community forum where
everyone with an interest in mental health
participates in an open dialogue
www.trialogue.co

13. Developing a Mental Health Trialogue
Network in Participating Communities
‘Mental Health Trialogue Network Ireland’
 Emerging as a process outcome of the leadership
programme
 7 areas and then snowballing
 Integrating with existing Trialogue groups where they
exist
 Local facilitation & sustainability
 Enabling interested people/groups to step outside their
own bubbles to experience others views perceptions and
suggested solutions
 A communication network
 Web, advertisement, local public area notices
 Parallel process to leadership teams in local mental
health communities with option for the Trialogue
participants to become active in informing and
further developing community response to
mental health issues within…

14. Participating Sites
 South Tipperary
 Dublin South Central
 Galway
 Donegal
 Dublin South West
 Mayo
 West Cork

15. Mental Health Trialogue Network
 Funded through GENIO
 Core project team
 Steering group
 Local community facilitation
 Participants
 Interested others

16. PROJECT AIMS
 To facilitate the establishment of community
leaders in the area of mental health
 To develop a community forum using the
‘Trialogue’ processes
 To strengthen the voice of people with
mental health problems & families/ carers
regarding needs & supports in their
communities
 To provide a focus for developing
awareness and action around mental health
within communities

17. HOW THE AIMS WILL BE
ACHIEVED
 Establish monthly Trialogue meetings in 7
communities in Ireland during 2011
 Create an online Mental Health Trialogue
collaborative community accessible to
public
 Provide a learning forum for leadership
teams to develop community development &
Trialogue facilitation skills

18. BENEFITS OF THE
PROJECT
 Emergence of community leaders in relating to
mental health problems and community response
 Increased understanding of mental health problems
among community members
 Increased capacity among people with mental
health and their families & carers to advocate for
and determine supports needed in communities
 Provision of a community focus for actions aimed at
developing mental health awareness and action
 Creation of an online resource and Mental Health
Collaborative Network

19. As a result of participating in 2 or
more Trialogue Meetings …….
 Peoples understanding of mental health and mental distress increased
 SU= 64%, P = 84%, FM = 56%, Com 67%.
 People are more informed about how people respond to, manage and cope
with mental health problems
 SU = 72%, P = 63%, FM = 89%, Com = 100%
 People are more aware of what is good and not so good about the mental
health services in their community
 SU = 64%, P = 73%, FM = 55%, Com = 100%
 People have increased awareness of where and in what way people with
mental health difficulties experience stigma and discrimination in their
community
 SU = 71%, P = 68%. FM = 67%, Com = 100%
 People are more aware of who has a responsibility for promoting mental
health and dealing with mental illness in their community
 SU = 43%, P = 69%, FM = 44%, Com = 66%
SU = service users; FM = family members; P = professional care
providers; and Com = other interested community members

20. www.trialogue.co