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5th Symposium Open Dialogue 2012
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 )
5.
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
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)
11.
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
Each person speaks and expresses their understanding or perception on the menaing of experience (therapeutic interaction) who are inturn listened to by the others who then get their turn Participants reflect on the whole picture an dtogether try and create some menaing that makes sense to them all or at least can be mutually understoood. The very act of putting each persons story into the equation, in itself creates new meaning. Through dialogue, people are in a positoin to explore ways of embracingdifferent perceptions or agreeing conjoint ones. Consesus is good but not necessarily as long as mutual understanding is on the way to being reached Don’t have to abandon beliefs as long as we understand and respect others perception.
Each person speaks and expresses their understanding or perception on the menaing of experience (therapeutic interaction) who are inturn listened to by the others who then get their turn Participants reflect on the whole picture an dtogether try and create some menaing that makes sense to them all or at least can be mutually understoood. The very act of putting each persons story into the equation, in itself creates new meaning. Through dialogue, people are in a positoin to explore ways of embracingdifferent perceptions or agreeing conjoint ones. Consesus is good but not necessarily as long as mutual understanding is on the way to being reached Don’t have to abandon beliefs as long as we understand and respect others perception.