Regular readers of my blog will know that I am committed to social work playing a more influential role in improving relational and systemic family approaches to working with people in mental distress, their families and carers. The peer supported Open Dialogue approach is gaining traction in mental health services and for me it captures much of what social work is about. I am therefore delighted to introduce Yasmin Ishaq, Service Lead for Open Dialogue in Kent, as my guest blogger this week.
Receiving the 2016 National Social Work Award for Creative and Innovative Social Work Practice for contributing to the development of the Open Dialogue approach in Kent feels like the start of a journey but also the culmination of several years of promoting this way of working.
During my Open Dialogue training in 2014/15, the value of understanding what motivates me as an individual and social worker was central to understanding what I contribute to others, including colleagues, service users, families and organisations. [Continues below]
What is the Open Dialogue approach?
Open Dialogue…is both a philosophical [and] theoretical approach to people experiencing a mental health crisis and their families/networks… [The] approach [involves] well-integrated inpatient and outpatient services working with families and social networks, as much as possible in their own homes. Teams work to help those involved in crisis situations be together and engage in dialogue.
From the Open Dialogue UK website
Find out more
[Continued from above] I qualified in social work 27 years ago and have worked within mental health services for the last 21. In that time, I have seen the impact of social determinants and how this informs ways of understanding mental distress.
The term ‘recovery’ is an often used phrase in mental health practice in the UK but I question this terminology when the biomedical model still dominates much of our practice. Recovery is not just about remission of symptoms - from a social perspective it also involves regaining positive roles and relationships that may have been disrupted.
Research suggests that recovery may involve a journey of both personal change and social reengagement, which highlights the importance of creating, accepting and enabling social environments within which recovery can be supported.
The majority of personal difficulties are rarely experienced in isolation but usually within family, social, cultural and community contexts. Yet in the world of mental health services I found an individualistic reductionist way of understanding mental distress that is led by the biomedical disease model. This way of working challenged my understanding of mental distress which I saw through a lens of relational crisis, often significantly affected by social determinants.
Increasingly, over the last 10 years or so, I have become disillusioned by a model of care dominated by a biomedical understanding of mental distress, particularly in relation to psychosis (I previously managed an early intervention in psychosis service).
The Early Intervention in Psychosis Service (EIPS) model has given greater emphasis to social and psychological factors in the overall treatment of psychosis. However, I have still found within the wider context of treatment the emphasis has remained focussed on adherence to a medication regime that ultimately coveys a message of deficits that need to be corrected rather than understood.
It was approximately 7 years ago I heard Jaakko Seikkula speak about Open Dialogue and immediately felt something resonate within me that started a journey of discovery and dedication to support change in the UK that could embrace the approach.
I saw a key role for social work practice in this approach with its strong psychosocial emphasis that embraced choice, empowerment, inclusiveness and what Seikkula termed ‘co-creation’ of understanding between practitioner and service user/family.
The role of social work in mental health services attunes with the seven principles of Open Dialogue. Strategically, the Care Act 2014 and NHS England Five Year Forward View also emphasise the need for professionals to work with the identified assets and strengths of individuals and their support networks.
I leave the last word to a carer I recently spoke to. I asked her what did having this approach mean to her and her family.
She stated that for the first time she did not feel alone. The approach was helpful, giving the family the time and space to talk and share in a spirit of mutuality and reciprocity. It is a way of being with the self and others both personally and professionally – and that is why it’s of such great value to social work practice today.