Open Dialogue: tackling the power imbalance between mental health service users and staff

Andrew Strong of @ALLIANCEScot reflects on a new model for mental health support that could help break down power imbalances between service users and staff.

For a word which is used so often, power is incredibly difficult to define.

But as NHS Health Scotland point out in their excellent briefing note  on power and health and social care, “power exists in the relationships between people and groups of people, sometimes organised and sometimes not.”

One of our most common experiences of power is the relationship we all have with the experienced and knowledgeable professionals working in our health and social care system.  For many this relationship can be tricky. One of the most common concerns expressed on Care Opinion is the feeling of being a number and not a person and that “the system” has disempowered people and left the expertise and experience they have of their own lives, feelings and conditions at the door.

Critics of the mental health system in Scotland suggest that it places too much emphasis on dealing with the short term diagnosis and treatment of a crisis, rather than placing the emphasis on long term, more sustainable approaches .

The Open Dialogue approach, the subject of the Health and Social Care Academy’s latest research report, is a model of support designed for people experiencing psychosis pioneered in Finland, seeks to change this dynamic, with impressive results. It is not a radical alternative – but more a shift in approach away from traditional psychiatry – placing the emphasis on discussion about the best way forward that includes people with mental health problems, families, friends, and professionals in designing solutions.

Key elements include immediate support within 24 hours of first contact, no set agenda for network discussions and crucially professionals are expected to share their feelings directly with the whole network, alongside those of family, friends and neighbours. Often this can include disagreements between professionals about the best way forward – but openness and honest creates a situation where everyone is equal in the decisions that follow.

These principles have the potential to fundamentally rebalance the power dynamic in a way that could be beneficial across all types of services. But it requires policy makers and practitioners to make difficult decisions for it to happen. After all, it could be a threat to existing professional roles, assessment and treatment models and loss of professional control.

This type of approach requires a level of bravery – and doesn’t come without risks. But we need transformative answers to difficult questions – and the best ones always rely on putting the expertise of people at the centre of the approach.  In England, many NHS Trusts are setting up pilots with agreement to evaluate and deepen the evidence base.

In my view, it’s not the approach that matters, but breaking down the power imbalance that will make the biggest difference. In Scotland it’s time to reflect on whether we want to be part of creating a different path for the services of the future.

This post was originally published on the ALLIANCE Scotland website. 

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