Exploring patients' experience of peer-supported open dialogue and standard care following a mental health crisis: qualitative 3-month follow-up study

Abstract

Background Experience of crisis care may vary across different care models. Aims To explore the experience of care in standard care and ‘open dialogue’ (a peer-supported community service focused on open dialogue and involving social networks for adults with a recent mental health crisis) 3 months after a crisis. Method We conducted semi-structured interviews with 11 participants (6 received open dialogue; 5 received treatment as usual (TAU)) in a feasibility study of open dialogue and analysed the data using a three-step inductive thematic analysis to identify themes that (a) were frequently endorsed and (b) represented the experiences of all participants. Results Four themes emerged: (a) feeling able to rely on and access mental health services; (b) supportive and understanding family and friends; (c) having a choice and a voice; and (d) confusion and making sense of experiences. Generally, there was a divergence in experience across the two care models. Open dialogue participants often felt able to rely on and access services and involve their family and friends in their care. TAU participants described a need to rely on services and difficulty when it was not met, needing family and friends for support and wanting them to be more involved in their care. Some participants across both care models experienced confusion after a crisis and described benefits of sense-making. Conclusions Understanding crisis care experiences across different care models can inform service development in crisis and continuing mental healthcare services.

The contribution of anthropology to the study of Open Dialogue: ethnographic research methods and opportunities

“…These have explored the impact of the Open Dialogue approach on mental healthcare practitioners, clients and networks. For example, studies of patient experience and outcomes found that Open Dialogue helped patients to feel heard and supported (Jacobsen et al, 2018;Bergström et al, 2019;Sunthararajah et al, 2022) and improved social functioning and quality of life by standard measures (Kinane et al, 2022). Studies of treatment sessions showed that dialogue which allowed clients to dominate and involved symbolic (rather than pragmatic) language was associated with good outcomes from psychotic crisis (Seikkula, 2007).…”

“It has to be better, otherwise we will get stuck.” A Review of Novel Directions for Mental Health Reform and Introducing Pilot Work in the Netherlands

“…The model prioritizes providing permanent housing to people experiencing homelessness in an attempt to integrate care and recovery initiatives [91]. Other programs that focus on more personal and social aspects of care and recovery are Peer-Supported Open Dialogue [92,93], Wellness Recovery and Action Plan (WRAP) [94], Individual Placing and Support (IPS) focusing on rehabilitation in work and education [95], and variants of assertive community treatment (ACT) such as resource-group ACT and flexible-ACT [96].…”