This study aims to explore the use of the open dialogue approach (ODA) in a community mental health service. The ODA is a collaborative framework designed for individuals facing complex mental health challenges, such as psychosis, which has shown positive outcomes for people with psychosis in Finland.
Interpretative phenomenological analysis informed the exploration of five mental health nurses’ experiences of using ODA, illuminating their views on the efficacy and mechanisms of action of ODA. Data were generated through semi-structured interviews. Ethical approval had been awarded.
The overarching theme that was revealed through thematic analysis was that of the importance of power in the therapeutic relationship. Sub-themes that were identified include the dichotomy of experiential learning versus formalised training; the efficacy of ODA; and barriers to the implementation of ODA in the UK.
The limitation of this study is its small size (n = 5) and the fact it was limited to the nursing profession alone and to one specific service within one health provider. However, the themes generated within this study are transferrable to other similar areas and something others should consider.
The findings underscore the need for flexibility in implementing ODA within the UK context and, most importantly, how the principle of tolerance of uncertainty can be ameliorated whilst maintaining the apparent effectiveness of ODA (as reported subjectively by all participants). Also, training, support and supervision are crucial for clinicians to effectively adopt ODA. Finally, ODA was reported by all participants as being effective for service users and was viewed as a positive experience for staff which may help with staff burnout and help with staff retention.
ODA by its very nature operates on a transparent relationship between those experiencing psychosis and health professionals. This directly challenges the legislative processes in the UK, where conversations about risk assessment and management are often covert and recorded in medical notes. Integrating ODA into the UK mental health culture promotes the maintenance of a therapeutic and transparent relationship between people accessing mental health services and mental health professionals. All participants reported that ODA appeared to have a positive effect upon service users, and this may act as a protective factor against staff burnout and help with staff retention. Finally, further research is necessary to validate its impact within the UK and to inform broader clinical practice and policy development.
