Written evidence submitted by Mrs Val Jackson (Family Therapist and Open Dialogue Trainer at Self employed) (CMH0063)

Val Jackson

As a family therapist for many years, I worked with families who were impacted by psychosis. I formed a group for family members and friends wanting to campaign for change in MH services. Family members felt excluded and often blamed by services. Often they didn’t want to see a family therapist because of the implications of the label that the family were broken, damaged. I trained to be a self-employed Open Dialogue trainer because I was already aware of the astonishing research undertaken in Northern Finland where the approach originated, medication was greatly reduced, hospitalisation was reduced, 84% of individuals with a significant mental health problem were able to return to work. This research was repeated over a long period of time, with similar results.

As a trainer in Open Dialogue for 11 years I am aware that families and their loved ones feel heard and involved using this approach. The progress made is sustained so reducing the revolving door effect. Research in Kent has shown that the approach is effective, cheaper than standard services and more acceptable to families. Kent NHS has a lovely video of a family talking about their experiences.

Open dialogue aims to bring together all those involved in someone’s care, from family, friends and others who love the client, to any service that is felt to be needed. Rather than clients being referred on to other services, they are brought together with the social network of the client, with decisions being made collaboratively. The aim is to have all the decision making within the network. Also very important is the continuity of the relationships between the practitioners and the client, with the former aiming to stay involved throughout the life of the problem. The transfer from one team to another to another is not conducive to the trust that is needed with service users and families for real progress to be made. There is more information on my website www.developingopendialogue.com

For this approach to be rolled out cost effectively all the main services likely to be involved should be housed together in small geographical hubs ideally with visibility on the high streets.  This makes it easy for this need adapted approach to bring in other services as required, whether it be housing, employment, addiction services etc. Staff need to have a basic training of how to respond dialogically to people and networks, not to leap into fix it modes. The aim is to ensure the client and their network are supported to work together, rather than disabling the valuable resource that with support they can and want to be.  The approach can also be used with children and schools, and used effectively (as in Northern Finland) can reduce the number of young people who continue to adult services.

As I write we are all waiting for the results of the ODDESSI trial, an RCT that is evaluating the effectiveness of the OD approach in five trial sites. To measure and monitor there are several tools available, Score 15 is an app developed by family therapists which clients, families and others can access safely on a digital device to give their views. There are other session rating scales that can be digitised to coordinate national monitoring. Levels of medication use, hospital stays and employment status are easily available measures.

In conclusion I believe this approach to be so ethical that when I first learned about it, I was shocked that it wasn’t being used in the UK. Now at least there are many countries around the world starting to embrace it.

January 2025