S56: Open Dialogue – Practice & Science: A Conversation

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By September 11, 2019 No Comments

Authors: Kim Mueser, Alan Rosen, Maree Teesson, Paul Denborough, Deborah Warner

Year: 2019

Event: 2019 TheMHS Conference

Subject: Open Dialogue - Practice & Science: A Conversation

Type of resource: Conference Presentations and Papers



Kim T. Mueser, Ph.D. is a clinical psychologist at the Center for Psychiatric Rehabilitation, Boston University, and Professor of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry. His research interests are on the development and evaluation of psychosocial interventions for persons with serious mental illness. His work has involved a range of different treatments, including integrated treatment for co-occurring mental illness and substance use disorders, cognitive behavioral therapy for posttraumatic stress disorder, illness management and recovery, cognitive remediation, family psychoeducation, interpersonal skills training, and treatment of first episode psychosis. He has published several hundred peer reviewed publications and co-authored over ten books. His research has been supported by the National Institute of Mental Health, the National Institute on Drug Abuse, and the Substance Abuse and Mental Health Services Administration.

Alan Rosen is Professorial Fellow, Illawarra Institute of Mental Health, University of Wollongong, and Clinical Associate Professor, Brain & Mind Centre, University of Sydney. He has 40 years of experience as a Senior Consultant Psychiatrist, Service Director, and Director of Clinical Services of the Royal North Shore Hospital and Community Mental Health Services. In March 2013, he was appointed Deputy Commissioner of the Mental Health Commission of New South Wales. He has reviewed Mental Health Services for governments and administrations in 5 Australian states and the ACT. He has been invited speaker and/or performed consultancies on service development in several Australian states and territories, UK, Ireland, Netherlands, Sweden, Denmark, Italy, USA, Canada, China, Thailand, Hong Kong, Argentina, Spain, Portugal and New Zealand. He is the author or co author of more than 150 published and submitted journal articles or chapters on studies of 24 hour community based alternatives to acute and long term inpatient care, rehabilitation and recovery, assertive case management and integrated mental health service systems; more inclusive interdisciplinary mental health teams, including peer workers, early intervention in psychosis; psychiatric stigma; dual disorders, deinstitutionalization, consumer issues, family interventions, Aboriginal, developing country, rural and remote mental health, cultural influences on mental health service systems, qualitative and quantitative outcome measures, recovery measurement, impaired doctors, research and evaluation in mental health, service standards, the National Mental Health Strategy, Global community psychiatry, Human Rights of individuals with severe and persistent mental illnesses, international comparisons between Mental Health Commissions, and the history of Australian Psychiatry. Alan has been involved with TheMHS since 1991 as a founding board member. He has presented at TheMHS Conferences and Summer Forums on a wide variety of topics since its inception. Alan is completing training as a trainer in open dialogue. Alan was conferred as Officer of the Order of Australia in the Queen's Birthday Honours, 2014.

Maree Teesson is Professor and Director of The Matilda Centre for Research in Mental Health and Substance Use, Director of the NHMRC Centre of Research Excellence in Prevention and Early Intervention in Mental Illness and Substance Use (PREMISE) and NHMRC Principal Research Fellow at The University of Sydney. She is also a Fellow of the Australian Academy of Health and Medical Sciences and the Australian Academy of Social Sciences, a National Mental Health Commissioner and Member, National Health and Medical Research Council. She is also a founding member of TheMHS Board since 1991. Maree’s vision is to build the world’s leading dedicated translational research program for the prevention and treatment of co-occurring mental health and substance use problems. She seeks to increase our understanding of substance use and mental health problems, prevent these where possible and improve treatment responses. Maree was conferred as Companion of the Order of Australia in the Australia Day Honours, 2018.

Paul Denborough is a child and youth psychiatrist and clinical director of Alfred CYMHS and South East Melbourne headspace. His clinical areas of expertise include chronic fatigue syndrome, anorexia nervosa and single session family interventions. As clinical director his main task is to implement recovery-orientated practice in both state and federally funded services. Given that he works in a child and youth service, helping staff feel confident in delivering family-based interventions has been a major focus of his work.

Deborah Warner is currently the Family Peer Worker with the Headspace Youth Early Psychosis Program, Alfred Mental Health Services, Frankston Victoria. She is the co-founder of APOD (Alcohol Prescription & Other Drugs) Family Support where she is a Family Worker. Both teams have adopted the Open Dialogue approach.

A structured conversation about Open Dialogue (OD), its practice and research underpinnings. The conversation between the presenters will be based on a number of questions and comments as set out below. The chair-person will draw the audience into the debate. The evidence base for Open Dialogue is inadequate, so is more rigorous research needed (Freeman et al, 2019) or should we stop researching it now (Mueser K, 2019)? How does the evidence stack up? Research of OD so far has had problems defining the key operational variables. Authors have seen the more subjective aspects and theoretical constructs of OD as fidelity criteria, rather than the more practical variables of the OD method, eg: a) regular home visits by the same 2 familiar practitioners, b) involving the nuclear and extended family, c) engaging a local resource network in regular meetings, and d) applying more simplified and hence more operationable versions of the reflective dialogical method e) including peer worker OD training & enhancement to the team. While OD may or may not prove to be effective in the long run, the argument for its potency is sometimes confounded by ideological commitment to the argument that it may be a viable alternative to most or all medication usage (particularly anti-psychosis meds) but this has never been established by good quality research. Does the practice reflect the theory? Is the evidence less compelling than the promise? What is the opportunity-cost with regard to investment of time and resources?

Learning Objectives
Learning Objective 1: The audience will gain an understanding of the debates around the evidence for the Open Dialogue method.
Learning Objective 2: Open Dialogue is a promising method of treatment and care, but how should or should not it be implemented in mental health services?

References 1. Mueser K, Is More Rigorous Research on Open Dialogue a Priority? Taking Issue, Psychiatric Services J, 70:1, Jan 2019.
2. Freeman AM, Tribe RH, Stott JCH, Pilling S, Open Dialogue: A Review of the Evidence., Psychiatric Services J, 70:1, January 2019
3. Rosen A & Teesson M, Does Case Management Work? The evidence and the political abuse of evidence based medicine, ANZJP 2001,35:731-746

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