Open Dialogue Services Across the Globe: Navigating Contexts for Effective Implementation

Understanding context is crucial for assessing the effectiveness of an approach. It clarifies why the same approach might yield different outcomes for different groups, and how this methodology can be altered to better meet varied needs. Open Dialogue, which is guided by principles rather than a rigid manual, poses a challenge in quantifying and addressing fidelity measures, particularly in diverse contexts.

This topic is explored within a recent research article by Pocobello (Principal Investigator at HOPEnDialogue) et al. The study investigates the organisational characteristics and practices in implementing the Open Dialogue approach in mental health services. It incorporates a structured questionnaire to gauge adherence to Open Dialogue Guidelines and identify factors positively linked to self-assessment.

Conducted by 142 organisations across 24 countries, predominantly in Europe, this survey delved into various factors, including the structural characteristics of Open Dialogue services, the therapeutic context, workforce composition, team structure, staff training, supervision, intervision, research capacity, and peer involvement within the Open Dialogue framework. Results indicated that better Open Dialogue self-assessment correlated with increased training, supervisions, research capacity, and the involvement of multi-professional teams.

Part of the HOPEnDialogue study, this survey contributes to an international effort aimed at achieving consistent documentation of Open Dialogue practices. The overarching goal is to deepen our understanding of advancing Open Dialogue practices and assess fidelity to its principles.

Using tools from the ODDESSI (Open Dialogue – Development and Evaluation of a Social Network Intervention for Severe Mental Illness) trial, this study evaluates the transferability of ODDESSI outcomes to global contexts beyond the UK.

Beyond organisational culture/cultural context, the context of implementation also significantly influences outcomes. For instance, in Australia, there has been success introducing Open Dialogue into a school (check our blog on this topic here). Although markedly different from a crisis setting in mental health, it still delivers positive results, while aligning with the seven fundamental Open Dialogue principles: responsiveness, social network perspective, flexibility and mobility, responsibility, psychological continuity, tolerance of uncertainty, and expanding the dialogue.

The Open Dialogue Centre’s International Study Tour was, likewise, designed to explore ideas, thinking and evidence about the characteristics of success of Open Dialogue, as well as learn international training and implementation approaches, share Australian context, and build a global Community of Practice.

During the tour, it became clear that the successful implementation of Open Dialogue is not just affected by the culture of an organisation – but that Open Dialogue is, in turn, rooted in values that can profoundly impact organisational culture. These shared values, emphasising individual involvement, a social network perspective, hope, and workforce well-being, align with international services and represent needed changes in the Australian mental health system. These values echo human rights-based approaches endorsed by global conventions and national mental health initiatives.

In summary, it’s crucial to carefully consider these diverse contexts when implementing Open Dialogue, aiming to generate positive outcomes for all involved parties. It’s also fascinating to explore the ways in which Open Dialogue can then, in turn, influence the contexts in which it is implemented.

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