Patient and Client Council Open Dialogue Mental Health Conference What is Trialogue? Mental Health Trialogue Network Ireland Paddy McGowan, Liam Mac Gabhann Lorna Ni Cheirin, Dublin City University

Trialogue? The creation of a community forum where everyone with an interest in mental health participates in an open dialogue

In Trialogue meetings… ► Everyone is perceived as an expert by their experience ► The collective expertise creates learning, transformation and communication skills ► Respectful ground rules ensures open dialogue is possible ► The common denominator is an interest in mental health

Trialogue meetings in context ► Germanic speaking countries ► Open dialogue forums ► Organisational development and delivery ► Psychosis seminars ► Mental Health leadership programme at DCU ► Mental Health Trialogue Network

Open Dialogue “where it is perceived as a joint action that joins people together in a temporary mutual world experience. Participants have to be willing to engage in this dialogue or a situation needs to be created where it can ensue” (Bakhtin 1981) “where it is perceived as a joint action that joins people together in a temporary mutual world experience. Participants have to be willing to engage in this dialogue or a situation needs to be created where it can ensue” (Bakhtin 1981) ► Subject to subject (with,not to!) ► Co-creating and naming their world ► Don’t have to abandon beliefs or values

Characteristics of Open Dialogue Processes and Participation ► The dialogue is based on give and take as opposed to one way communication ► All people concerned by the issue under investigation should have the opportunity to participate ► Participants are obliged to help other participants be active in the dialogue ► All participants have the same status within the dialogue arena ► Experience is the point of departure for participation ► At least some of the experience the participant has when entering the dialogue is seen as relevant ► It must be possible for all participants to have an understanding for the topics under discussion (Gustavsen, 2001) ► An argument can be rejected only after an investigation (and not for instance, on the grounds that it arises from a source with limited legitimacy) ► All arguments to enter the dialogue must be represented by the actors (participants) present ► All participants are obliged to accept that other participants may have better arguments than their own ► Among discussion issues can be the roles occupied by participants with no one exempt from such a discussion ► The dialogue should be able to integrate a growing degree of disagreement ► The dialogue should continuously generate decisions that provide a platform for joint action

Examples of non open dialogue approaches ► Some community group practices ► Associations & voluntary groups ► Institutional norms & cultures ► Routine protocol & practice ► Hierarchical decision making ► Interviewing to fit the boxes (monologue) ► Ward rounds ► Service access protocols ► Management committees ► Enforced democracy (majority/loudest rules)

Developing the Mental Health Trialogue Network in Participating Communities ► Emerging as a process outcome of the leadership programme ► 7 areas and then snowballing ► Integrating with existing Trialogue groups where they exist ► Local facilitation & sustainability ► Enabling interested people/groups to step outside their own bubbles to experience others views perceptions and suggested solutions ► A communication network  Web, advertisement, local public area notices ► Parallel process to leadership teams in local mental health communities with option for the Trialogue participants to become active in informing and further developing community response to mental health issues within…

Participating Sites ► South Tipperary ► Dublin South Central ► Galway ► Donegal ► Dublin South West ► Mayo ► West Cork

PROJECT AIMS ► ► To facilitate the establishment of community leaders in the area of mental health ► ► To develop a community forum using the ‘Trialogue’ processes ► ► To strengthen the voice of people with mental health problems & families/ carers regarding needs & supports in their communities ► ► To provide a focus for developing awareness and action around mental health within communities

HOW THE AIMS WILL BE ACHIEVED ► Establish monthly Trialogue meetings in 7 communities in Republic of Ireland during 2011 ► Create an online Mental Health Trialogue collaborative community accessible to public ► Create an online Mental Health Trialogue collaborative community accessible to public ► Provide a learning forum for leadership teams to develop community development & Trialogue facilitation skills

BENEFITS OF THE PROJECT ► Emergence of community leaders in relating to mental health problems and community response ► Increased understanding of mental health problems among community members ► Increased capacity among people with mental health and their families & carers to advocate for and determine supports needed in communities ► Provision of a community focus for actions aimed at developing mental health awareness and action ► Creation of an online resource and Mental Health Collaborative Network

BENEFITS BEYOND THE LIFE OF THE INITIAL PROJECT BENEFITS BEYOND THE LIFE OF THE INITIAL PROJECT ► Dissemination of learning of the impact of Trialogue meetings on individuals, services & communities in Irish context ► Sustainable capacity built in 7 communities to offer Trialogue forums ► Mentoring of neighboring communities in developing community Trialogue forums by trained facilitators ► Continual sharing of information & learning via online community

So what happens in Trialogue meetings ► Pick a topic ► Right to speak or not ► Anonymity optional ► Moderated ► Freedom to leave your hat outside the door ► Guiding accord/ground rules ► An open conversation ► Transformatory in itself though not an action group…………………

Guiding Accord ► Mobiles off ► Personal safety maintained ► Respect each utterance and perspective ► Take on board others perspective ► Not required to give up own values or perspective ► One voice at a time ► Option to speak or just experience ► No talking over each other ► When speaking about meeting outside respect what was said in the space and don’t personalise comments