1. Open Dialogue in Notts Healthcare NHS Foundation Trust Simon Smith Executive Director of Local Services Corinne Hendy Peer Support Worker Anna Cheetham Consultant Psychiatrist

2. Open Dialogue in Local Services Consistent with Recovery Strategy – Enabling people to work with their own network to find solutions and live well – Staff supporting networks to be agents of change (rather than fixing people or problems) – Respectful, non-hierarchical, open and transparent relationships – a level playing field – No prior assumptions or hypotheses; ongoing ideas and theories are shared in dialogue S.P.S

3. Open Dialogue and shifting the culture of services Aims and objectives Improve people’s experiences of services Person and family at the centre of their care ‘no decision about me, without me.’ Improve staff wellbeing, staff retention and low sickness Collaborative working between person/family/staff Have a system that is sustainable and works for all. Everyone is considered an expert in their own life experiences – family incorporates staff as part of the network. Promotes team working. S.P.S

4. What is it? a)A philosophical/theoretical approach to people experiencing a mental health crisis and their families/networks. b)A system of care, developed in Western Lapland since 1980 when they had one of the worst incidences of ‘schizophrenia’ in Europe. c)Working with families and social networks, Open Dialogue teams work to help those involved in a crisis situation to be together and to engage in dialogue. d)It has been their experience that if the family/team can bear the extreme emotion in a crisis situation, and tolerate the uncertainty, in time shared meaning usually emerges and healing is possible. e)Now they have the best documented outcomes in the Western World. For example, around 75% of those experiencing psychosis have returned to work or study within 2 years and only around 20% are still taking antipsychotic medication at 2 year follow-up. C.H.

5. Making a start in Nottingham Open Dialogue Community Group (Charitable Association) Trust steering group (co-ordinates the POD – peer supported open dialogue) – POD is about bringing best of peer support practice and OD into services – Supporting the training and development of multi- disciplinary staff in AMH services – Develop a longer term plan of implementation – To become a strategic element of the Trust wide Recovery Strategy. C.H.

6. OD results vs TaU (over 5 years) Hospitalisation (days) Neuroleptics used Disability allowance Western Lapland N=72 31 33 19 Stockholm N=71 110 93 62

7. Norman Lamb quote “ Service user quote “I have never been able to share like this in all the years I have had in health care” Staff quote “This is the way I have always wanted to practice” C.H.

8. Progress so far 5 trained practitioners in two teams CRT/AO Working with one family Promotes cross team working Shared clinical experience Team supervision – reflective practice 3 mentors – workshops within teams 9 trainee places for 2016 cohort Teams work across community and inpatient settings. Reduces overall meetings over a period of 2 years. Reduces staff meetings, supervision is held in the meeting or group supervision. C.H.

9. Next Steps Research project Integrating with Recovery Strategy Coproduced SMART goals for open dialogue Increased staff trained in Open dialogue Improved overall culture/relationships Specific improvements in crisis resolution Increased numbers receiving full OD intervention C.H.

10. Outcomes/Goals Increased satisfaction for staff, service users and family members Improved family/network relationships Improved relationships between services and family units/networks Reduce use of coercion (physical, emotional and verbal) Improved CQC results Reduced use of medication Reduced length of inpatient stay Improved recovery (of personal goals) C.H.

11. If you or a family member had a mental health crisis what would your priorities be for the services that you receive? If you were a service manager What would you do to improve the quality of relationships between your staff and the people and their family members who use the service? C.H.