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Peer Support and Open Dialogue

Open Dialogue started in the 1980’s as a concept when a group of like minded practitioners found themselves working at Keropidis Hospital in Western Lapland. They were faced with an extremely high number of psychosis presentations,Finland at that time had the highest incidence of schizophrenia presentations in the Western Hemisphere. This group of clinicians responded by approaching the problem in a new way through an approach based on a family therapy intervention. This intervention evolved over the course of time into a therapeutic intervention in addition to an organisational model. The organisational model underpins the Open Dialogue concept and is embedded in the teams that practice this approach.

The original team were a group of practitioners from a range of professional trainings psychiatrists, psychotherapists, psychologists and those with a family therapy training too. At a later stage the model evolved into a model which all the clinicians within the team were trained in. The model was taught over a 2 year period and subsequently all team members were qualified to work as family therapists, the model has now evolved to including training those with lived experience in the same model as the clinical team. This concept of peer supported Open Dialogue is a British variant of the original model. This has been implemented in U.K. trainings from the first NHS training in Birmingham through to the original Open Dialogue team in Kent which contained peer support workers from the outset. Peer support workers exist in a number of teams within mental health services within the NHS in the U.K., they are rightly considered an important part of a team. Clients who have difficulty engaging with professionals often find communicating with someone who has experienced similar issues easier.

The peer support training has evolved in the U.K. with a recognition that peer support workers may have additional needs and training requirements, particularly if they have not worked in mental health services prior to training. The important aspect of peer support work is that individuals are paid and have the same rights as other employees, so often in the past those with lived experience have been treated as volunteers and not remunerated. I have noticed when visiting other countries and meeting with teams and staff that many still regard peer support workers as volunteers. They are often unpaid which I feel is disrespectful and disregarding of the experience they bring to the team. Although it may justifiably be argued that peer support workers are not sufficiently respected and this is reflected in their rates of pay and banding within the NHS system which is at the lowest end of the scale. Additionally without further recognised professional training they are unlikely to receive promotion or recognition appropriate to their skills, so they are forced to remain in a role that does not offer substantial additional development. The other aspect of peer support work that the workers find difficult is that they may be working with a team that treated them clinically in their past or have contact with wards on which they may have been inpatients. These crossover situations can cause stress and are worked with and processed through additional supervision.

About Author: I am Jane Hetherington Principal Psychotherapist with KMPT currently working in Early Intervention Services n Kent. I trained as an integrative psychotherapist and have worked in substance misuse, primary care and psychosis services. I have completed the Open Dialogue training and will be involved in the new Open Dialogue Service.

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