A fresh approach to mental health

Francesca participated in an innovative Finnish programme now being used to treat mental health problems in Bantry.

The Open Dialogue programme is different to the mainstream Irish mental health services — it encourages patients to involve loved ones or close friends in their treatment and it’s also completely transparent, explains Dr Iseult Twamley, senior clinical psychologist with the HSE:

“All important decisions are made in conjunction with the service-user and any family members they choose to include in the process,” she explains, adding that a guiding principal of the programme is ‘Nothing About Me, Without Me’.

Francesca joined the Open Dialogue clinic some months after its launch in Bantry last September, following the conclusion of a successful three-year pilot programme.

She had initially been referred to the mainstream mental health services after experiencing the onset of psychosis in April 2015.

“This was the first time I’d ever experienced anything like this,” adds the 26-year-old, who recalls that she was assessed by doctors in the mainstream mental health services and put on medication.

By September, Francesca seemed to have made a full recovery so she moved to Cork city and returned to the workplace.

But she relapsed, and this time, her GP referred her to the town’s newly-launched Open Dialogue clinic.

The Open Dialogue approach to treating mental illness had originally been introduced to Bantry on a pilot basis in 2012 following demand for a more inclusive treatment style from service users, family and mental health service staff. About 20 service users participated in that initial programme, which ran until 2015.

Feedback from the pilot, says Dr Twamley, was so positive that in September 2015 a mental health clinic using Open Dialogue techniques was established for all new adult referrals from the Bantry area.

Francesca attended her first Open Dialogue meeting three months later, in November 2015.

“I was asked to bring family members or anyone from my support network to the meetings and we were all able to express our needs and concerns, and process what we had been through,” she says, adding that the experience was “incredibly positive”.

“Being surrounded by a circle of people caring for me in a non- judgemental way and taking my long-term recovery seriously has ended my sense of isolation and made me believe that full recovery is possible,” she reflects, adding that the experience was very different to her first interaction with the traditional mental health services months before.

At that time, she recalls, she met with a number of different doctors and felt the service was “intimidating and impersonal and that my treatment was not in my control”.

In the Open Dialogue programme, she recalls, her care was consistent and she was listened to and valued as an equal.

“It’s transparent, unlike the mainstream system where the psychiatrist is writing notes while speaking to you — and also speaking with other family members about you when you’re not present,” which, as she points out, is “especially distressing” for someone experiencing paranoia, a major symptom of psychosis.

“In Open Dialogue, you’re present during every conversation directly about you.

“No decisions about you are made without you being present,” she explains, adding that in the established mental health services, she had the feeling that because she was unwell, her judgment was considered to be impaired and unreliable.

Open Dialogue, she says, “has brought me hope about my future, allowed me to stay off medication and return to a much better quality of life.”

Francesca now plans to return to university next autumn to qualify for a career in the mental health services.

TO DATE, says Twamley, the results at the Open Dialogue clinic in Bantry are extremely positive.

The clinic, which is treating about 40 service users from the area, is currently working with colleagues in the UK and Finland to access the long-term success of the programme, and to look at its feasibility for a future roll-out across Cork and Kerry.

Its supporters say the Open Dialogue approach is in line with the official policy of the Irish mental health services that the approach of the mental health service should be more inclusive of service-users and their families.

One of the biggest attractions for service-users, Dr Twamley believes, is its strict policy that no decision-making in terms of a service-user’s treatment takes place in their absence.

“People find that very important,” she says. “We write the notes in front of the client and they can amend the notes. They also get copies of any letters or documentations concerning their care.

“ It’s very transparent and very open and that is a shift in practice,” she says.

“Our service-users tell us they feel heard, and that they feel listened to.”

• The Open Dialogue Q&A session will follow the screening of documentary on Open Dialogue by filmmaker Daniel Meckler at Clonakilty Park Cinema on Tuesday at 3pm as part of the town’s Wellness Week, which runs from Wednesday to Saturday