Utvikling av Åpen dialog som tilnærming i offentlige psykiske helsetjenester

Erfaringer fra en norsk kontekst

Abstract

This doctoral thesis is part of a larger research project, "Open dialogue in network meetings", where the purpose was to train clinicians in the dialogue-based approach Open dialogue, and then to examine the experiences with the development of this approach in public mental health services in a Norwegian context. The study has a longitudinal, exploratory and participatory design, making use of quantitative and qualitative methods. Four hospital departments within the mental health care division at Akershus University Hospital, and to units in the primary health care service have participated in the study. A total of 42 clinicians and user- and relative representatives carried out a training program in Open dialogue. Clinicians who participated in the training program, or had other relevant training within the approach, were invited to further participation where the aim was to develop Open Dialogue in participating units. Forthy-three clinicians and 353 network meeting participants were included in the study. Data collection was done using semi-structured questionnaires and focus group interviews. Quantitative data was performed by use of descriptive analysis in SPSS. Qualitative data was analyzed by use of Reflexive Thematic Analysis. The study's main findings point to: (i) various promoters and hinders in the development of Open dialogue, such as personal and organizational challenges and an extended collaboration with colleagues and families, (ii) the clinicians' professional and personal learning and development processes, (iii), and the network meeting participants' excitement about participating in network meetings where they described being understood, respected and accepted, and were allowed to talk about what was important to them. The study's main findings are discussed through four related themes: (i) the clinicians' learning and development processes, (ii) collaborative dialogues, (iii) organizational preparedness, and (iv) from monologues to dialogues – changing view of man? The study provides implications for practice. It shows that Open Dialogue as an approach contributes to a change in the basic understanding of treatment and encouraging equal collaboration between patients, their social networks and professionals who help to humanize mental health work and promote the individual's right of self-determination. The study confirms previous research which shows that Open dialogue can help to promote a form of collaboration within mental health work that supports patients and the social network's different and unique perspectives and resources in treatment.