The current state of services in the U.K. and Open Dialogue
I am writing this with fury in my heart having just received a phone call from a supervisee who was distraught and concerned about the ethical implications for her in view of a sudden announcement that funding was being withdrawn from her service. This colleague works with families who require intensive therapeutic intervention, referred in by social services because of issues around neglect, emotional, sexual and physical abuse. The children and their carers (who may be members of their extended family) receive extensive long term work to repair the damage that has resulted from the adolescent’s early childhood experiences. This work is reparative in nature modeling to the children secure attachment and working with the family to gain an understanding of what is often very difficult and destructive behaviour. These children are sometimes excluded from mainstream schooling and have been passed from one relative/foster placement to another experiencing rejection and constant unsettling change. In addition to their original troubled early life with parents who were either unable ( through substance misuse, mental illness etc. ) or unwilling to parent and nurture their offspring.
My supervisee was adopting a variant of the Open Dialogue model in the therapeutic work. Whilst being unable to adopt an Open Dialogue service approach because she had to do remain with the service that was commissioned by social services which were a weekly extended therapeutic session. The service was informed that no further funding existed for their work and that they would have to discontinue sessions the following week. I find it difficult to believe that services could be decommissioned in such a brutal manner. Displaying complete disregard for the service users, carers and extended family and indeed for the future of these young people to whom we owe a duty of care. It seems to me to be a short term budget saving as undoubtedly these young people need this additional support in order to thrive. They will without this in probability end up a burden to the national budget through substance misuse, mental ill health, anti-social behaviour, and possible criminality.
This is my fear for Open Dialogue, that the funding will be insufficient and non-sustainable. Open Dialogue training is considered costly and the implementation of an Open Dialogue service within a mental health trust has cost and structural implications which impacts on already under-resourced services. In the current climate, the so-called “evidence based” therapies dominate although follow up does not indicate that the improvements are maintained. Certainly in the U.K. CBT is currently what is being commissioned by those who commission services with unfortunately very little understanding of the different models of therapy and what they offer to the individual …..as the service user does not benefit from a one size fits all model. Until recently family therapy has been on the decline because of the deemed to be expensive nature of a family therapy team and the cost of practitioner involvement. Thus I have grave concerns for the future of Open Dialogue being implemented in a fashion that is sufficiently pure and unadulterated and in Open Dialogue teams being able to replicate the Finnish model.
Author Bio: Jane Hetherington, Principal Psychotherapist at KMPT and an employee at Early Intervention Services in Kent, has completed Open Dialogue course and will be a part of the new Open Dialogue Course. She is trained as an integrative psychotherapist and has experience working in primary care, substance misuse, and psychosis services. Here, she writes about a few psychotherapeutic theories.