Then NHS and Open Dialogue

The nhs is a system unique to the united kingdom and describes collectively the pubic health services in england, scotland, wales and n. Ireland. The nhs was established by the labour government of 1948 as one of the major social reforms post the second world war, the founding principles being that there should be a provision of services that were comprehensive, universal and free at the point of delivery (apart from dental and optical care). The nhs is 98.8% funded from general taxation and national insurance contributions, 10% of gdp is spent on health the majority in the public sector the nhs employs 1.187 million. Within england there are 60 mental health trusts funded individually by clinical commissioning groups and it is the funders who decide the level and nature of clinical provision not the professionals. There is a lack of uniformity between trusts and the focus of treatment may vary substantially which is why in times of austerity and reduction is services combined with further difficulties as a result of brexit services and budgets are being slashed. These difficulties have impacted on pod with trusts having to be very focused on commissioning requirements and the treatment options narrowing and becoming behaviourally oriented. This development has made setting up an rct difficult as trusts do not  have the funds to enable the setting up of a dedicated team as in the finnish model that is the baseline for the trial in order to fulfil nice guideline requirements.

As practitioners we have spent considerable time and energy studying open dialogue both in the uk and in finland. To us the advantages of the model seem obvious and a kinder more compassionate way of being with a patient and their family than treatment as usual as currently offered in the uk. When we are asked by practitioners about open dialogue principles fellow clinicians state “that is what we do anyway”. Unfortunately that is not true, in mental health the emphasis is still on the medical model, with medication being often the initial response. Sadly continuity of care is also lacking in the current system. Service users and families are often having to tell and retell their stories to a range of practitioners from different teams as they make their way through the mental health system and this is distressing.