Section A. A thematic synthesis of service users and their social networks' experiences of receiving Open Dialogue. Section B. A grounded theory of how mental health professionals using Open Dialogue experience and navigate working within the NHS

Abstract

Section A
Background and aims: Open Dialogue (OD) is a social network-based approach to mental health care and has recently been adopted in multiple countries. Freeman et al. (2019) conducted a review of OD but concluded that no firm conclusions could be drawn due to the low quality of the studies. This thematic synthesis builds on Freeman et al.’s (2019) review by synthesising recent studies exploring the experiences of receiving OD and identifying implications for NHS mental health services attempting to implement it.

Methods: Databases were searched for peer-reviewed papers using relevant search terms. Twelve studies were identified which were then critically appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist (CASP, 2018). Thematic synthesis was used to integrate the findings across the studies.

Results: The synthesis identified four themes: “Network meetings felt emotionally safe”, “dialogism facilitates communication and new understandings”, “Open Dialogue can shift traditional power dynamics” and “Challenges with family involvement and the format”.

Conclusion: The findings suggest that transparency and a supportive therapeutic relationship created emotional safety in the network meetings. The dialogical work enhanced communication and created opportunities for new perspectives. Participants also valued the inclusion of family and having agency over their care. However, some challenges were identified regarding the inclusion of family and the dialogical format.

Section B
Background and aims: Open Dialogue (OD) is a therapeutic approach and a way of organising mental health services. It has been introduced within the NHS as an addition to existing mental health teams. However, there is a limited understanding of professionals’ experiences of using OD within the NHS. Therefore, this study explores how NHS professionals experience delivering OD and how they navigate any challenges that arise.

Method: The study used Corbin and Strauss’ grounded theory. One focus group and ten individual interviews were completed with fifteen participants.

Results: The model captures six categories: “Being drawn to Open Dialogue”, “Open Dialogue is a rewarding way of working”, “tensions emerge at ideological, team and individual levels”, the importance of the team context”, “team-related strategies for working with tensions” and “sustaining themselves”.

Conclusion: The findings suggest that professionals experience the approach as a highly valuable and enriching way of working whilst also encountering multiple challenges. The specific team context that they were working in appeared key to influencing the degree to which these tensions emerged. Over time, they discovered ways to work with these challenges by using team related strategies and sustaining themselves.

Date of Award	2025
Original language	English