Open Dialogue: Realising the therapeutic potential of social networks

• Written by: Benjamin McElwee — See Me Scotland — Health and Social Care Policy and Practice Officer
• Published: 27th August 2018

Benj McElwee, of See Me, writes about the inherent value of drawing upon social networks when conceptualising health and social care.

Within Western Europe there has been a drive towards taking people out of institutional care, reducing acute psychiatric, and supporting people to live within the community. Arguably, it’s only within the anointed therapies and recovery outcomes that differences remain.

Evolutionary scientists argue that humans as a species are so successful due to our tendency towards integration and our ability to cooperate[1]. Our culture is saturated with an understanding that it is our social support networks that sustain us, yet within mental health this area is all too often neglected.

Recent research has emphasised the importance of personal wellbeing networks in recovery. For people with severe and enduring mental health problems, the highest wellbeing is experienced by those with diverse and active networks where the majority of support is provided by friends and colleagues as opposed to just practitioners[2]. The influence of social networks upon other health outcomes has also been demonstrated. For example, one individual in a network becoming obese is often associated with weight gain in their friends, siblings, spouse, or neighbours[3].

Previous studies have also shown a link between social capital (including household or family-level social capital[4]) and depression in adults[5] and with mental health/behavioural problems in children and adolescents[6]. For people with mental health issues, it’s been suggested that the degree to which they are accepted is dependent on “how well they adopt their society’s rules and norms and appear as “normal””[7]. Thus, it could be argued that there’s a circular relationship between lack of societal integration and the absence of valued social roles, and risk of/presence of mental health difficulties. Similarly, other research has argued that stigma is the fundamental cause of population health inequalities, with social isolation the pathway through which its effects are mediated[8].

Moving towards models of community-based care makes sense – but only if we acknowledge that individuals need social capital and networks to support their wellbeing and that those with mental health problems may face challenges in attaining these, such as self- and structural stigma, a tendency towards withdrawal and very real experiences of discrimination. We also must acknowledge that people can become institutionalised, and dependent upon day-centres, A & E departments, or other sources of support that they see as vital lifelines.

Open Dialogue as an approach acknowledges the impact of the lived environment and social support on mental health recovery – and therefore involves existing networks and the places where a person is most comfortable, such as their home, in the therapeutic approach. Continuity of care is embedded within the approach, acknowledging the importance of trust in strengthening the impact of therapeutic relationships.

Another key element of some Open Dialogue models is that mental health support remains throughout recovery – as a safety net – allowing people to stand on their own two feet, take positive risks, and to slip and be caught if necessary. What good does it do to rip the bandage off with the new skin attached?

5th September will see experts and people with lived experience of mental health crises gather to discuss how Open Dialogue can benefit those in Scotland.

If you wish to attend the event, or if you have any questions about the event or Open Dialogue, then please contact academy@alliance-scotland.org.uk . The closing date for registering for the event is 31st August 2018.

[1] https://www.sciencedirect.com/science/article/pii/S030326471400080X (this link will take you away from our website) 

[2] https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/personal-wellbeing-networks-social-capital-and-severe-mental-illness-exploratory-study/5622A7942CC0C86BCDD14D5288305A68 (this link will take you away from our website) 

[3] https://www.nejm.org/doi/full/10.1056/NEJMsa066082 (this link will take you away from our website) 

[4] http://journals.sagepub.com/doi/abs/10.1177/1010539513496140 (this link will take you away from our website) 

[5] https://www.sciencedirect.com/science/article/pii/S1353829217309814 (this link will take you away from our website)

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270040/ (this link will take you away from our website)

[7] https://onlinelibrary.wiley.com/doi/full/10.1111/inm.12046 (this link will take you away from our website)

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682466/ (this link will take you away from our website)

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