Contribution short abstract:

This paper contributes insights from a collaborative ethnography between anthropologists and clinicians researching an innovation in NHS psychiatric crisis care named ‘Peer-supported Open Dialogue’. It speaks to the ethics of navigating asymmetrical relationships in healthcare and academic contexts.

Contribution long abstract:

In 2019, the UK’s NHS implemented the world’s largest randomised controlled trial of ‘Peer-supported Open Dialogue’ (POD), a Finnish innovation from the 1980s advocating a social network approach to psychiatric treatment. An ESRC-funded anthropological study (APOD) launched simultaneously as independent but complementary to the RCT, comprising clinicians who trained as ethnographers and anthropologists who trained as Open Dialogue practitioners, of which I am one. We spent three years in the ‘field’ across two RCT sites/community mental health teams, delivering and researching POD. We also incorporated dialogical principles into our collaborative analytical and writing processes.

Improvising a collaborative methodology enabled multi-sited research and the recording of experiences from different subject and disciplinary positions, although this demanded the navigation of multiple sets of relationships between researchers, supervisors, co-practitioners, and patients.

Being the only PhD student and BAME member of the APOD research team marked me as different from the perspective of NHS interlocuters, based on preconceived racialised and gendered roles; perhaps it was inevitable that I aligned with NHS clinicians who were also positioned at the lower ends of organisational hierarchy. How do such alliances induce possibilities and challenges in collaboration?

Significantly, how did these asymmetries translate into therapeutic and research relationships with patients? Being a former patient (peer) myself might counteract ethical quandaries in these relationships to some extent, but what of their continuity? As an NHS practitioner, circumventing boundaries is frowned upon but as an anthropologist, surely it is unethical to abandon patients after using them for ‘data’?