Paper short abstract:

Drawing on a collaborative institutional ethnography conducted by anthropologists and clinicians, this paper tackles the unfolding of, and future of ‘Peer-supported Open Dialogue’, recently implemented in the UK’s NHS under the world’s largest randomised controlled trial of this innovation.

Paper long abstract:

‘Open Dialogue’ is a Finnish psychiatric innovation from the 1980s, garnering attention globally after reporting impressive rates of recovery, reduced hospitalisation, and minimal use of psychotropic medication. It is now being implemented in the UK’s NHS via a randomised controlled trial in response to perceived failures of the existing medical paradigm and calls for a social network approach to treating distress. Complementary but independent to this trial, an Anthropological Study of Peer-supported Open Dialogue was launched and a team comprising anthropologists (who trained in Open Dialogue) and clinicians (who trained in ethnography) became embedded in two trial sites (community mental health teams) to study its unfolding. My PhD project, affiliated with the aforementioned team, demonstrates tripartite engagement as an anthropologist, Open Dialogue practitioner, and peer.

During a time where NHS mental health services were perceived as dysfunctional in their use of resources, Open Dialogue’s promise to reorganise services in a clinically- and cost-effective way, enabled it to take hold. Open Dialogue itself views crisis as an opportunity to mobilise social networks polyphonously, enabling patients to regain agency. To deliver this therapeutic intervention, clinicians must then engage in ‘undoing’ their expert, solution-driven practices and respond tentatively and compassionately as ‘humans’.

What of anthropologists investigating innovations such as Open Dialogue that present as stable assemblages? How are the outcomes of such innovations evaluated and what of their sustainability into the future? This paper assesses to what extent healthcare systems are repackaging and circulating historical innovations when attempting to ‘undo’ their past.