Open Dialogue: An Investigation of the Network Intervention & its Implementation in Mental Health Services

Open dialogue (OD) has emerged as a transformative approach in mental health care, emphasizing relational-based interventions. To date, research has been limited on OD implementation practices in mental health services, particularly in relation to adherence. Due to variability in the context OD is implemented in, further understandings are required to support its adoptability to local needs. The current thesis endeavours to describe a programme of research consisting of two studies aimed at addressing this gap. Study 1 describes a systematic review exploring the evidence-base for OD intervention studies (n = 28) to understand implementation practices and adherence to OD. The systematic review, designed in line with PRISMA guidelines and employing a narrative synthesis, highlighted positive a varying level of adherence to OD principles, while a range of barriers and facilitators that may affect the adoption of open dialogue were found. Study 2 details a phenomenological, qualitative design that employed semi-structured interviews with network members and practitioners (n = 7) to critically examine open dialogue implementation practices and adherence to the approach in inpatient mental health services. Findings indicated good adherence to the model and illustrated five individual themes centring around culture, influencers, training, systems, and personal values. Themes contained both barriers and facilitators to implementation. Through a multi-methods approach, combining findings from a systematic review and qualitative study findings, the results underscore the importance of balancing standardization with flexibility to ensure OD’s scalability without compromising its transformative potential. Synthesized findings suggest OD's collaborative ethos conflicts with structured care systems. Successful implementation requires balancing barriers (resistance, ambiguity) with facilitators (leadership, training), adapted fidelity frameworks in order to continue the growth of rights-based approaches in services