9.127 Using the Open Dialogue approach to solve the crises in primary care and rough sleeping               31.1.18

Paper for Clinical Commissioning Groups (CCGs) Health and Wellbeing Boards (HWBs) and Mental Health Trusts, including Sussex Partnership Foundation Trust.

Notes of a study day with Nick Putnam in Hackney, London on 19.1.18. By John Kapp, 22,Saxon Rd Hove BN3 4LE, 01273 4117997, 31.1.18

1 Summary of conclusions and recommendations

Since 2015, there have been two unprecedented epidemics afflicting the South of England: a near doubling of rough sleeping, and a mass exodus of GPs. Both crisis are unintended consequences of the Department of Work and Pensions (DWP) policy of appointing Psychological Wellbeing Practitioners (PWPs) to get benefit claimants back to work, by being ‘treated’ by their GP with antidepressants. These are mood altering drugs which are now being taken by 1 in 10 of us in England (5.5 million) mostly against NICE guidelines, which say that talking therapies are to be preferred. They have side effects, including addiction, and may make patients suicidal or homicidal and frightening to live with. GPs feel guilty at generally doing more harm than good, so retire early, now at an average age of 55.

Both crises can be cured by spending the Better Care Fund (going up to £5.8 bn pa from April 2018) in the way intended by Parliament, by adopting a policy of ‘medication to meditation’, Councillors on Health and Wellbeing Boards (HWBs) should call their CCGs to account to create Community Care Centres as mental A&Es, open 24/7 for crisis care, staffed by existing licenced providers of effective treatment incorporating the Open Dialogue approach to treat all vulnerable people (including addicts) on a self-referral basis with NICE recommended Mindfulness Based Cognitive Therapy (MBCT) 8 week courses, and supporting meditations, including Family Constellation Group Therapy (FCGT)

2 Who is Nick Putnam?

3 What is the Open Dialogue approach?

4 Has Open Dialogue been trialed?

5 What are the principles of Open Dialogue?

  5.1 Give immediate help.

  5.2 Involve the social network.

  5.3 Flexibility.

  5.4 Responsibility for the care plan.

  5.5 Continuity of psychological care.

  5.6 Tolerance of uncertainty.

  5.7 Dialogism.

6 Clinical trial of Open Dialogue in the NHS

7 The Open Dialogue approach should be adopted in all mental health interventions.

8 Mental health interventions in the NHS are provider-centred and paternalistic.

9 Access to treatment is via a GP.

10 Assessment

11 Talking therapy

12 Antidepressant medication.

13 Side effects of medication are the root cause of the crisis.

14 Statutory access times compared.

15 The solution is to create a system with better treatments for mental problems.

16 Better Care Fund. (BCF)

17 Community Care Centres as mental A&Es.

18 How many Community Care Centres have been created to date?

19 How many Rachels and Daves have been treated to date?

20 Why has the BCF not been spent in the way that Parliament intended?

21 Where has this disconnect come from?

22 How can the disconnect be connected?

23 What would happen if they did take this responsibility?

24 Could medication be the root cause of the crisis of the epidemic of rough sleepers?

25 What is the neurological cause of behaviour?

26 Can we change our behaviour?

27 Why do people become addicted?

28 How can addiction be healed?

29 How can addiction be cured?

30 Who can be an effective therapist?

31 What is the most effective therapy for addiction?

32 Conclusion.

Appendix 1 My letter to the Brighton Argus, as published on Tues 30.1.18 on p10.

Appendix 2 My invitation, handed to councillors on the Health and Wellbeing Board with a copy of my letter as printed in the Argus (see appendix 1) at their meeting on 30.1.18 at Hove town hall.

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