Staff perceptions of Open Dialogue: a Q-methodology service evaluation examining perceptions amongst non-implementing clinicians

Background The Open Dialogue (OD) approach to the care and treatment of those experiencing psychosis have been increasingly implemented in the UK and NHS Trusts since 2015. Existing research and service evaluations have typically examined the perceptions of OD amongst service users and implementing clinicians. Less researched are the perspectives of those not directly delivering OD within services, of whom research suggests there may be more ambivalence about OD. This service evaluation aimed to determine wider organisational perceptions of OD by examining perspectives of non-implementing staff.Methods Sixteen non-implementing staff working in services delivering OD took part in this Q-methodology study, ranking statements about OD according to their personal endorsement.Results Inverted factor analysis identified a best-fit three-factor model, representing viewpoints held by participants. Narrative interpretation highlighted Factor 1 reflected a general positive regard for OD, the majority viewpoint amongst participants. Factor 2 depicted a more sceptical recognition of the practical and emotional challenges of OD. Factor 3 reflected uncertainty and concerns about OD‘s conditional efficacy, highlighting the need for more guidance.Discussion Findings reflect openness towards OD within the Trust but highlight organisational barriers to its implementation. Additional perspectives towards the medical model of mental healthcare are discussed.