The Bloomsbury Colleges | PhD Studentships | Studentships 2019 | Innovation in Psychiatric Crisis Care: An Ethnographic Investigation into Peer-supported Open Dialogue (POD) in Inner London
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Innovation in Psychiatric Crisis Care: An Ethnographic Investigation into Peer-supported Open Dialogue (POD) in Inner London

Principal supervisor: Professor David Mosse, SOAS University of London

Co-supervisors: Dr Andrew Fugard, Birkbeck, University of London

Award includes tuition fees and a stipend of £16,777 including London Weighting (at 2018/19 rates, so slightly higher for 2019 entry)

100% FTE for 3 years, from September 2019.

Project Description:

Worldwide, the focus of mental healthcare has shifted to community settings, either to lessen dependence on high-cost hospitalisation, or (in LICs) because such institutional-professional care is unavailable. But in the UK, reduction of in-patient beds alongside rising demand places immense pressure on community crisis services, now responsible for more people with severe illness including suicide risk. Service-user voices are raised against harrowing, socially disconnecting and often repeat-cycle experiences of crisis, waiting, diagnosis, hospitalization, medication, abandonment on discharge, and return to crisis, with excessive resort to A&E and compulsion, discontinuity of care and failure to engage with the social conditions and meaning of their distress. Such challenges motivate criticism of mainstream individual-focused, diagnosis-driven, drug-treatment and ‘disease model’-based approaches (e.g., Kinderman 2014).

 

Open Dialogue (OD) is a radical social-network alternative developed in Finland from the 1980s. It is an approach to crisis care which involves family/social networks and encourages clients’ own insights, meanings and frameworks of understanding about what is happening to them in crisis (Seikkula & Olson 2003). As well as rapid response and team continuity through a crisis, the approach involves a ‘dialogical’ process. Instead of privileging psychiatric expertise/ diagnosis, this uses diverse participant voices to reconstruct problems and cultivate agency. Organisationally, OD rethinks professional and patient roles and hierarchies, for example by recruiting peer-workers with lived experience of mental illness.

 

Compared to treatment as usual, OD in Finland showed improved psychosis alleviation, quality of life, return to work/study and lower levels of medication and hospitalisation (Seikkula & Olson 2003). This attracted wide attention, and the NHS is implementing a variant Peer-supported Open Dialogue (POD) through a multisite cluster randomised controlled trial, the 5-year NIHR-funded Development and Evaluation of a Social Network Intervention for Severe Mental Illness-ODDESSI (Razzaque & Stockmann 2016).

 

ODDESSI and participating NHS Trust teams have agreed to a complementary in-depth immersive anthropological study of POD and its social-institutional context across varied sites with a team of researchers, including peer- and clinician-ethnographers. The Bloomsbury SOAS-Birkbeck partnership and PhD project sits within this larger programme.

 

Aims/Objectives:

The PhD project investigates Peer-Supported Open Dialogue as an approach to crisis care in the London borough of Haringey, characterised by economic inequality and ethnic/cultural diversity. It aims to explain how POD works in practice through description of the micro-processes of the dialogical approach, the social dynamics of mental health teams and clients, and the experience of different roles (clinician, peer-worker, client, carer). It asks how inter-culturally translating and translatable is this radically participative approach to ‘medical’ care given varied moral/cultural assumptions around mental distress, ‘patienthood’, gender and kin relationships, medical expertise or the stigma/ dishonour surrounding mental illness? Particular attention is paid to peer workers and to the effects of ‘peer’ identity and ‘deploying’ mental illness experience (Cubellis 2018).

 

Fieldwork methodology

This ethnographic study involves training with and becoming embedded in a POD therapeutic team in Haringey, shadowing the team, attending to the moment by being there, participating in ‘network meetings’ with clinicians, clients and members of their social network (family and others) as another voice, keeping a reflective diary, alongside conducting interviews with clinicians, peer-workers and family members. A case-study approach follows a selected small sample of clients and their networks into the community over a 12-month period tracking processes of social re-entry following crisis.

 

The viability of the method has been established from related projects (in UK, New York and Berlin). Understanding the subjective aspects of POD will be deepened by recruiting a person with experience as a mental health service-user to this scholarship.

 

The PhD would fit within the larger anthropological project (including PI and postdoctoral researchers) submitted for grant funding and NHS Integrated Research Application System (IRAS) approval, but it is not dependent on the outcome of such grant application.

 

The PhD project will start in September 2019 with literature review, conceptual development and ethnographic research training (SOAS), Open Dialogue training (in 2020), one year’s field work (2020-21) and data analysis and writing-up (2021-2022).

 

Candidate requirements

We invite applications from outstanding and highly motivated students  who have a Master’s degree in anthropology or related disciplines (e.g., human geography, sociology, development studies) focused on ethnographic research methods; and an undergraduate degree (1st class honours or 2.1) in a relevant discipline. The candidate will have excellent skills for, and prior experience of, conducting ethnographic research or be trained in ethnographic methods. Personal experience of mental health service use will be an strong advantage.

The studentship is open to applicants who would be assessed to have UK/EU fee status.

Significance

This is a unique opportunity for an anthropological complement to a large RCT study of an alternative mental health model with global significance for psychiatric care. Ethnographic findings will help tailor OD for uptake in a complex inner London environment, advance existing ethnography of OD-like services (in UK, Finland, New York and Berlin), while offering insight on the RCT trial itself. The PhD will make a theoretical contribution to anthropology tracing OD through systemic/relational therapy and dialogism to its roots in the work of Gregory Bateson and Mikhael Bakhtin. It addresses, comparatively, global mental health questions: (1) how to accommodate different understandings of mind and mental distress, and (2) how to take account of social relationships in the cause and healing of crisis. It explores the limitations of a prevailing culture of psychiatry which treats mental illness as residing within the psychology of the individual, and why recovery from psychotic illness appears better in certain social conditions, often those without developed psychiatric care.

Subject Areas/Keywords:

Mental health; anthropology; ethnography; social/cultural psychiatry; Open Dialogue, peer workers; social networks; crisis care; urban communities

Key References:

Cubellis, L. 2018     Care Wounds: Precarious Vulnerability and the Potential of Exposure. Culture, Medicine, and Psychiatry.
Cult Med Psychiatry. 42(3): 628-646.

Gilburt, H. 2015. Mental health under pressure. The King’s Fund.

Kinderman, Peter 2014. A Prescription for Psychiatry: Why we need a whole new approach to Mental Health and Wellbeing. Palgrave McMillan

Razzaque R. and Stockmann T. (2016) An introduction to peer-supported open dialogue in mental healthcare. Bjpsych Advances 22(5): 348–356.

Seikkula J. and Olson M. (2003) The open dialogue approach to acute psychosis: Its poetics and micropolitics. Family Process 42(3): 403–418.

 

Further details about the project may be obtained from:

Principal supervisor: Professor David Mosse (dm21@soas.ac.uk)

Research webpage: https://www.soas.ac.uk/staff/staff31472.php

Further information about Research degrees in Anthropology & Sociology is available from: https://www.soas.ac.uk/anthropology/programmes/phd/

 

Application forms and details about ho to apply are available from:

Candidates wishing to apply for this fully funded three-year, full-time PhD studentship starting September 2019 must complete both an admissions application and a studentship application. These are separate processes.

STEP 1: Admissions Application

Apply for the Research Degrees programme in History using SOAS’s online admissions form. See: https://www.soas.ac.uk/history/programmes/phd/for information and ‘Apply Online’ link.

 

Applicants must submit a complete online application for admission as soon as possible and no later than the studentship deadline (16:00 UK time, Thursday, 14 March 2019).

 

Further guidance for applying for admission to the MPhil/PhD programme and documents you need to submit is available at http://www.soas.ac.uk/admissions/pg/research/howtoapply/.

 

IMPORTANT: Please state in the admissions application that you wish to be considered for the Bloomsbury  Colleges PhD Studentship, use the title of the studentship (project title: Innovation in Psychiatric Crisis Care: An Ethnographic Investigation into Peer-supported Open Dialogue (POD) in Inner London)

as your Research Proposal Title and state Prof David Mosse

as your Proposed Supervisor.

Use your Supporting Statement to explain why you are motivated to apply for this particular project, and what skills and experience you will bring to the project. In your 2,000 word Research Proposal please respond to the project description and elaborate on how you would approach the project theoretically and methodologically based on your previous academic training and experience.

 

STEP 2: Studentship Application

Apply for the Bloomsbury Colleges Studentship by completing and submitting the application form the application form https://docs.google.com/forms/d/e/1FAIpQLScA_wTHASxvGo4YppO9v-alTT-C0osva4KlApWbLffbl0XsrQ/viewform?vc=0&c=0&w=1

 

to scholarships@soas.ac.uk by no later than 16:00 UK time, Thursday, 14 March 2019.

 

Closing date for applications is: 16:00 UK time, Thursday, 14 March 2019.