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All material appearing in this volume is in the public domain and may be reproduced or copied without permission from SAMHSA.

Citation of the source is appreciated.

Additional copies of this publication are available from:

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E-mail: nmhic-info@samhsa.hhs.gov

Acknowledgments

Many supporters read the document at different stages to give me feedback: Fred and Sharon Newman, in Florida, Betty Weathers in Atlanta, Ann Marshall, from Alabama, Laurie Weber, a co-coordinator of several Pioneer Dialogues, in Florida, and Jacki McKinney, in Philadelphia.

Barbara Lee, from Tampa, Florida, helped with the research summary and bibliography; Sally Clay, in Florida, edited and proofread. Barbara Jackson, in Florida, was also a proofreader. Final proofreading and editing were done by Norma Wagner and Rosemary Jones. Thanks to Natalie Reatig in Washington, D.C., and Irena Rutenberg in New York City for their support.

Many thanks to Janet Foner, who assisted with the coordination of the Pittsburgh Dialogue, wrote a summary report, and reviewed the draft for the manual, and to Stephen Ferrante, in Florida, who wrote sections of the Facilitation guidelines.

Two articles were written by consumers who added a special dimension to the manual — Darby Penney wrote “The Recovery Dialogues” that describe dialogues that were held in the State of New York. Sylvia Caras wrote Internet Dialogues which describe how to communicate on the internet.

The assistance of all the folks involved in the two “Pilot Dialogues” was invaluable, especially from coordinators Dr. Ken Thompson and Linda Morrison, in Pittsburgh, and Renee Constantino and her staff at the Mental Health Association in Palm Beach County. Thanks to J. Rock Johnson and others, in Nebraska, for their efforts to plan a dialogue there.

Finally, I want to acknowledge and give special thanks to Paolo del Vecchio, Risa Fox, and Iris Hyman at the Center for Mental Health Services whose assistance was greatly appreciated.

Funding for this project was provided by the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services (DHHS). The opinions expressed in this document reflect the personal opinions of the authors and are not intended to represent the views, positions or policies of CMHS, SAMHSA, DHHS or other agencies or offices of the Federal Government.

— Gayle Bluebird
Author

Table of Contents

Foreword

Introduction

What is a Dialogue?

Different Models of Dialogues

Develop the Dialogue
Organize a Committee
Choose a Title and Theme
Develop the Budget
Set up the Meeting Logistics
Select a Location
Select Participants
The Invitation Letter
Plan Meals
Use Volunteers
Technical Considerations
Name Tags and Participant Packets
The Evaluation Form — Don’t Forget
Time Limits and Time Frames
Ending Dialogues

Facilitation
Select the Facilitator
Use Co-Facilitators
The Role of the Facilitator(s)
Start the Roundtable Dialogue
Present Conduct Guidelines
Set Agenda
Maintain Flow of Conversation
Deal with Conflict
Stick to the Agenda
Future Plans and Strategies
Record the Dialogue
Conclude the Dialogue

Conference Dialogue
Selecting Participants
Planning
Send Letter and Brochure
Using Speakers
Preparing Small Group Dialogues (Optional)
Choosing Facilitators

The Day of the Conference Dialogue
Registration
Welcoming Remarks
Keynote Speaker
First Panel
First Dialogue Session
Lunch
Second Panel and Dialogue Session
Open Mike
Ending the Conference

Attachments
Sample Brochure for Conference Dialogue
Sample Evaluation for Conference Dialogue
Sample Agenda for Conference Dialogue

Appendices
Appendix A: What Happens After the Dialogue
Appendix B: Internet Dialogues
Appendix C: The Recovery Dialogues
Appendix D: Glossary of Terms
Appendix E: Literature Summary
Appendix F: Bibliography
Appendix G: Advisory Group
Appendix H: List of Resources

Foreword

The Center for Mental Health Services (CMHS), a part of the Substance Abuse and Mental Health Services Administration (SAMHSA) was created in 1992 to meet the need for an entity within the federal government that focuses on real-world experiences, services and evaluation. CMHS works to promote mental health and prevent the development or worsening of mental illnesses when possible. Changes in the public mental health care system are affecting both mental health consumers and practitioners. Mental health care is focusing less on stabilization or custodial care, and more on rehabilitation and recovery; part of this new focus is to involve consumers more than was customary in the past. The widespread adoption of managed care programs and new technologies (particularly changes involved in approaches to medication), along with the continuing problems of discrimination/stigma associated with mental illness, offer tremendous ongoing challenges to the ability to provide high quality mental health care. Current conditions make it important more than ever to establish partnerships — not just building one-to-one relationships, but also creating lasting, productive alliances at both the system and policy level.

Through dialogue people can come together for a mutual exchange of ideas, observations and experiences. Dialogues go beyond the usual interactions between practitioners and recipients of mental health services. They provide a safe environment in which participants may speak freely to create better understanding and mutual trust and respect.

For the first time ever, this participatory dialogue manual, developed by mental health consumers, offers a blueprint for action. It describes the benefits of dialogue meetings and provides easy-to-follow detailed specific action steps on how states, local communities, providers, managed care organizations, advocates, family members and consumers can organize meetings to develop working partnerships to improve mental health service delivery. The goal is to bring all stakeholders together on a level playing field and to develop the kinds of partnerships that are needed to improve mental health services.

CMHS has successfully initiated a number of consumer/provider dialogues using the methods outlined in the manual. After each dialogue, participants remark about the value of the dialogue and the impetus the dialogue has provided to instill changes, initiate additional programs, and examine the insights offered.

Dialoguing, communicating, and partnering are ongoing processes. These dialogues offer hope for a foundation of sincerity and openness that will lead to significant improvement of mental health services because both providers and mental health consumers are effectively communicating and discovering the importance of such a unique collaboration.

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Introduction

“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it’s the only thing that ever has.”
— Margaret Mead

In July 1997, the Center for Mental Health Services convened a two-day meeting in Arlington, Virginia, Consumers and Psychiatrists in Dialogue. The meeting brought together twenty individuals who were equally divided between current and former recipients of services (consumers), and psychiatrists from all over the United States. This historic meeting provided opportunities for people to explore uncharted territory through communication exchange. The meeting was a success, measured by the reported feedback from those who participated.

It was recommended that dialogues be replicated among other constituencies at state and local levels, and for a written report to be distributed to a wide mental health community. Another recommendation was to create a manual for people to learn how to create similar dialogues. This volume is in response to that last recommendation.

Background

Dialogue is not a new concept. Participatory Action Research, twenty years ago, created a new paradigm for the conduct of research using dialogues nationally and internationally.

In the mental health arena, three roundtables were convened in 1989, by the Community Support Program, under the National Institute of Mental Health, to discuss the issue of involuntary treatment. These three meetings (held first with consumers, then psychiatrists and consumers, lastly with consumers, psychiatrists and family members) were the inspiration for a conference model, Pioneer Dialogues, the first of which was held in Broward County, Florida, in 1992. The two-day dialogue conference was held at South Florida State Hospital, bringing consumers and professionals together to discuss basic consumer issues and strategies.

In other parts of the country, similar dialogues were being held. New York State convened a series of Recovery Dialogues between psychiatrists and consumers. Darby Penny, New York’s Director of Recipient Affairs, describes one of these dialogues in the manual. Dialogues were also organized between state commissioners of mental health and mental health consumers under the direction of Ann Loder, consumer advocate from Florida, while working with the National Consumer Policy and Research Workgroup.

Why are Dialogues Important?

To Talk About Differences, There Must Be a Partnership

Pilot Dialogues

In order to determine whether the steps outlined in this manual were adequate or complete, two pilot dialogues were held in Pittsburgh, Pennsylvania, and in Palm Beach County, Florida, both during the Spring of 1998. Each differed in the dialogue model that was used. Pittsburgh used the roundtable model; Palm Beach County used the conference model.

New approaches that worked in previous dialogues have been added to the “how-to” steps in this manual. Approaches that did not work were considered just as valuable, because they could be used as examples of what not to do. You will find many references to the pilot dialogues throughout the text.

Other dialogues mentioned in the text are: the Pioneer Dialogues held in Broward County, Florida (1992–1995), a dialogue between psychiatrists and consumers held in Arlington, VA (1997), and Recovery Dialogues held in the state of New York. Nebraska is used as an example, several times, to illustrate the difficulties of organizing a dialogue in a rural state.

About the Manual

Although articles and reports have been written describing the benefits of dialogues, writing about them is not the same as organizing them. The goal was to create a practical manual with simple, concise, information that anyone could use. Steps are included that talk about everything from location selection to how to plan meals. Two models of dialogue are presented, the conference model, and the roundtable model. Most of the steps in this manual are applicable to both models, but specific steps for the conference dialogue have been added. Examples in the form of vignettes have been added to most of the steps, as well as tips that can be helpful.

Dialogues are also an art form, a variation on the art of conversation, in which listening is as important as talking. A short narrative tells you how to be a good listener. Another form of dialogue is communication on the Internet. A chapter explains how to use it and also lists Web sites for discussion of mental health issues.

The manual is for anyone to use. The main issue presented is mental health, but most of the guidelines will also work for other groups. The population that is the minority, or who has the least power, should take a lead in planning a dialogue as much as possible. In a mental health dialogue, consumers should take the lead. Consumers are the reason for the dialogues because consumers are the subject of the dialogue. Creating a forum for equal exchange is a goal, but it should not be forgotten that one of the primary reasons for dialogues is for professionals to learn more about consumers from consumers.

The Art of Listening

A good dialogue requires you to be a good listener. Sadly, many people do more talking than listening. Even while listening, we are thinking about what to say, or we are listening to what’s going on in our own head rather than
what is being said by the other person. Many of us want to talk, but few of us really listen.

The first step in being a good listener is to be truly interested and concerned about the other person. Start listening from the beginning. Clear your mind from other distractions and focus on what the other person is saying.

Listen Objectively

If you listen with the intention of taking issue with what the other person is saying, you will not be able to understand what the person is saying under any circumstances. Good listening requires that you suspend judgment, cut through emotional barriers, and keep an open mind.

Listen for the Main Idea

New information requires that you understand the point the other person is making. However, sometimes the speaker may not be clear enough to be understood. Ask questions for clarification. Make sure you can summarize the gist of the message when the person is finished speaking.

Listen for Details

Specifics of a message are much more difficult when they involve names, dates, places, facts, and figures. Try to remember which details are important, but make sure that you don’t pay so much attention to details that you lose the overall concept of what is being said.

Listen to What is Not Being Said

Be aware of body language, tone of voice, eye contact, and gestures. It is often what is not said that conveys the true message of what a person is saying. Your own body posture and attentiveness will influence what and how the person conveys information. Assume a posture of attention. Look at the person while he is talking. It may not improve your ability to listen, but it may have an effect on the other person.

Language Used

The generic term consumer has been used for persons who have or are currently receiving mental health services. It is used only when necessary, because it has been the most accepted term, not because it is the most popular. Other terms such as consumer/survivor/ex-patient might have been used, but adding words may be cumbersome. Most often, the words “people” or “persons” are used for description.

Dialogues are being conducted all over the country, in many different ways. They are being used as part of research and evaluation, to evaluate consumer satisfaction, and to train staff in mental health agencies and hospitals. There are many other possible purposes. Let this guide inspire you to create other dialogues. How they take shape is up to you. Last word: Have fun creating your dialogue! Have fun using the manual!

What is a Dialogue?

“An ounce of dialogue is worth a pound of monologue.”
— Leonard Ray Frank

A dialogue is a forum in which two or more groups of people are brought together as equals to explore their differing views, experiences, and belief systems, in this case, about mental health topics and issues. A dialogue is structured to allow for exploration of one’s own perceptions and attitudes, as well as to listen to other people explore their own.

All dialogues have the following common goals and objectives:

• Create better understanding and mutual respect among consumers, family members and professionals.
• Allow participants to speak from their experiences and belief systems in an atmosphere of safety.
• Create partnership ventures through compromise and consensus.
• Change attitudes and practices in the mental health system.

Dialogues Promote:

• Listening
• Serious inquiry
• Risk taking
• Curiosity
• Healthy conflict
• Openness
• Diversity inclusion
• Consensus building
• Empathy
• Understanding

But Discourage:

• Assumptions
• Being judgmental
• Argumentativeness
• Divisiveness
• Closed-mindedness
• Hidden agendas
• Uniformity

Different Models of Dialogues

Roundtable Dialogue

A Roundtable Dialogue is an open discussion group with 20–25 participants. It brings people together who have different perspectives on mental health topics and issues. The group may consist of two or more specific groups. The Roundtable relies on a respectful facilitator or co-facilitators who treat people as equals and are sensitive to individual needs.

Conference Dialogue

The Conference Dialogue combines speaker presentations with small group dialogues. The audience may include up to 125 people who gather as a group and break up into smaller groups (up to 25) where participants interact as equals. The Conference Dialogue may be used as an annual event to honor our accomplishments, to educate, and to involve a particular aspect of a mental health system.

Both styles of dialogues are intended to help people to understand each other by talking over differences and sharing similarities in life experiences. The results are improved relationships which can help to establish partnerships within the mental health system.

Both Dialogue Models Include:

• Participant guidelines
• Facilitator guidelines
• Goals and objectives
• Participant selection guidelines
• Time for networking
• Conduct guidelines
• Plan for shared meals
• Timekeepers
• Time for strategies
• Evaluation forms
• Participant packets and name tags

Conference Dialogue Model Only:

• Requires more funding
• Planning takes longer
• Agenda more detailed
• Uses speakers/panelists
• Include arts and entertainment
• Small pre-set dialogues
• Uses more volunteers
• Requires brochure
• Location needs differ
• “Open microphone”

Develop the Dialogue

Organize a Committee

• A lead person from an agency will initiate the dialogue. This person may later become the coordinator of the dialogue.
• Keep small, approximately five to six people. Too many people on the committee will be confusing and make it harder to complete tasks on time.
• Include representatives of key constituency groups. Make sure consumers are on the planning committee.
• Always include primary consumers (direct recipients of services), as the dialogue is intentionally established to hear their views; however, a family member may be included, if applicable.
• Select people who have organizing abilities, writing skills, and fund-raising experience.
• The sponsoring agency should be represented whenever possible. The agency should be able to provide secretarial support and other technical assistance, including the ability to fax, send mailings, and print copies.

Other selection criteria to be considered:

• Enthusiasm about the dialogue.
• Familiarity of members, i.e., do committee members know each other?
• History of working together (because individual strengths and working styles will already be known).
• Commitment to meet the demands of frequent meetings and tasks.

If planning a dialogue from long distance, committee members may meet by conference calls and e-mail. Long-distance planning creates other considerations such as whether a face-to-face meeting is indicated, how to delegate responsibilities, participant selection, etc.

Organizing a dialogue can be a long, tedious process that requires committee members to build trust. The planning process involves ongoing and open communication between the committee members and is often a learning experience as significant as the event itself.

The committee determines:

• The purpose of the dialogue
• Groups to be represented
• Length of dialogue (one or two-day meeting)
• Whom to invite
• Date, location, and time
• Type and model of dialogue (Roundtable or Conference)
• Selection and choice of coordinator and/or co-coordinators (It is helpful to have two coordinators because they can share responsibilities and one can take over for the other if necessary)
• Dialogue agenda

The coordinator(s):

• Demonstrate leadership
• Do the majority of the work
• Bring information to the committee for decisions
• Set agendas and time-lines for completion of tasks
• Keep the committee’s work on schedule
• Serve as primary spokespersons for the event
• Make on-the-spot decisions when necessary

The committee may want to add additional people for specific tasks, but the nucleus group should remain intact for consistency, to make major decisions, and to keep things running smoothly.

The committee should allow two to four months to plan a Roundtable Dialogue, and at least four months for a Conference Dialogue.

Choose a Title and Theme

Choose a broad theme or concept for a first dialogue, such as recovery, mental illness, partnerships, or stigma and name accordingly.

Subsequent dialogues are more specific and focus on defined issues such as the criminal justice system, homelessness, state hospital closings, or out-patient commitment.

Keep the title short, concise, and catchy in order to grab attention.

Examples

• The planning group in Pittsburgh, Pa. (March 1998) named their dialogue, “Talking with Each Other: For a Change.” The sub-title was a double entendre. “Finally we are talking together instead of not communicating, AND getting together to talk, pointing out the way to change.”
• “Pioneer Dialogue” was the name given to the first Conference Dialogue held in January, 1992, in Broward County, Florida. The word “Pioneer” was chosen because, as defined in Webster’s Dictionary, pioneer is a “group originating a new idea,” and because of a second Webster’s Dictionary definition, of “a plant capable of establishing itself in barren soil.” “Pioneer Dialogues” has become a common name that other organizations are using in other parts of the country.
• Palm Beach County, Florida (June 1997) used the “Pioneer Dialogue” trade name with the sub-title “The Experience of Recovery.” Their second Pioneer Dialogue in 1998 dealt with more specific issues and was called, “The Health of the Mental Health System and How it Affects You.”

Pittsburgh, March 1998
“Talking with Each Other: For a Change”

Broward County, Florida, 1992
“Pioneer Discussions”

Palm Beach County, Florida, 1997
Pioneer Dialogue
“The Experience of Recovery”

Focus Questions can be developed to yield information that is desired from the dialogue. The committee should be careful to construct only broad questions, since the specifics of topic discussion should come directly from the participants in the dialogue.

Example

• Three roundtable discussions were convened in 1991–1993 by the National Institute of Mental Health’s Community Support Program.

The meetings focused on the subject of involuntary treatment and five basic questions were developed prior to the meetings, as follows:

1. What are the involuntary interventions used by the mental health system?
2. How and why do people get treated against their will?
3. How do involuntary interventions affect people who experience them?
4. What are potential alternatives to involuntary intervention?
5. What are the implications of answers to questions 1–3 for research, training, and program development.

Develop the Budget

A budget must be created with estimated costs for the dialogue.

Find out first if all needed funds are available or if fund-raising will be necessary.

Determine whether a written proposal with narrative and budget is required.

Sample Budget Items

• Site location
• Meals/refreshments
• Coordination
• Organizer of dialogue
• Facilitator fees
• Travel expenses
• Audiovisual equipment
• Documentation fees
• Printing
• Mailing and postage
• Hotel accommodations
• Recorder fees

Suggestions for Possible Funding

Government Funds

Participating Agencies

Private Funds

No Funds

Two Dialogue Budgets:
(Note that the two different styles of dialogues vary in expenses.)

Funds for the above dialogue were raised through the Office of Educational and Regional Programming in the amount of $1,000 and $500 each came from the Pennsylvania Providers Association and the State Community Support Program.

Commentary from Pittsburgh organizer/consumer, Linda Morrison: “We probably could have done it cheaper, but we were in the belly of the bureaucracy and we had a good marketer. There were no strings attached to the money.”

Funds for Pioneer Dialogue on Crisis Alternatives included approximately $1,500 allocated by government adult mental health funds. Two local hospitals, the State Protection and Advocacy Center, and a community mental health center provided the balance of the funds. In addition, family member groups volunteered to serve food and provide desserts for lunch.

We have provided you with only two sample budgets; however, there have been many dialogues, each with their own variations.

Note
In Nebraska, a planning committee was formed to create a dialogue
which never got off the ground because the funding was not in place. In retrospect, one of the planners concluded: “Funding has to be in place . . . and only when funding is in place can you operate as a planning committee.”

“Funding has to be in place . . . "

Set up the Meeting Logistics

Day and Date

• Select a day that meets the needs of most participants.
  
• Consider providers’, administrators’, consumers’ preferences.
• Consult a calendar for already scheduled conferences.
• Note that air fares are cheaper when the weekend is included.
• Decide on a start and finish time (consider traffic patterns during business hours and people’s family needs).

Set up:

• Day
• Date
• Hours
• Location
• Meals
• Breaks
• Smoking areas

Select a Location

A Conference Dialogue requires a large central meeting room plus break-out rooms with circular seating for small group sessions. This site must be able to support the total number of desired participants. For example, if the total number is 100, at least five break-out rooms are needed. Frequently, locations are considered ideal for the conference in every respect except for adequate rooms for the dialogue sessions. At some conferences, outdoor space has been used or rooms usually used for other purposes or a large meeting room broken into sections.

A Roundtable Dialogue requires a large meeting room with people seated at a table in a rectangle or square. It is important that all participants can see each other.

An ideal site has:Adequate lighting (windows important)

• Adequate rest rooms
• Wheelchair accessibility
• Kitchen space (optional)
• Coffee makers available
• Electric outlets
• Parking
• Transportation to and from airports
• Good acoustics
• Comfortable chairs
• Public transportation accessibility

Hotel Settings

The selection of a site will be dependent on the budget. Select a hotel if there is enough money in the budget. Hotels are desirable because they are convenient. Arrangement of meeting rooms and other details are automatically taken care of, and meals are prepared and served.

Note

Costs vary from city to city depending on the size. Meeting rooms vary greatly in price depending on the facility. Time of year affects rates. (Areas that attract tourists in the summer may lower rates in winter, and vice versa).

Check the Following Before Selecting a Hotel

• Parking space and fees — Check to see whether the hotel offers a discount or free parking for conference participants. Also make sure there are adequate parking spaces.
• Hidden costs for extras — It is important to ask whether there are additional costs for microphones or other special equipment.
• Acoustics — Make sure the rooms have adequate acoustics so that people can hear each other.
• Accessibility for disabilities — Check for accessibility for wheelchairs, sign language, guides, etc.
• Food — Be sure to check menus and costs. Most hotels will let you sample food in advance. Some will even offer a free meal for this purpose if you ask.
• Staff friendliness and helpfulness — Does staff take time to answer your questions? Do they return your phone calls in a timely manner? Do they offer suggestions? Does your intuition tell you that they will be friendly and helpful to the participants who attend the dialogue?
• Centralized location — Is public transportation accessible, close to participants’ homes, and near the airport?
• Surroundings and furnishings — Are surroundings pleasing to the eye? Are they comfortable and inviting?
• Directions to the hotel — If you choose a hotel make sure you ask for written directions and a map to include with the invitation. Most hotels have these available including directions from the airport, and to restaurants near the hotel. Nothing is more frustrating than to have participants circling streets in a busy commercial area only to arrive at the meeting late, totally exasperated.

Lower Cost Alternatives

• Agency boardrooms and conference rooms
• Colleges/educational centers
• Training rooms in banks, companies, hospitals
• Public libraries
• City Hall
• Schools (generally available only when school is not in session)
• Churches (not usually advised if religious icons are present)
• Community centers
• Homes are a possibility if nothing else seems workable.

Examples of site selections

• In Palm Beach County, Florida, the Mental Health Association held two successive conference dialogues in 1997 and 1998. The first dialogue was held at a United Way office. The second year dialogue was held in a hotel. The conference organizers were all in agreement that the hotel setting was better although more expensive. Tom Menard, one of the planners, stated: “What we lost in money, we gained in less stress.”
• The Pittsburgh Pilot Roundtable Dialogue planners chose a hotel. Generally speaking, everything was ideal. However, there were two problems. First, the planning group forgot to give instructions on how the room should be set up. As a result, the beginning of the dialogue was delayed. Second, this was one of the meetings during which there was loud noise in the next room.
• The original “Pioneer Dialogue” in Broward County, Florida, would not meet any of the standards for comfort as have been set forth in this manual. The conference site was situated far from where most of the attendees lived. The chairs were straight back and uncomfortable, the acoustics were terrible (an old air conditioner went on and off making it almost impossible to hear) and break out rooms for the dialogue sessions were far away from the general meeting area. Despite these drawbacks, the conference dialogue was a major success! Everyone loved it because it set precedents for involving an entire community to make changes in the mental health system.
• A high school was selected for a “Pioneer Dialogue,” for which there was no charge. All criteria were met with only one drawback. The size of the auditorium was too large for the audience, which filled only one fifth of the room. The problem did not become apparent until the day of the dialogue when people spread to all areas of the auditorium, some at the entrance, and some near the stage. The meeting was difficult to hold together, though in many ways the site was ideal.
• One of the best site selections was for the 1996 Pioneer Dialogue, Broward County, that was held at a Unitarian Church which offered pretty grounds with flower gardens and trees and a large patio off the main meeting room. Break-out rooms were adequate. Generally speaking, churches are not recommended they may be offensive to some who are non-religious. Unitarians are a secular congregation, consequently the meeting rooms were acceptable to all participants. The rental cost was also reasonable. All in all, this may have been one of the nicer settings for a conference.

Sometimes you try an alternative location, the next year a hotel, and compare . . .

Sometimes the site appears perfect, but gaps in planning can disrupt . . .

Sometimes a site appears marginal, and “it works” . . .

Sometimes a site that has no costs, has costs (if it is not working) . . .

And sometimes it all comes together.

Select Participants

Invite people who will contribute to the dialogue and who will be affected by the outcome. Selected individuals should have good communication
and listening skills, and have expressed an interest in participating in the dialogue exchange.

A Roundtable Dialogue should be composed of no more than 25 (preferably 20) people. A 20-person dialogue should be equally divided among consumers, providers and/or family members.

A Conference Dialogue may not have equal ratios. A 30–40% consumer representation may be adequate if the goal is to educate providers. Make sure that consumers share lead roles.

Note

Consumer and provider definitions may be interchangeable. Some consumers are providers and vice versa. The definition of a consumer used in this manual is a person who has received direct services in the mental health system and who openly defines himself/herself as an advocate for other consumers.

Key Factors in Selecting Participants

• Cultural backgrounds
• Geographic representations
• Background in leadership
• Political perspectives
• Employment-related diversity
• Gender
• Sexual orientation
• Age considerations
• Physical abilities
• Socio-economic backgrounds

Consider the Following

• Should only those consumers who can articulate an ideology be invited?
• Should non-verbal consumers be invited?
• Should consumers be invited if staff members from their agency are participating, creating possible power imbalances?

These are issues to consider, but generally speaking, we recommend that participants should be verbal and have some opinions on issues. Occasionally someone will make a comment, “The dialogue doesn’t represent all consumers.” Usually, when one hears the stories of dialogue participants it becomes evident that they were not as articulate as they are now.

In Nebraska, the planners were concerned about whether they had enough consumers who were ready to participate in a Roundtable Dialogue. J. Rock Johnson, a consumer advocate, made the following observation: “It becomes obvious to me that dialogues are not designed and may not be suitable for ‘bootstrap’ situations such as ours. The expectation is that there is an existing pool of consumers who are self-assured, articulate, and can be at ease with authority figures. My thinking was that we could use this vehicle to help find persons with potential and help develop them. That is still our intention.”

Diversity

It is important to reach out and include as many people as possible from different racial and cultural backgrounds. Perspectives on mental health differ greatly, and people of color have been discriminated against, not only in society, but in the mental health system as well. Sometimes they are added as an afterthought. Jacki McKinney, consumer advocate (PA) states: “Most of the time, no matter how large or small the meeting, there’s only one or two people of color present. I am excited, as I see that dialogues can be used as a positive tool to correct this.”

In Arlington, Virginia, a dialogue between psychiatrists and consumers, in 1997, included a diverse group of people who were Asian, Polynesian, African American, as well as people with differing sexual orientations, religious and age backgrounds. Janet Foner, consumer advocate from Pennsylvania, stated: “The inclusion of persons with so many different backgrounds made it a truly rich experience.”

“. . . dialogues are not designed and may not be suitable for ‘bootstrap’ situations such as ours.”

“. . . no matter how large or small the meeting, there’s only one or two people of color present . . .I see that dialogues can . . . correct this.”

“. . . different backgrounds made it a truly rich experience.”

Other Considerations

Consider whether to invite an individual who has a history of grandstanding or being hostile or disruptive at meetings. While it is important to be inclusive of all viewpoints, it is also important to ensure as much as possible that participants are not going to be disruptive. Talk to an individual before inviting him/her, define the problem, ask for cooperation, and ask for an agreement to follow guidelines. If the person agrees, fine; if not, reconsider the invitation.

Example

• The planning group from Pittsburgh was worried that a potential invitee might not be able to be objective at the meeting and decided to discuss it with the individual ahead of time to express their concerns. The person agreed to follow the guidelines, was invited, and only had to be reminded once that “a dialogue is not a debate, and every person’s opinion is valid.”

Pittsburgh
“. . . a dialogue is not a debate, and every person’s opinion is valid.”

Finally, the Pittsburgh dialogue raised the question regarding the presence of observers. It was clarified that all participants should be full participants, not observers.

The Invitation Letter

An invitation should be sent well in advance of the dialogue.

For a Roundtable Dialogue, the letter is sent to individuals who have been pre-selected by the committee. The letter should specify pertinent information.

• Who — The name of the sponsoring organization
• What — The event (title of the dialogue)
• Where — Location of the event, including, address, phone number, fax, and e-mail, if possible
• When — Day, date, and time
• Why — Objectives, specific goals for the meeting

Make sure to mention if there are any costs involved and whether meals are included. Request that casual clothes be worn. Also, ask if there are any special needs requiring accommodation. After all the pertinent details of the event are given, an RSVP should be requested with an expected date of return.

For a Conference Dialogue, an initial notice should be sent to mental health agencies, selected individuals, and other facilities to alert them about the upcoming dialogue. Later correspondence will include a brochure that provides more detailed information (See illustration of a brochure in the conference section).

Plan Meals

Meals are an important part of the dialogue. Plan meals that keep the group together so that people can socialize with each other and network to exchange information. Participants should be told in advance that meals are part of the dialogue.

Selecting Foods

Continental Breakfast

Coffee, juice, muffins or sweet rolls. Make sure there are selections with little or no sugar such as fresh fruit. Set a cutoff time for coffee in order to minimize distractions during the dialogue.

Buffet Style Lunch

Simple foods such as sandwich ingredients, cut-up vegetables, finger foods, and salads are good choices. Make sure that vegetarians and people with special diets are accommodated, including persons with religious restrictions. A choice of beverages may include iced tea or lemonade.

Food Preparation

Food can be prepared at the dialogue if the site includes kitchen facilities. However, make sure that participation in the dialogue is not compromised by persons who are involved in food preparation, and that the kitchen is far enough away from the dialogue to avoid distractions. A special committee may be appointed to take care of the food and all of the tasks involved. Another option is to have food prepared in advance and delivered.

Use Volunteers

Recruit volunteers from the invited participants to perform a variety of tasks. This maximizes participation and helps to make participants feel like they are an important part of the planning process. Volunteers can help prepare food, design a brochure, set-up rooms, greet, video or audiotape the conference, keep time, etc.

Note

Use consumers as volunteers whenever possible. Try to pay stipends for performing a variety of tasks. Be creative . . . use volunteers as photographers, “taxi drivers,” ushers, etc. We call stipend volunteers “paid volunteers.”

Technical Considerations

Flip Charts

• Write in bold capital letters
• Use dark colored ink
• Number each page for reference
• Use colors for highlighting
• Keep one idea heading per page
• Post on walls for easy reference
• Pre-cut masking tape and put tape on sides, not top, to remove it easily

Video/Audiotape: “To Tape Or Not To Tape”

Roundtable Dialogue

Videotaping and audio-taping is discouraged in a Roundtable Dialogue because participants may not be as open or honest in their discussions. However, a Roundtable Dialogue may be audio-taped only for the purpose of documenting minutes for a summary report.

Conference Dialogue

Videotapes or audio-tapes may be made of speakers and panelists at a Conference Dialogue, but the small group dialogues should never be taped. Assign someone to keep track of when to change the tape and to make sure the tape player is near the microphone. Give the task to someone who has experience with the audiovisual equipment.

Note

Be sure to have signed consent forms for anyone video or audio-taped.

Example

• Dialogues were videotaped in the state of New York between psychiatrists and consumers and they were used as effective training tools. However, a key organizer, Darby Penney, New York State Director of Recipient Affairs, stated: “ . . . the discussion may have been freer and deeper had they not been taped. There was one of our six sessions that was not taped, and my sense is that conversation was much more intense and dealt with more difficult topics than the others.”

“ . . . the discussion may have been freer and deeper had they not been taped.”

Name Tags and Participant Packets

Hand out name tags at the beginning of the dialogue. Name tags can be purchased or made by hand with an artistic design. Cardboard place cards
are also important at a Roundtable Dialogue. Place cards can be labeled with names and placed ahead of time in order to diversify seating arrangements. Participant packets can provide all participants with information pertinent to the dialogue, such as dialogue guidelines, agenda and a list of participants.

Participant Packets May Include:

• Dialogue guidelines
• Agenda
• Blank paper
• Pen
• Acknowledgments
• Resource articles
• Brochures of local programs
• Names and addresses of all participants

The Evaluation Form

. . . Don’t Forget!

Reasons for evaluating the dialogue:

• To determine whether the dialogue was helpful
• To identify areas of improvement'
• To assess the effectiveness and whether to continue

Design a one-page form that is user-friendly and simple with carefully constructed questions for the information needed. (See samples in “Attachments”)

Establish a rating system, with five choices (1–5) that designates excellent to poor.

Include open-ended questions with adequate space for comments and suggestions.

Ask questions like: What did you like best about the dialogue? What did you like least? What suggestions do you have for improvement?

Rate the Following:

• Overall presentation
• Facility/location
• Food and service
• Facilitators and speakers
• Topic relevance
• Pacing
• Start and finish time

Give attendees the option of not revealing their names and addresses. This option encourages candid responses since people write comments more freely if they do so anonymously.

Collect forms at the end of the day.

Note

Do not give people the option of sending forms back since they rarely do. In order to ensure that evaluation forms are completed, announce their importance at opportune times during the day and request that people return them before leaving.

Time Limits and Time Frame

In a Roundtable Dialogue, set specific time limits for the introduction and for the closing session.

A Conference Dialogue must have carefully planned time frames for each section of the day and for speakers and panelists.

Designate someone to be the timekeeper who will use a stop watch or timer.

The timekeeper will need to present information such as, “We have about two minutes for each person. When you hear the bell or see the signal that your time is up, please try to finish your thought quickly, so that everyone has a chance to speak.” If presented correctly, even those people who dislike time limits may like the challenge. Individuals may get a chance to laugh at themselves if they start to go over the time. The group can laugh with them.

Ending Dialogues

Both dialogues should end with spontaneous comments from participants.

In a Roundtable Dialogue it is called “Round Robin,” for which an hour is allowed for final comments.

A Conference Dialogue ends with “Open Mike” (microphone). Both of these methods are explained in more detail in their respective sections.

Facilitation

Select the Facilitator

Dialogues are interactive and participatory events. They rely on effective facilitation to promote participation, stimulate interaction, and summarize information. A skillful facilitator, therefore, is a major player in the success of a dialogue.

Choose a facilitator with the following qualities

• Energetic, enthusiastic
• Good active listening skills
• Able to be neutral on sensitive issues
• Previous experience
• Preferably a consumer

Consider the Following

• Whether to use a person on the planning committee or someone outside of the planning process.
• Whether to choose a person not associated with your mental health system to ensure total neutrality.
• Whether or not to select a consumer or professional. One possibility would be to utilize a facilitator and a co-facilitator — one a professional, and the other one a consumer.

Use Co-Facilitators

Two facilitators can share roles and responsibilities. However, one person should take the lead. A co-facilitator can take over if the lead facilitator gets stuck, or if the group becomes stagnant. A co-facilitator can also add information or clarify points being made. Another role may be to record suggestions on a flip chart, serve as timekeeper, and be available for any unanticipated situations that may arise.

The Role of the Facilitator(s)

The facilitator(s) role involves each of the following tasks:

• To create a safe, open, trusting and supportive environment for all group members.
• To guide the group activity and discussion.
• To keep the channels of communication open.
• To sense moods and feelings within the group.
• To keep the group focused.

Directive, Participatory or Non-directive Facilitator(s):

A Directive Facilitator — Asks prepared questions and keeps the discussion focused on those questions.

A Participatory Facilitator — Starts the discussion by reminding the group of the goals and objectives of the dialogue, then invites suggestions on how to proceed as a group, as well as on the specifics of what will be discussed.

A Non-Directive Facilitator — Declares the discussion open, sometimes acting as a “gatekeeper” like the participatory facilitator. He/she will only be involved directly in the discussion when it gets too heated or if there is more than one person talking at the same time.

A good facilitator uses all three styles at different times, and will know when to apply each one. The group that is tightly reined will be less creative, and if too unstructured may lose focus and will not be cohesive. The facilitator who is most effective is eclectic and intuitive to group needs.

A factor in facilitation style may be determined by the particular group and the goals of the dialogue. It may be appropriate for the facilitator to interact as a group member if it is decided the group will benefit.

The facilitator’s primary role, however, is to manage process and time. While doing so, the facilitator should allow the group to direct itself as much as possible, and only introduce new topics to keep the discussion flowing in a positive direction.

Facilitator Top 10 Tips:

1. Greet participants when they enter the room.
2. Acknowledge suggestions.
3. Use names of participants as often as possible.
4. Watch out for your own biases.
5. Avoid interrupting.
6. Allow the group to solve problems.
7. Maintain eye contact.
8. Give positive reinforcement.
9. Recognize sponsors.
10. Remember, this is their show, not yours!

Facilitator Pitfalls:

• Not managing monopolizers.
• Talking down to the group.
• Not finishing on time.
• Telling a flat joke!
• Using sexist language.

Start the Roundtable Dialogue

Welcome Everyone

• Tell a joke or anecdotal story.
• Brief group members on the purpose and objectives of the dialogue.
• Acknowledge individuals who planned the dialogue.
• Give recognition to sponsors and underwriters.
• Review housekeeping information, including location of rest rooms smoking areas, time for lunch, and ending time of dialogue.

Introductions

The facilitator should start the introductions so that participants will feel comfortable with him/her and serve as a model for others when it is their turn to introduce themselves.

Information requested may include whether the person is a consumer, family member or provider, job title or employment, advocacy affiliation, whether they are a parent, or grandparent, and where they live, or other pertinent information.

Set time limits for participant introductions (three minutes each for a 20-person dialogue).

Present Conduct Guidelines

The following guidelines should be observed:

• Be considerate.
• Be able to consider new ideas.
• Avoid professional jargon.
• Feel free to ask any questions.
• Have fun!

Ask the group if they have any other guidelines to add.

Set Agenda

Pre-selected topics or focus questions should be presented to dialogue participants for their approval or modification. The group should approve the focus questions, make minor changes, but not alter them entirely.

• Allow a limited amount of time for modifications.
• Usually the initial topic is first-person stories and narratives.
• Set approximate time frames for all topics.
• Make sure to allow time for future planning and closing.
• Set times for breaks and lunch, and ending time.

Maintain Flow of Conversation

While the dialogue group session is taking place, it is the job of the facilitator to maintain the flow of communication within the group. In order to do this, the facilitator should use the following techniques:

• Building/Crediting — Add to others’ ideas or suggestions. It can include picking out from what everyone says and adding additional clarification.
• Encouraging — The facilitator should be friendly and responsive to members and their contributions and make positive, genuine, reinforcing statements about participants’ input.
• Harmonizing — Encourage people to explore their differences and appreciate each other’s point of view.
• Clarifying — Clarify vague statements, as well as offer facts or relevant information about issues being discussed. This technique can include answering questions, interpreting or reflecting ideas and suggestions, or giving and seeking information to clear up confusion. At the same time, the facilitator should avoid interrupting or speaking too long. Interruptions may be necessary only when a person has talked too long or has strayed from the subject.
• Summarizing — Summarize statements made by members of the group. These summaries generally recap what has been said or covered; pull together ideas that are related, and identify areas of agreement. A summary can also restate suggestions after the group has discussed them.
  
• Motivating — The facilitator is expected to keep the discussion process flowing. If the group becomes stagnant, he/she can change the direction of the dialogue, suggest a break, or ask the group where it wants to go next. The facilitator can also introduce a new topic. It may be necessary to restate the goal or purpose of the discussion session. If the group reaches a consensus, acknowledge it, and move forward.

Deal with Conflict

As group members interact, it is likely that their perspectives will clash or contradict. This contradiction can create conflict within the group session. It is the job of the facilitator to evaluate this conflict and determine if any intervention is necessary.

When assessing conflict, the facilitator should consider these key points:

• Allow a reasonable amount of subject-related conflict. Such conflict is healthy for the group.
• Encourage the group to thoroughly weigh, explore and examine topics and issues, including conflict.
• Do not retreat from tension-filled situations.
• Minimize conflict among members on unrelated topics.
• Keep the group focused on ideas, not personalities.
• Remain neutral during disagreements. Avoid taking sides.
• Avoid being heavy-handed or too controlling.

Note

Recognize that controversy can spark creativity, promote growth, and build allies. Do not feel compelled to discourage or stop conflict immediately. Remember that feelings, emotions and conflict are legitimate factors in the dialogue process. It is important for the facilitator to recognize this from the start.

Stick to the Agenda

Stick to the planned agenda as much as possible. When you see that participants are ready to move on, go to the next agenda item. Sometimes the dialogue will take on a life of its own, but the facilitator should remind the group that there are topics still to be discussed.

Future Plans and Strategies

The last portion of the dialogue should be used for creating strategies and initiatives and making future plans:

• Take all suggestions and place on the flip charts.
• Allocate at least one hour for strategizing.
• End with a challenge.
• Ask everyone to commit to a task.
• Prioritize suggestions.
• Write participants’ suggestions on the flip chart.
• Make plans for reconvening if the group decides to do so.

Record the Dialogue

Designate a person to record minutes of the dialogue which later become the summary report and/or documentation of the meeting. It is important that the draft of the report be read and approved by all of the participants before being put into final form. When recording:

• Respect confidentiality when taking notes.
• Do not tag responses with participants’ names.
• Do not feel compelled to note everything.
• Be concise, brief, and summarize.
• If a consensus is reached on a topic or suggestion, record the item.

Conclude the Dialogue

The Round Robin is the final portion of the Roundtable Dialogue. Allow an hour at the end of the dialogue for last-minute comments, suggestions and expressions. Instruct each person to take a turn around the group to provide input, but make sure to state that people can pass.

Timekeeping is particularly important during Round Robin. First determine the total amount of time remaining in the dialogue. Then divide that time by the number of participants so that each person receives an equal amount of time. A timekeeper will keep close tabs on each person.

After the Round Robin, show appreciation for everyone’s participation. The closing remarks are sometimes very personal and reinforce connections between people, making the day a memorable one.

Conference Dialogue

This section describes the particular steps that need to be added to organize a Conference Dialogue.

Selecting Participants

• Approximately 50–150 people.
• Use the same criteria as for a Roundtable to select participants.
• Ask mental health agencies to select participants after receiving a letter and brochure that includes the number of slots allotted.
• Send individual family members, consumers, and advocates separate invitations.
• Invite public officials and dignitaries.

Note

VIP guests should be full participants but may not be able to stay for the entire conference.

Planning

• Planning takes at least four months.
• The core planning group may add special subcommittees for tasks.
• Early in the planning stages inform mental health constituents about the conference for their information and involvement in planning.

Dialogue as Training Day (Inservice):

Send Letter and Brochure

Two months before the Conference, send the first letter of invitation to mental health agencies, organizations, and individuals. The letter should be written on agency stationery and signed by the executive director.

The letter assigns a specific number of registration openings for each agency proportionate to its size. Request that mental health consumers be included, as well as persons with different cultural backgrounds and other diversities.

The Brochure

A brochure should be enclosed in a second letter to be sent to all invitees one month before the Conference. The brochure should include all of the factual material. It may include art work and illustrations that are appropriate to the theme of the conference.

Include a registration form in the brochure that will be returned in order to pre-register all participants. For expediency, agencies may fax or e-mail back the names and titles of the participants. Individuals can mail their registration forms or could also fax or e-mail them. When all names are in, compile in categories in order to prepare the dialogue sessions in advance. (Please note that advance preparation of the dialogue sessions is optional).

For an example brochure, see “Attachments.”

Brochure Should Include:

• Title and theme
• Date, time and location
• Purpose/philosophy
• Information about the conference
• Goals and objectives
• Cost, if any
• Conference coordinators and guest speakers
• Conference agenda
• Who will attend
• Registration form
• Sponsors and funding agents
• Names of planning committee
• Phone contact for additional information

Using Speakers

A Conference Dialogue includes a keynote speaker and two sets of panelists (for a one-day conference). A keynote speaker talks for no more than 30 minutes, panelists are given 15 minutes each for a panel of four.

Steer away from long introductions and formal recognitions that distinguish speakers from other participants in the audience Treat all participants as equals.

Preparing the Small Group Dialogues (Optional)

Allow two hours to organize the small group dialogues. This can be accomplished by a small sub-committee. The committee members must be familiar with the local mental health community professionals and consumers in order to pre-set the small groups.

Assign approximately 20–25 (preferably 20) participants to each group. More than 20 individuals is difficult to manage, however you need to allow for people who leave or do not appear. It is essential to know, in advance, how many breakout rooms are available in order to determine the size of the groups.

Gather all of the names of pre-registered participants. Although there will be people who do not register in advance, it is essential to know most of the attendees’ names and affiliations in order to create a balanced group of participants for the dialogue sessions.

Sort participants’ names and arrange them according to status, providers, administrators, family members, therapists, psychiatrists, etc. Be sure to include people at all levels of work experience, i.e., front line staff, volunteers, etc. Ideal groups include diverse participants who have different perspectives on mental health issues.

Designate a different color or symbol for each group. A designated symbol or color is attached to the participants’ name tag the day of the dialogue. Participants will be given instructions on the location of their group session corresponding to the symbol or color.

Make a plan for the break-out groups. It is recommended that people stay with the same group for each dialogue session.

Choosing Facilitators

A facilitator and co-facilitator should be selected for each small group dialogue.

Ask the panelists to serve as facilitators of the small group dialogues in order to provide continuity and expansion of ideas that were presented. Panelists generally have the necessary skills, but be sure to offer them the facilitator guidelines.

Persons chosen to be co-facilitators should include a mixture of consumers, professionals, and family members.

Guidelines for facilitators should be developed and enclosed in their packets. It is desirable to offer facilitator training prior to the Conference Dialogue. Skills should include active listening, dealing with conflict, redirecting, and leading the group toward consensus. Role playing situations can be helpful.

The Day of the Conference Dialogue

Documentation

Registration

Registration materials, cash drawer (if applicable), name tags, participant packets, etc. should be assembled, and ready for distribution at the earliest registration time. Allow at least one half hour for registration prior to opening ceremonies.

Registrars should be well informed in order to answer questions.

Assign one registrar for persons who come to the conference without pre-registering.

Serve refreshments during time of registration in an area that will not interfere with the conference. Make sure to establish a cut off time.

Welcoming Remarks

The conference coordinator should welcome all participants, state the theme of the dialogue, review participant guidelines, and set the agenda for the day. The coordinator usually introduces the keynote speaker.

Keynote Speaker

It is desirable that a consumer be the keynote speaker whenever possible, either an out-of-town guest, or a recognized individual from the local community.

First Panel

The first panel takes place after the keynote speaker.

Typically the first panel includes first person narratives and stories from the perspective of consumers, family members, and providers. All panelists must be given careful time limits (10 to15 minutes each for a panel of four). It is essential that the panel not exceed an hour in order for the dialogue sessions to have enough time.

First Dialogue Session

All participants go to their assigned room. The facilitators start the group with first name introductions and present the subject matter which relates to what was discussed by the first panel. The small group dialogue is conducted in the same manner as a Roundtable Dialogue. However, discussion will be limited by time constraints, therefore limiting the scope of discussion.

Flip charts should be used to place suggestions and other feedback. At the end of the session, one of the facilitators will be responsible for transcribing flip chart information to a report sheet which is given to the conference coordinator.

Lunch

Time allotted for lunch should be long enough to allow time for networking. An art exhibit and/or book display table would add another dimension to
the conference. It may even be desirable to have entertainment presented by local consumers.

Second Panel and Dialogue Session

Timing is important. The conference coordinator should pull everyone together for the second panel discussion. The second panel usually focuses on problems, barriers, and solutions to current mental health issues.

Open Mike

The Open Mike session for a Conference Dialogue is a final feedback session conducted with the entire group.

A pre-appointed emcee moves about the audience with a microphone and encourages people to get involved. A good emcee will know how to encourage people to come up and speak in front of an audience.

Participants should be told they only have one-to-two minutes to speak. The emcee will inspire the audience to express themselves spontaneously with comments ranging from serious to humorous. Subject matter could include thoughts about the conference, suggestions, personal anecdotes, jokes, poetry, songs, etc. It is always nice to end Open Mike with an inspirational thought or song.

Ending the Conference

End the Conference Dialogue with an expression of appreciation and final acknowledgments.

Collect evaluation forms. In Palm Beach County, Pioneer Dialogue, 1999, the coordinator announced at different times during the day, “We have certificates of attendance for everyone to receive, but you will only receive one if you fill out the evaluation form.” Everyone did.

Certificates of attendance are a nice reward and can be given out as participants leave the conference.

Attachments

Sample Brochure for Conference Dialogue

This sample is of a tri-fold brochure printed on two sides.

front side

back side

Sample Evaluation for Conference Dialogue

This sample is of a one-page evaluation, printed on one side.

Sample Agenda for Conference Dialogue

This sample is of a one-page agenda, printed on one side.

Appendix A

What Happens After the Dialogue?

One way to measure the success of dialogues is to note what happens afterward. A good dialogue is one that results in concrete plans for the future, incorporating the suggestions received from the dialogue participants. All of the suggestions should be reviewed and prioritized in order to develop action plans. Each community’s needs are different. Recommendations may include requests for more dialogues on special issues or with different groups, or plans for new program development.

Some Results from Pilot Dialogues

In Pittsburgh, participants’ suggestions included plans to hold all-day dialogues in ten other counties in Western Pennsylvania, as well as follow-up dialogues on topics such as managed care. Participants at the 1998 Dialogue requested that family members be invited to future dialogues, as well as a broader group of consumers. Other goals focused on the need for consumer sensitivity training in professional educational programs, particularly for medical residents. It was suggested that consumer-run drop-in centers be used for visitation and on-the-job training. It was also recommended that a set of “best practices”, describing quality programs and consumer groups be catalogued for professional use. A written report of their first dialogue was sent to major stakeholders in their county system. Proposed plans will be implemented in the next year. In the meantime, people still talk about the dialogue they attended.

Palm Beach County made plans for dialogues and trainings (some of them related to legislative issues) as a result of their conference dialogue. Letter writing campaigns were underway during an election year and a training session was held for consumers to inform them about candidate’s issues and ways to respond. It was decided that “Pioneer Dialogue” would become an annual conference each year to focus on a different aspect of their mental health system. Other recommendations included the need for increased consumer involvement in district planning and enhancement of their drop-in center, “Peer Place.” Participants who attended Pioneer Dialogue from nearby districts took an interest in the conference, and are making plans to organize their own.

At the national level, dialogues are being held between consumers and different professional groups, i.e., psychologists and nurses. A dialogue with children is being considered, with special regard for confidentiality issues. This Manual is one of the outcomes from a recommendation made at the 1997 dialogue between psychiatrists and consumers. Other recommendations were to establish possibilities for more communication and shared endeavors between psychiatrists and consumers, to replicate dialogues at the state and federal level, and to improve access for consumers in different parts of government and managed care. Some of these issues are being worked on and are at various stages of readiness. As one participant at the national dialogue said: “Success is a journey, not a destination.”

What About Partnerships?

One of the goals for dialogues is for partnerships to be created between diverse groups to develop and conduct dialogues. The question is whether partnerships after the dialogue are sustaining.

Depending on what is meant by partnerships, too high expectations may not be realistic. Differences that existed prior to the dialogue do not automatically disappear. People’s attitudes will hopefully shift to some degree, but it must be considered that persons with different perspectives usually have different work and life experiences. Consumers who are developing new self-run programs rely more on life experience than professional degrees. Providers, on the other hand, are required to hold licenses that dictate mode of treatment which limits flexibility. Both groups have certain vulnerabilities. While professional providers are concerned with risk factors and liabilities, consumers worry about being co-opted into adapting to medical model practices.

Positive partnerships then, might be defined as learning partnerships in which both groups agree to continue the dialogue and plan activities that are mutually beneficial. This may include working on strategies to follow up on recommendations or training on subjects that are helpful to both groups. Informal gatherings that bring people together socially will also help to break down barriers. Full partnerships will occur because people want them to and when they are ready. Full partnerships are like any other relationship. They are chosen. They are trusting. They treat each other as equals. In the mental health arena, this will take time and work. Dialogues are a good way to start the process.

Appendix B

Other Dialogues

Internet Dialogues

Computer-mediated communication is a new dialogue technology. Electronic mail — e-mail — is less formal than usual written exchanges and less textured than in-person dialogue. E-mail is forgiving of punctuation and spelling errors and typos. E-mail is intolerant of affectation and tends to ignore pedigree. E-mail substitutes for nonverbal communication, not usually with literary expression of mood and affect, but more often with icons: for instance :) for smile, or <grin>. Those who like to use voice and presence and non-verbals to communicate are not always comfortable.

Computer-mediated communication generally takes place on a neutral and level field. Feedback is quick; gratification is frequent. People Who have-not can use free e-mail from their public library on equal footing with e-mail from a mental health program director. Rural areas without even cheap local phone service can
use wireless, satellite links and Web TV. Third world countries, newly wired, are installing state-of-the-art infrastructures.

People Who experience mood swings, fear, voices and visions (People Who) have found each other on the Internet through news groups, Web pages, and mailing lists. They have found support, mutuality, and advocacy for system change. They have found relief from the loneliness associated with seeming different, cutting edge medical information, and quick error correction of bad data. They have found a range of views about psychiatric disabilities, from iatrogenic to disease.

People Who have also found the mental health professionals online. There are a large number of professionally oriented mailing lists — for instance about forensics, psychopharmacology, managed care, outcomes; some welcome People Who as a valued resource, some open the lists only to professionals.

Exchange with a mental health professional by e-mail has a different tone from in-person exchange. The territory is neutral — one's own computer screen rather than a therapist's private office or a mental health director's conference room. The Person Who can take whatever space and time is needed to express a point of view, can set the context of the response by excerpting from a previous message, can readily provide supporting ideas and evidence that the professional might not have considered. Those in conversation are not limited by having to share a fixed amount of time, are not limited by having to stay focused on the topic, are not limited by the inherent power imbalance between professional and Person Who.

People Who dialogue with peers about work opportunities, and advocacy and rights issues, and about managing the situations that earned them a psychiatric label. People Who dialogue with professionals about advocacy and rights issues, especially forced treatment; and about DSM diagnoses, prognoses, and psychotropic medications, and especially new treatments.

People Who read news groups like alt.society.mental-health, sci.med.psychobiology, alt.support.depression, alt.support.anxiety-panic, alt.support.loneliness, and soc.support.depression.family. Moderated news group discussions stay focused. Many unmoderated people like to post to unmoderated news groups, and opinions are apt to be polarized.

People Who visit the many mental health information Web sites. Generally this is a one way exchange — the visitor reads what is provided, perhaps makes a comment to the Web master. Some Web sites provide chats and have some interaction. Some Web sites are actually run on bulletin board software and have more interactivity.

People Who use Internet Relay Chat and other chat software and situations to join in synchronous exchanges with each other and with professionals.

Managed care companies and public health providers are beginning to use modem technology to provide patient management and support.

And then there are lists. There are lists for moods — Walkers (melancholy), Pendulum (mood swings); for voices and visions — Schizoph; for advocacy — Act-Mad; for safe support — ClubMad; for spirituality — MadSpirit; for working as a consumer mental health professional — TwoHats; for state-specific issues — MHCONSUMERS-OR. The exchanges are international, asynchronous, and vigorous. Some lists generate upwards of 100 e-mail messages a day. Content varies from humor, to dismay about psychiatric labels and public images, to reviews of newly released DSM's, to newspaper articles. Some participants post a reply to almost every message they read; some only read. Internet lists help to realize the slogan of the South African anti-Apartheid movement: "Nothing about me without me."

The MADNESS list states, "We bear witness each to our own experience with madness, to how we have been treated, and to the social consequences we have felt. We bear witness to the common vision and aspirations of People Who experience mood swings, fear, voices and visions.”

Lists are effective organizing tools. SAMHSA/Center for Mental Health Service organized a Walk the Walk: With Lives Touched by Mental Illness in May 1998. A hundred Internet users planned ways to participate on a list devoted to the Walk. Australia and Canada planned parallel events, as did some other United States cities. Posters and symbols were devised and posted on the Web, the message People Who desired to communicate was hotly debated and finally agreed, and press releases were drafted and distributed. Now it seems there is new momentum among those consumer/survivors wanting to make improvements especially in public mental health systems.

People Who are politically active have found support for resistance to involuntary treatment and resistance to unconsented electro-shock, as well as encouragement for Advance Directives, support for including independent grievance procedures in managed care contracts.

Appendix C

The Recovery Dialogues
A Personal Reflection and a Cautionary Note