3.6 Mia Kurtti - it took 15 years

In this episode Gareth and Fiona are joined by Mia Kurtti, who has been working at the heart of what we now call Open Dialogue as it developed in Finland. We ask for her reflections on how this way of working came about and how something that originated in rural Finland can be translated to British shores and embedded into the NHS with our diverse urban populations.

POD at Central and North West London NHS Foundation Trust

Fiona Eastmond | LinkedIn

Transcript

Narrator 0:11

Welcome to season three of open POD pod. My name's Fiona and I'm an open dialogue practitioner, just beginning to develop some hours of practice.

Gareth 0:20

Hello everyone, I'm Gareth Jarvis, I'm the medical director of the adult mental health services at Central and Northwest London,

Narrator 0:27

we'd really love it. If the things that we talk about in this podcast, Could sit alongside any learning that anyone's doing about open dialogue.

Gareth 0:35

Welcome everybody. Fiona and I have a very special guest today. We have Mia Kurrti joining us from Finland, from the Tornio Open Dialogue team. perhaps Mia, you'd like to introduce yourself first.

Mia 0:49

Yes, well, thank you so much for inviting me. it's very exciting to be here. so yes, my name is Mia. I have been working in healthcare from the mid 90s. that's quite a long time ago, since I started. and I have been working in Western Lapland, healthcare system from 2001. I've been working there as a psychiatric nurse, also as a manager in the services. during the last 10, 15 years, I've been doing quite a bit of training and supervising in different countries. as a trained, trainer for family and couple psychotherapy and open dialogue. and during the last few years, I have been off from work. I've been doing some more studies in Helsinki University on social and public policies because I was part of the process in collaboration with the World Health Organization, WHO, when they were creating The guidelines for good practices some years ago. So we were developing the part that was describing the services. in Western Lapland for Open Dialogue. And that was really powerful process for me as well, to get more familiar with the ideas around human rights. And yes, so that was really, and then there was a COVID pandemic time, my daughter moved away from home, you know, all this middle life crisis stuff. So I've been doing something different for the last two years. my primary. task and work at the moment is the training and supervising, which is very inspiring and humble making work.

Gareth 2:41

Maybe we could start there, actually, of thinking about you as your role as a trainer. Because that's how I first encountered you, was when you came across the UK to help with some of the training that I was attending. from your perspective, what are key things that people need to understand about open dialogue as they enter into it for the first time?

Mia 3:03

Well, I think, the way I started my work as a trainer wasn't actually that I was thinking that I was doing training or offering training. It was more about. Introducing, our work and inviting people to, because that was one of my roles in Western Lapland to organize the international meetings when people came there to learn from the work. And of course, that was also learning for us as well. But I wasn't thinking that I was training open dialogue for people. It's more, and this is the core thing for me when doing trainings and supervisions, that how do we go into the spaces, in different roles when we are training or supervising? Is it about telling people? about something or is it about inviting people to learn together and explore together that, that kind of, what is important to us from where we come from? Because I think that when we are talking about training in general, no matter what it is, and for example, open dialogue, I think it is definitely more than implementing something.

Gareth 4:14

Um.

Mia 4:14

Uh, It is the same as it is in so called treatment that we don't do open dialogue. It's about the process. It's about the dialogue where we are co creating something together.

Gareth 4:28

Yeah.

Mia 4:28

that is one of the main things when I think about training open dialogue that First thing that we need to do is really to be curious about all participants kind of reasons to be there and the reasons to develop the services, what are the challenges there? Why they think, what do they need to change in the service delivery system? Because as you know, In the eighties in Finland, it didn't start. So that people started to think that now we are going to do open dialogue. It was about what do we need to change in the system? And it took 15 years until the words open dialogue were used. So it's about the dialogue in the training process to And I don't know, was I responding to your question even, but that's where I went when, when you were asking that, that what are the first things people need to understand about open dialogue? Well, then I would also say that, it has at least the three Dimensions into it, the service delivery system itself, how do we organize the services to support the dialogic practice and that is one dimension, the dialogic practice itself, the network meetings, how do you build a process with the person, in the center of care, with the network, with other agencies. So it has all these dimensions and then the last one, of course, the worldview. How do we see the suffering in humanity? If we have medical ideas, if we are embracing that, diagnosis or not, and all these questions that can be conversations that can be very heated sometimes. So how do we have all those voices in the room? Because we are, after all, working in a healthcare system, in that context where that language is used very much and those concepts.

Gareth 6:32

I I really found what you were saying about, inviting, someone to be part reflecting where they're coming from as part of the process. And that's actually every time you'd enter into a conversation about training, that it is a co production. It's going to be something new each time, which feels like it very much mirrors for me, the process that we would do within an open dialogue setting when we're working with people, we're trying to help. So this is something about trying to model, what we, ultimately want to see people, how we want them to be. with others right from the beginning.

Mia 7:10

Yes. And that is many times, there is the kind of, Tension lies in between that, that we need to be understanding. I'm talking from the, if I put my hat on, where I'm a nurse working in a system, I need to understand, what I'm supposed to be doing when I come to work. I need to be understanding the premises there are, from the leadership, from the society. I mean, things need to make sense to me. That I'm able to trust, that I'm able to relate with people I'm working with. I'm able to relate with people who are conducting the services. how that space is provided for people, for them to make sense what they are trying to do. And then there are these societal frames, kind of demands from the people, from the families. From the organizations, there's lots of tensions. so how to navigate, in there, I think it's a huge question all the time for all the people who are working in the systems and people who are navigating when they are trying to have support and help.

Gareth 8:27

So you were mentioning that it took about a 15 year process for this way of approaching mental health care to emerge and you joined the team in the sort of mid 90s. What are your recollections of where things were at that point and how did it continue to sort of iterate and develop?

Mia 8:47

Well, from the mid nineties, I was working in elderly care in Finland, and then I went to actually to India to work there as a volunteer worker. I went to Keropudas, the Western Lapland, first time in 2001. and in that time, there was a lot of very positive energy It was only a few years back when they got all the good results From the research. So they were really bringing these ideas to all the parts of the organization. my main work or most of the years that I spent in 2000 was in adolescence and children's services. Outpatient setting. on that time, we got funding from the government and we started to build the services from the scratch by discussing, with the agencies in the area first, what has been done so far. So it was really not only psychiatry developing the services on their own. It was really in collaboration and co creation with the. Existing services. there was this very strong culture from the early eighties with discussing with the families. we didn't have the term peer or the service user in that time. It was very simple. the kind of procedure was, transparent and simple by asking from the families and people all the time from the eighties that, how is this working, what we are doing In network meetings, as you know, we are always asking that are the other things, how is this going for you? And are the other things we should be discussing kind of checking all the time, especially in the beginning of the process that what is required here. And also when we had the research processes, so people were used to this transparency that we are asking all the time how we are doing and is this working what we are doing, but also People are seeing that staff is asking from themselves, very critically also at many points, that, are we doing the right thing? So this whole atmosphere was there when I went there and we started to develop the services for the adolescents and children. And of course, the very big emphasis on training. I was taught very early on, That psychiatry can be humane and should be humane, and we need to, instead of, opposing psychiatry and mental health services, we really can change the way people are met there, Birgitta Alakare, who was the lead psychiatrist for decades there, always said that we can change. And the problems that are there at the moment, the overuse of medication, overuse of hospitalization, and all these problems that institutionally, the institutions are providing as we know, the closed systems. she said always that we have known these problems from the very early on from the 70s and 80s. So that was the message for us new workers there back in the days.

Gareth 12:28

You mentioned Brigitte, Mia, because she always seems to be a key figure that comes up in the stories of when I speak to people from the team in Tornio. And unfortunately, she's no longer with us. And so I've never had a chance to meet her. But I'm just sort of curious about who she was, the person, her contribution to the team from your recollections.

Mia 12:51

well she was the psychiatrist and the trainer also in Open Dialogue and Family and Couple Therapy. And she was, one of her main things was that, the key features in her way of being was that she was always Doing the work, even though she had lots of responsibilities, on, administration level, but she always wanted to work with families and the teams. And one of the main things that she did was that she trusted. She trusted the workers, and that was of course, one of the key things when we think about the leadership in general, what are the tasks for the leaders? One task for them is that they trust the workers, of course, so that they are able to do the work. she always said to us that please trust the process. no matter how you do the mental health, work it's always challenging and difficult in so many ways. and she really trusted the networks and she trusted the power of relationships. She trusted the power of connection. So that was her, I think her main contribution was the trust that she was offering for us. And she was really building the frame and she said to us that you don't need to worry about the fundings or the framework of the work. I take care of those. So please continue the excellent work that you are doing here. But she was also very, critical and challenging We could trust that she could say when she was worried about something, and yet she was always very respectful, even though when she was worried about some of the things that might be happening in the processes.

Fiona 14:47

That sounds really like excellent management to me.

Gareth 14:53

I wonder if that's a helpful moment for us just to have a brief reflection, Fiona, about what we've been hearing so far. I found that, a really useful and interesting idea about actually, the trust that needs to be put in the staff by the leadership that following the process, trusting the networks, that the right answers will emerge from the conversations.

Fiona 15:16

yeah. What struck me was a, a feeling as Mia was saying that there was no need for the team to worry about. the funding and the frameworks and, that is a very relaxing kind of way to work. And the feeling that I got was just a little bit of relief, like kind of, ah, that sounds lovely.

Gareth 15:41

I guess one of the things I often think about with that is that those are sort of things outside of our zone of influence about, I try to, within my role to sort of try and influence where I can around this stuff, but certainly on the frontline team sort of area, it's often outside of our zone of influence. what I'm interested with within the pilot that we're trying to sort of develop in CNWL is the transitioning of the team away from this sort of micromanaged medical model culture through to a more open dialogue, way of working and approaching work and some of what Mia was talking about there about the, Spaces that were created for the team to reflect on their own practice on the way that their system was set up locally within that team. I was quite interested in there about what your thoughts around what are the essential ingredients for a team to be functioning in this way.

Mia 16:32

Hmm. Thank you. Oh, it's so nice to be reflected on. I really like this. and Fiona, when you were talking, when I was listening to you, I really remembered, one of the key things, when we talk about the trust is the circumstance in our everyday work where we need to tolerate the uncertainty and to be able to do that, we need to be held. By the leadership, and we need to be trusted because if there's no trust, the team doesn't have ability to tolerate the uncertainty. Uh, yeah. So, so that was something that really came very strongly to me. Gareth, can you say again that your thought around, Did you use the key elements of the team or?

Gareth 17:26

I said, yeah. So I guess one of the things that in the UK context, we, we've had emphasized through the training is this, these spaces for intervision. Which I think is a bit of a neologism that came in the UK space. And this idea that we have meetings on regular basis where the team come together and reflect on supporting each other around the work. that's been very different in each context. It's appeared in the UK, so it's something we're trying to navigate a bit at the moment as we're getting these teams to transition into that. So, I guess it was particularly in the thoughts around what spaces do you create within your teams for supporting each other?

Mia 18:09

Yeah.

Gareth 18:09

sort of

Mia 18:10

Well, one of the things that how we have been describing our way of being in Keropudas and what has been known also, for the outsiders, when, other people come from other parts of Finland to do internship, doctors or nurses or psychologists. Many of them usually know that our teams are very independent and the staff is very independent and autonomous because we don't have the system of psychiatrists. defining the situation and the diagnosis and the, and the crisis first. it is really the staff who is taking care of the process, from the beginning, based on this idea of, psychological and emotional continuity in the process. in the eighties and nineties, when we talk about the independency and about the ideas of, continuity of care, it goes back to the eighties when they had the research. And they were doing the research and when they were looking at the so called good outcomes from the first episode psychosis, the processes of those, and they were looking at the chart, the patient's, notes. Yes. So when they were studying those, They saw that in all those situations, there was a team, of practitioners. And as you know, from the early eighties, there was this policy that each individual, worker in the organization gets the three year, psychotherapy training for open dialogue, for the family therapy, which later on evolved more into a dialogic practice. and the work with the families and networks, but it was a family therapy training. So there was this idea that when people are trained, they are able to take the responsibility of the crisis and the team. So it doesn't require, and of course this was also connected to the worldview where the diagnosis wasn't required as a first thing before people could start to work, with the families and networks. That led to this situation where teams were working as a multicultural or the multi professional team, and the doctors were just one part of the team, as all the other workers too, and making their contributions in a needs adaptive way. Because as we know, diagnosis and medications and all the things that, psychiatrists, expertise cover, they also need it very much in the processes. But how that is done, and, as Birgitta was always saying, that everybody should have the training, including psychiatrists, that we can all take the role of facilitating the, dialogic and therapeutic processes.

Gareth 21:16

So we've got psychiatrists within this system, but they're just one member of the team. They're sort of alongside the others. They could be called upon for their expertise and input when they're needed, but they're not necessarily calling all the shots and setting the frame.

Mia 21:31

Yeah. That has been the core idea during the last, uh, yeah, 40 years. But again, I haven't been there now during the last years, and I don't know how the new, management is, has been kind of defining the roles nowadays.

Gareth 21:46

you described a multi professional background of these teams. Nurses and social workers and the therapists. What sort of,

Mia 21:54

it's occupational therapists, nurses, most of the staff is nurses, psychologists, social workers. in Finland, we don't have culture yet around peer workers.

Gareth 22:08

Mm hmm.

Mia 22:10

But we were actually one of the first organizations that started to develop, The peer training, 10 years ago, 2014, we started our first, Peer training. So nowadays they are also part of

Gareth 22:27

Mm.

Mia 22:28

not many of them, but, some people are working in our system.

Gareth 22:32

So you've got these multi professional teams of lots of different backgrounds that are trusted to lead their own work with the network, without necessarily needing the sort of inputs of, a psychiatrist or it doesn't have to be deferred to.

Mia 22:48

Yes, but of course, there's always a psychiatrist in each team.

Gareth 22:53

Yeah.

Mia 22:54

And it used to be so that there was a, it was following the same idea of the continuity. So there was one psychiatrist. as part of the team. So it wasn't changing, but nowadays when there's a lack of psychiatrists in, in many places in Finland. So it's, it's, there can be several different doctors visiting one person's process, but the core idea has been that there's this one psychiatrist who is part of the team and knows the team and they all know each other.

Gareth 23:28

so all those elements sound not dissimilar to what we would have in the UK, but a standard mental health team would have all those elements that you're describing, in terms of the professionals available. on a practical day to day basis, do you have meetings that you would come together to talk as a team?

Mia 23:45

When we talk about the unit,

Gareth 23:47

Mm.

Mia 23:48

come together, once a week, uh, to discuss about the different practicalities in the unit. In general, what happens here? What are the trainings available? Many practical things. Sometimes we were using the time to discuss about the key principles, the seven principles during sometimes maybe the tolerance of uncertainty was the thing that we were really discussing that how are we handling this at the moment here. Sometimes it was around the continuity. Or the immediate help, really the discussions in a general level about the organization that how do we, are we doing well here? Or do we need to discuss about the different details? and then we also have always the supervision. I don't like to work either, the word, supervision. So I understand your decisions to make it intervision. but the idea is to. It's basically that we have somebody outsider who is facilitating a space for us where we can discuss about the dilemmas and challenges we are facing. It can be, among each other. Because As we know, we are all humans, we get things, and all the things that take place in the organization and between the staff, of course, has an impact to the work that we are doing with the clients and citizens and the family. So we need to be facing them and discussing about the relational challenges we might have. for the supervision space, we can invite families, so we can discuss together there, we can have a network meeting there, where we have a reflecting team, so we can learn together about the work we are doing, families like it a lot, many times, they really appreciate to have a group of people offering their reflections to the process, in supervision, it's always professionals who are being assessed, not the family.

Gareth 25:56

I love that idea, the idea of actually inviting in the families to be part of the continuing developing space of the team feels very much in the spirit.

Mia 26:08

Yes.

Gareth 26:09

And I also love what, something else I drew out there from that was, that you have conversations about the approach and that the elements described within open dialogue, or the principles are kind of almost like an aspirational thing. And it's never finished. It's always a sort

Mia 26:26

never finished. I mean, never. It is. And, and the use of reflections, that's, that's something that we can talk on and on because from where I do my reflections, from is, is a constant conversation, of course, for all of us, where do I have my value base at the moment? for me. How is my private life contributing to the work I do? there's all these things that we can explore. And I think we have the ethical imperative to explore those things when we are working in mental health services and psychiatry.

Gareth 27:07

yeah. there's this, idea I've been playing with in some conversations with other people recently about. We are our most important asset and tool that we have in the work. We as ourselves, and therefore we have this moral obligation to continuously reflect and develop and refine who we are in the work.

Mia 27:30

Yes.

Fiona 27:32

I'm a bit curious about, an ethical imperative. An ethical imperative to use ourselves in the work is, Something I'm very familiar with as a peer worker. something that, I think professionals that I've been working with as excellent and amazingly experienced and compassionate, people that they are using themselves in the work is something that's completely new for them. So I was wondering if you could expand a bit on the ethical imperative.

Mia 28:07

I think, the first is, of course, the kind of, legislative, circumstance. Where in psychiatry and social services, we have, the power given by legislation to interfere. into people's spaces in many levels to their spaces and to their bodies as well. And when we are holding that kind of power, I don't think it's discussed enough at all. I don't think it's, acknowledged, in the educational, educational programs. Okay. Nursing, social, well, social work probably is, at least in Finland, acknowledging that more. but not in healthcare, because it is defined as treatment or as care. So, and I think the human rights, of course, and WHO has been focusing on this, in their latest work during the last few years, when they have been doing the new recommendations and guidelines. So, this is the kind of one dimension to it, for me. But then I think that, because we have had this in house training culture for decades, which has meant that we, as coworkers, we have been together in these processes, where we have been exploring our own family narratives, our own experiences, We have been experiencing how it is to be invited to trust. in those training programs? how does it feel to be invited to listen to reflections, what you have been sharing? so we are kind of practicing all of that and to have all those deep and private experiences of those processes have been significant, I think. And those are also contributing to the building of trust. Because of course, when I have been sharing my, history and my life events and my wounds with my colleagues, it is very different to go, and work as a team in a crisis. And it really sets up a very different level of tolerance of uncertainty because there's a deeper level of trust.

Gareth 30:40

I think it's probably one of those things, Fiona, that a lot of our teams, I feel like this is probably one of the biggest hurdles that they have to sort of move through or over. as they try and enter into a different way of working, is this idea of self disclosure, with colleagues of exploring self, that's so often set as such a firm boundary in the traditional way of doing mental health services in the UK, to have these very hard boundaries of no personal disclosure, of we're all very professional and we don't share of ourselves, we only share at a very superficial level. and I found this sort of repeatedly over the last decade as I've sort of worked with lots of different people now in helping them to sort of come towards understanding open dialogue. This so often comes up as a, Oh goodness me, that's such a leap for them to wave it off. But, but, I know from your perspective as a peer worker, that's different.

Fiona 31:44

I think it is a leap, but it's not a leap as far as you may feel it is. as I often say as a peer worker, there's a lot that I don't discuss. And there's actually a lot that I do discuss with my peer worker colleagues where we have that trust. The Office. At Argo House, when all the peer workers are in, it's a very, very different place from other office environments. And I say office, I also mean team environments. The things that we talk about that are usually to the work and relevant to ourselves are a lot more personal. We've got a higher level of trust. We understand that we all have backgrounds. We all have had experiences. there is something different about the level of trust between two peer workers and between a peer worker and somebody who has a professional background with years of experience, but that does actually depend how long they've known each other and how many times they've talked, really talked, it takes a lot of time to carve out those spaces and what we call intervision, supervision, talking really. Talking and listening is something that we've quite literally, I think, as NHS, over the past 10 years been taught not to do with each other. And I think we need to unlearn that. I feel like there isn't a process of learning how to do open dialogue. It's really a process of unlearning, selectively unlearning. the things that we now find are no longer of any use to us in terms of relating to people, relating to others, relating to people that we want to call patients, or people that are our colleagues, or indeed anyone across the organization. it's a sea change and it's not going to happen in 10 seconds. but we've started, we've started as we mean to go on. do think that teams could learn a lot perhaps from the levels of trust there are between great teams. This is not confined to peer workers.

Gareth 34:29

yeah,

Fiona 34:29

that I've worked in who love and trust each other. And there's something, and this may be a UK culture thing, because I do think there are cultural differences between the UK and Finland. And I find the teams that work best together have their intervision in the pub, but they go every week. They socialize together. and I guess I wondered, I suppose, in those two cultural differences.'cause I, I'm conscious that we are bringing something that developed in the Petri dish of Finnish culture

Mia 35:06

Hmm.

Fiona 35:07

into some, into not only a UK culture, but also, kind of horrifyingly and NHS culture. Even those two things sometimes fight. And I wondered if either, if either of you had any reflections on those, cultural differences of levels of trust, and whether the, the English stiff upper lip comes into it.

Mia 35:31

There were so many things that you were just saying, Fiona, that really kind of, stood out for me. I'm firstly thinking, before talking about the cultural things, I'm thinking about this, disclosure. the idea around, disclosure and what does it mean. And I think that, training is a very good thing. Place for people to, feel that because as we know, we are all individuals. For other people it might be easier to bring in something more private in the process of care, in network meetings. But we need to be able to try that out, to feel our boundaries and feel the levels of trust where we can enter. And it's really a process of awareness about ourselves and about the relational safety, what is possible for us. the cultural thing is, just huge I mean, what do you, nowadays when we are living 2025, as we know the world has been coming together in so many ways, where do we find local cultures that are very kind of, that you can define easily and say, this is local culture because everything is so. globalized in some ways, unfortunately westernized as well. So that's something that I have been thinking a lot. But of course when we think about Finland, one of the key elements in the 90s, I mean in the 80s and 90s also, was that we were and still are part of the Nordic welfare, the ideas around that. democratic societies, but then again Finland has a long history of being occupied by Sweden and then Russia, and we have very specific language. We can't really relate to other people in this world, language wise. in my experience that has been maybe creating some kind of distrust but maybe The feeling of being not so connected because Finnish as a language is very different from any other languages in the world, except for the Estonia. So that has been definitely one of the key features here, but of course, Again, when we come to the Western Lapland, we live in the border of Sweden and we can just walk to the Sweden and there is their own language in this area that has a very specific position in, Finnish and Swedish, languages. culture. We have families who live both sides of the border, and we come together, every now and then. And that is one of the reasons why the pandemic was very traumatic for the community here, because families were literally split off from each other during that time. But there is definitely in this area, culturally, there has been this, history of reaching out, and the ideas around diversity, where families have been formed from people who are living in different countries. But I don't know what's, what do you think, what is specific in UK context

Fiona 39:03

Certainly in the context in which we're working, myself and Gareth, that, we have a very high level of diversity, I was really curious to hear you say, and use the word, families that are formed from people from different countries, I think we have a lot of that here. And in our own way, perhaps we are forming a family of people from different countries speaking here amongst ourselves today.

Gareth 39:33

I think that's often something we constantly grappling with within the NHS, because whenever we sort of hold up a sort of cold, harsh mirror to ourselves, the inequalities really jump out in terms of outcomes, um, and pick a protected characteristic of your choice, it's, we do poorly on it, in terms of access and outcome. Westminster has over 85 different languages that are spoken across it, we have lots of sub communities across the patch. We know that many of those we are hard to access, from their particular context and background. And a lot of, what we've been doing in the last year is trying to grapple with some of that in the, when thinking about open dialogue of How do we acknowledge and integrate that sense of diversity? And I've always felt this huge opportunity within this way of working because of the space that's created for people to tell their story, for their voice to be heard in what way they want it to be heard. that there is so much more chance for a meeting of perspectives and context and new understandings to be created. I feel this opportunity here for us to start closing some of that gap on inequality.

Fiona 40:55

I think that in lots of ways we're kind of crossing borders, not boundaries.

Gareth 41:01

something about that you were talking about there, Mia, that feels so resonant about the story of Tornio, of where it is, of it sits on that, border, that it's always had to have a sort of cross cultural dialogue. And it's part of the story here. Of having to have conversations to try and make understanding across languages that can't meet.

Mia 41:26

But in the same time, Finland in general and Lapland also is very kind of a, rural area. We have, in the beginning, there was in this area 70, 000 inhabitants. Nowadays we have a bit less than 60, 000.

Gareth 41:45

Right, gosh.

Mia 41:46

Yeah, the context is so very different when we compare it to London. And most of the, the people, of course, we have more multicultural, uh, kind of cultures here. I mean, people coming from different countries, moving to Finland, but then again, they go to the bigger cities because there's more opportunities for living and providing than in Tornio. So the context is very different from London.

Fiona 42:20

Yeah, we have a, it's not just cultural is it, it's I guess it's socioeconomic as well. And it's the really hot blend of living with a lot of space around you and not very many people. And living with not very much space and lots and lots of people. I think that those things are very useful and pertinent to reflect on, those differences. but also the similarities we have,

Gareth 42:48

I was going to jump to a similarity that sits at the core of that for me, it's isolation. Social isolation happens in both of those contexts. Whether it's because you are physically isolated in a more rural context, or whether you're socially isolated in the city, because actually we know in cities it leads to disintegration of social order. Constructs. both of those, and we were talking about this with some of our service users recently. We were having, we brought them around to have a bit of a reflection on where we got up to with the service so far and the development of the pilots. And we were hearing from them and their families about where they got it. And they were talking about something about this way of working and I can't put my finger on it, but it just sort of works. And as we sort of went more and more way through this conversation, we sort of came to this idea of actually, it was the emphasis of the social in the way of the working. was that because it keeps getting pushed up to primacy of always asking and interested in how are you connected to others, it feels like one of the really key ingredients.

Mia 43:51

yes, I agree.

Fiona 43:53

Your use of the word connection, Gareth, reminded me of the EM Forster quote, only connect. Thanks.

Gareth 43:58

I just want to give a huge thanks to you, Mia, for taking some time out of your schedule to record some of your words of wisdom. we've loved having you here and I've loved this conversation. I wonder if you'll come back sometime and have another conversation with us.

Mia 44:15

Yes, thank you, Gareth and Fiona. This was really wonderful, because when you come to these spaces, I've done some of the things during the years, and you never know, what kind of situation it is. I really experienced this as a very warm and lovely environment and definitely, yes, I would love to continue one day either in podcast or in person or whatever. Yeah. Thank you so much.

Fiona 44:42

that would be wonderful.

Mia 44:46

Thank you.

Narrator 44:47

And that's it for this episode of Open Pod Pod. Join us for the next episode.