“Open Dialogue” is an innovative approach to acute psychiatric crises developed by Jaakko Seikkula, Markku Sutela, and their multidisciplinary team at Keropudas Hospital in Tornio, Finland.
The principles and values of Open Dialogue are simple. People are met in crisis within 24 hours of contact and daily until the crisis is resolved. Hospitalisation is avoided and its consequential stigma, preferring to meet in the homes of those seeking their services. They avoid the use of anti-psychotic medication wherever possible. All those who have something to say are invited including the networks of the person and mental health services. The latter are integrated into a comprehensive service and the same Open Dialogue team work with the client and their social network throughout the life of the problem. In addition people are offered other therapies as required e.g. employment support, individual therapy, occupational therapy etc.
The aim of the meetings is to develop a dialogue, giving a voice to all concerned putting the person at the centre. Psychotic experiences are understood as something (usually traumatic or stressful experiences) for which there has been no language. Over time a shared meaning is developed that establishes a context for the experiences. Staff come from a variety of backgrounds but the majority are also trained family therapists/psychotherapists.
The results of follow up studies have been remarkable (5 year follow-up Seikkula et al. 2006):
- DUP (duration of untreated psychosis) declined to three weeks
- About 1/3 used antipsychotic drugs
- 83 % returned to full employment
- Few new schizophrenia patients: Annual incidence declined from 33 (1985) to 2-3 /100,000 (2005)
- The influence of this relational approach is spreading with teams and services in the US, Germany, Norway and Denmark working in this way.