A new way of working with mental illness: the open dialogue approach

I started an amazing new training course last week in a way of working called Open Dialogue. I first heard about the approach about a year ago and as soon as I went on the introductory day I felt inspired.

Open Dialogue is a way of working with people experiencing a mental health crisis, developed in Western Lapland in Finland over the last 30 years. It's the only psychiatric system used in Western Lapland.

The Open Dialogue approach has the best documented outcomes for 'schizophrenia' in the Western World. 75% of people experiencing psychosis return to work or study within 2 years of first contacting the service and only 20% are still taking anti-psychotic medication by the end of this 2 year period. This compares very favourably with outcomes in the UK both in terms of employment and ongoing use of medication (anti- psychotic medication is often continued indefinitely for people diagnosed as having schizophrenia, even after a first psychotic episode).

The emphasis of the Open Dialogue approach is about the patient as a person who lives/has lived in a particular social environment and who is making sense of their experiences. Even if the person's way of understanding their experiences seems bizarre, we still need to listen to what they say, as well as the people around them. So Open Dialogue teams meet with both the patient and their family/colleagues/friends/professionals involved in their care. They encourage them to listen to and hear each other, to tolerate the strong emotions involved and the uncertainty associated with the crisis. Everything the team says is expressed tentatively, respecting all the different ways of understanding the situation.  

Through this process, possible ways of understanding what has happened emerge, along with potential solutions. The patient is always involved in those solutions and the team never discuss the patient away from their presence. There isn't a rush to cure people. Yet paradoxically, the outcomes of this approach are much better than those of a conventional medical treatment.

There were several people who had personal experience of mental health difficulties on the course and I found some of these people incredibly inspiring in their passion to help others. Someone said that the thing that had helped him the most was being told it was okay not to be okay. Being compassionate towards people who are suffering seems to me to be at the heart of this approach. I have never been on a training course where that atmosphere pervaded the room in the way it did last week. Participants didn't immediately have to  be experts or fear making mistakes. People were open about what they were finding difficult and were met with warmth and support. This genuine respect, openness and kindness means we can tolerate distressing feelings. It opens up a space to think about what is going on in a crisis and to find ways out of it, without the necessity for lifelong medication.

 

 

 

 

I started an amazing new training course last week in a way of working called Open Dialogue. I first heard about the approach about a year ago and as soon as I went on the introductory day I felt inspired.

Open Dialogue is a way of working with people experiencing a mental health crisis which has been developed in Western Lapland in Finland over the last 30 years and it's the only psychiatric system used in Western Lapland.

The system has best documented outcomes for 'schizophrenia' in the Western World. 75% of people experiencing psychosis return to work or study within 2 years of first contacting the service  and only 20% are still taking anti-psychotic medication by the end of this 2 year period. This compares very favourably with outcomes in the UK both in terms of employment and ongoing use of medication (anti- psychotic medication is often continued indefinitely, even after a first psychotic episode).

The emphasis of the Open Dialogue approach is about the patient as a person who lives/has lived in a particular social environment and who is making sense of their experiences. Even if the person's way of understanding their experiences seems bizarre, we still need to listen to what they say, as well as the people around them. So Open Dialogue teams meet with both the patient and their family/colleagues/friends/professionals involved in their care. They encourage them to listen to and hear each other, to tolerate the strong emotions involved and the uncertainty associated with the crisis.Everything the team says is expressed tentatively, respecting all the different ways of understanding the situation.  Possible solutions emerge through this process. The patient is always involved in those solutions and the team never discuss the patient away from their presence. There  isn't a rush to cure people. Yet paradoxically, the outcomes of this approach are much better than those of a conventional medical treatment.

There were several people who had personal experience of mental health difficulties on the course and I found some of these people incredibly inspiring in their passion to help others. Someone said that the thing that had helped him the most was being told it was okay not to be okay. Being compassionate towards people who are suffering seems to me to be at the heart of this approach. I have never been on a training course where that atmosphere pervaded the room in the way it did last week. Participants didn't immediately have to  be experts or fear making mistakes. People were open about what they were finding difficult and were met with warmth and support. This genuine respect, openness and kindness means we can tolerate distressing feelings. It opens up a space to think about what is going on in a crisis and to find ways out of it, with

 

 

 

 

I started an amazing new training course last week in a way of working called Open Dialogue. I first heard about the approach about a year ago and as soon as I went on the introductory day I felt inspired.

Open Dialogue is a way of working with people experiencing a mental health crisis which has been developed in Western Lapland in Finland over the last 30 years and it's the only psychiatric system used in Western Lapland.

The system has best documented outcomes for 'schizophrenia' in the Western World. 75% of people experiencing psychosis return to work or study within 2 years of first contacting the service  and only 20% are still taking anti-psychotic medication by the end of this 2 year period. This compares very favourably with outcomes in the UK both in terms of employment and ongoing use of medication (anti- psychotic medication is often continued indefinitely, even after a first psychotic episode).

The emphasis of the Open Dialogue approach is about the patient as a person who lives/has lived in a particular social environment and who is making sense of their experiences. Even if the person's way of understanding their experiences seems bizarre, we still need to listen to what they say, as well as the people around them. So Open Dialogue teams meet with both the patient and their family/colleagues/friends/professionals involved in their care. They encourage them to listen to and hear each other, to tolerate the strong emotions involved and the uncertainty associated with the crisis.Everything the team says is expressed tentatively, respecting all the different ways of understanding the situation.  Possible solutions emerge through this process. The patient is always involved in those solutions and the team never discuss the patient away from their presence. There  isn't a rush to cure people. Yet paradoxically, the outcomes of this approach are much better than those of a conventional medical treatment.

There were several people who had personal experience of mental health difficulties on the course and I found some of these people incredibly inspiring in their passion to help others. Someone said that the thing that had helped him the most was being told it was okay not to be okay. Being compassionate towards people who are suffering seems to me to be at the heart of this approach. I have never been on a training course where that atmosphere pervaded the room in the way it did last week. Participants didn't immediately have to  be experts or fear making mistakes. People were open about what they were finding difficult and were met with warmth and support. This genuine respect, openness and kindness means we can tolerate distressing feelings. It opens up a space to think about what is going on in a crisis and to find ways out of it, without the necessity for lifelong medication.