A key feature of our mainstream mental health system is the presence of “experts,” especially psychiatrists, who believe they know what sanity is, and who see their job as suppressing ways of thinking and experiencing which they deem pathological. They tend to be quite certain that they are correct and that other points of view are simply wrong.
What would happen if professionals were less certain, and if they were aware that any point of view might contain only part of the truth, and if they supported open-minded discussion aimed at finding value in multiple points of view?
A few decades ago, professionals in Northern Finland decided to try that approach, and they invented something called “Open Dialogue.” They found it to be much more effective than standard care, and they reported outcomes such as about 82% free of psychotic symptoms after 5 years, 86% back in jobs or education, and less than a third on long term antipsychotic drugs compared to over 90% in standard care.
Questions were raised about this data however. It was pointed out that they hadn’t done a truly randomized study, and it was claimed that their approach might only work in the northern Finnish culture, and would not transfer to other locations.
That’s why it’s important that a large randomized study has just been concluded in the UK, and it found that Open Dialogue is an effective approach outside of Finland. The approach was not as successful as hoped, especially in the sense that it did not significantly reduce the time to relapse after first recovery (the principal hoped for effect) but, according to researcher Russel Razzique, it did find all of the following:
“1. The odds of being admitted to hospital for severe mental illness were three times less for those who had Open Dialogue compared to standard care
“2. The proportion of people who spent any days in hospital, across the whole 2 year follow up, reduced by 52% for those who had Open Dialogue compared to standard care.
“3. The odds of being re-referred to a crisis or secondary care service was halved for those who had Open Dialogue compared to standard care
“4. Patient defined recovery (people’s rating of their own relationships, work, study and other self rated markers of recovery) improved for those who had Open Dialogue compared to standard care.
“5. The time it took to relapse with another episode of mental illness was marginally longer in Open Dialogue, but this difference with standard care was not statistically significant.
“6. Quality of life, relating to overall health, was improved for those who had Open Dialogue compared to standard care
“7. Patient satisfaction with the care they received was higher for those who had Open Dialogue compared to standard care”
This article reports on the study: Open Dialogue versus treatment as usual for adults presenting in crisis to mental health services in England (the ODDESSI Trial): a multisite cluster-randomised trial
Or you can find out more in this webinar that discusses the study, presented by some of the researchers:
