Open Dialogue- Successful in treating Psychosis in Finland

I had seen something on this a while ago, but a documentary has now been made about this technique that is helping many people in Finland, without medication. The nurse in the youtube trailed states that  Schizophrenia is just a name for an experience that people have had that they cannot find words to express ( or something like that!!)

Here is a snippet from the blog of the documentary maker Daniel Mackler.

 second key thing I learned about Keropudas Hospital, which, like most mental hospitals, is placed on the far outskirts of town (in their case, on the edge of the forest), is that it’s a rather large hospital that is relatively unused. There are one or more whole wards that are unused. I remember visiting one. It looked like an average, spacious hospital unit, but it was silent — and empty. It was dusty. Nothing was happening there. And the reason: they no longer have patients for them. They’ve developed such an effective system of helping people get well from psychosis, and get permanently out of the psychiatric system, that they no longer need so many beds. (No wonder they have some of the lowest per capita spending for psychosis anywhere in Finland — at least that’s what I’ve heard. When people get fully well, and are able to get off all their psychiatric drugs, they save the system a lot of money.)

Also, much of the work they do helping people with psychosis, most of it, in fact, has nothing to do with the hospital itself. In most cases they don’t prefer that people in crisis come to the hospital, and they don’t even do much therapy in the outpatient clinic that is located at the hospital. In fact, their hospital outpatient clinic has only one therapy room — one therapy room to serve a population of around 70,000 people!

Granted, the Open Dialogue clinicians do have an outpatient therapy clinic in each of their catchment area’s two largest towns (Tornio and Kemi), but they even prefer to avoid using these clinics for therapy, if at all possible. Their best preference is to meet in people’s homes. The therapists, usually a team of two or three trained family therapists, travel to the homes of the people in crisis. The clinicians made a point of telling me repeatedly that they saw no value in having people come to the hospital for therapy, because of the stigma. They felt that if they could help people get better at home, in their natural environment, then it was all for the good. Also, the clinicians told me repeatedly that they learned far more from people by seeing them in their homes than they could ever learn by seeing them in such an artificial place as a hospital or clinic.

So, although some of what I’m writing overlaps with the content of my film, I feel this is important enough to bear repeating. In two weeks of staying in Western Lapland, I really came to believe that this program is what it claims to be: a program that helps a lot — a lot — of people get well from psychosis, without meds. Although in one sense I gained this belief by talking with clinicians, who said things that people who have never watched someone go through the process of recovery (or who hadn’t lived it themselves) could have known, I gained it more from talking to the people they worked with.

As I said, I sat in on many Open Dialogue sessions, and although they were mostly in Finnish (sometimes, when the people coming for help felt comfortable, they adjusted and spoke in English for me), I still was able to gather a surprising lot — about their openness, their humanity, and their respect. Also, sitting in the sessions gave me an entrée to talk afterward with the people coming for help, the so-called clients and their families. One thing that struck me profoundly, even in really complicated and sticky emotional situations — situations that would have ended up with someone getting heavy medicated almost everywhere in the United States, but weren’t ending up that way here — was that I didn’t meet a single person seeking psychiatric help here who was bitter, or even unhappy, about the treatment they were getting. In fact, I didn’t find “treatment” to be a dirty word in Western Lapland. Nor was “psychiatry.” That struck me as bizarre, because for me both of those words have an inherent dirtiness for me, the second especially. And that’s entirely because of my own experience with each, both personal and professional.

What I heard from the Finnish people seeking help was that they felt the Open Dialogue system was fair — and honest. They also told me repeatedly that it felt “normal” to them. They used those words repeatedly. Interestingly, most of them seemed to have no idea that psychiatry was commonly hated and mistrusted in many other parts of the world, and even in parts of their own country. In fact, when I explained this to them many were genuinely surprised, as it contradicted their experience. This led them to tell me other things they liked best about their system. And they liked many things.

They liked the openness and frankness of the therapists. They liked it that above all else their own voices were heard and valued. They liked it that they had a key say in the decision about whether or not psychiatric drugs might be of benefit to them or not. They liked it that they had alternative options to drugs presented to them. They liked it that when they were in crisis they could invite their family and friends and other important people from their lives into therapy meetings — if they wished.

They also liked it that the therapists worked in teams, right in session — because they liked listening to what the therapists had to say to each other, in the middle of session. They told me that they felt they deserved to know what the therapists were thinking! And doesn’t it make logical sense?

They also told me that they liked it that their therapists met with them immediately in their crises, and didn’t put them off for months on endless, bureaucratic waiting lists. They liked it that therapists gave them the choice of meeting in their own homes or in clinics. They liked it that hospitalization was only used in cases of dire safety issues, and that hospitalizations were generally quite short. And they also liked it that visitors like me were so interested in what was going on with Open Dialogue — and were also interested in their lives. Many of them wanted to know what I myself thought of their lives, their situations, and of their therapy too. And, because it was Open Dialogue, and because I felt safe there, I shared my opinion. And they valued it. And it even felt therapeutic — which felt good to me.

 You can see the whole article on this website here http://beyondmeds.com/2011/03/21/finnishopendialogue/

Here is the youtube video

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