Adapting Open Dialogue to the United States initiative
Calm In The Storm
Open Dialogue (OD) is a systemic approach for responding to the extreme states and emotional distress that characterize psychiatric crisis or psychotic experience.
Instead of immediate hospitalization or medication, or waiting days or weeks for care – the two most common responses in many mental health systems – the OD approach sends a professional team including a psychiatrist and other trained professionals to meet the person in distress right away, where they are (often in their home with family or friends), as often as needed until the crisis has passed, and on an ongoing basis, without artificial limits.
Time To Breathe
OD practice seeks to delay decisions about medications when possible to limit the harms of over-prescribing. Decisions about medication use and other care are made in collaboration with the person at the center of concern, their supporters, the psychiatrist and other team members. A commitment to ‘tolerance of uncertainty’ prioritizes time to understand a person’s experience instead of the usual rush to diagnose and treat.
Space To Grow
Initially developed in Finland, the approach has spread across Europe and the Americas, inspiring clinicians and health administrators with research results showing it has reduced the frequency of ‘psychotic episodes’ in those who receive the services, and preliminary data that shows that incidences of psychotic disorder diagnosis has dropped in the region where the practice is the dominant form of care.
After 5 years of OD treatment in Lapland, 82% of participants had no remaining psychotic symptoms and 86% had returned to full employment. Only 35% had used antipsychotic drugs (Seikkula et al., 2006). Similar results emerged from Tornio between 2003 and 2005.
Open Excellence supports research designed to characterize and assess the effectiveness of the OD approach in multiple international settings.
That began as an initial pilot project at a community mental health program in Massachusetts in 2015 and continues today as an expanding pilot project at Emory School of Medicine and Grady Memorial Hospital in Atlanta, Georgia and in the international research and development collaboration called HOPEnDialogue.
Glen was a participant in the first pilot project in Framingham, Massachusetts and in this video he shares how his experience of Open Dialogue there changed the course of his life.