Open Dialogue is a model of mental health care pioneered in Finland. It involves a family and social network approach and healthcare staff are trained in family therapy and related psychological skills. It has since been taken up in a number of countries around the world, including much of the rest of Scandinavia, Germany and several states in America.
The approach is completely different to the mental health system in the UK, where medication is paramount. Open Dialogue does not ask what is wrong with a person, it seeks to understand what has happened to them.
The Open Dialogue model centres around regular network meetings. These involve the patient, together with his or her family members, as well as extended social network. The network meetings are the only forum where decisions are made, with the client remaining at the centre of the process. This enables a strong emphasis on independence and long- term recovery from day one.
A further core element of the model in the UK -– also used in services such as New York -– involves the inclusion of peer workers within each team. Peer workers are seen as experts in their own right, working with patients and extending social networks where necessary. They also work locally to cultivate a wider supportive peer community.
Open Dialogue sees mental health difficulties as expressions of distress and trauma that haven’t found words and meaning. The aim of the meetings is to develop a dialogue, giving a voice to all concerned putting the person at the centre.
Results from non-randomised trials are striking. For example, 72 per cent of those with first episode psychosis treated via an Open Dialogue approach returned to work or study within two years, despite significantly lower rates of medication and hospitalisation compared to treatment as usual.