The Open Dialogue approach to mental health care

In the NSW Mental Health Commission’s strategic plan for 2014-2024, Living Well, the need for a recovery-orientated approach to mental health care is emphasised alongside the need for a stronger focus on young people, early intervention, and involving families and carers in treatment and in service design. Open Dialogue is an innovative approach to mental health care that specifically meets this need.
 
Originating in Finland, Open Dialogue is an approach to mental health crisis intervention and on-going care for people experiencing a crisis. It is a person-oriented approach, which aims at mobilising an individual’s psychosocial resources by engaging the person, the family, and the individual’s social network in a series of meetings.
 
There is currently no formal manual for Open Dialogue and interventions are based on the following seven main principles of treatment: 1) Immediate help. 2) A social network perspective. 3) Flexibility and mobility. 4) Responsibility. 5) Psychological continuity. 6) Tolerance of uncertainty. 7) Dialogism. 
 
“Dialogical” psychotherapeutic discussions about experienced needs and difficulties aim to increase the capacity of the crisis-struck individual and his/her family and extended network to take action in their own lives.
 
Evaluations of the effects of Open Dialogue in Finland are encouraging, demonstrating improved clinical and functional outcomes after five years. On the basis of a register-based cohort study, Seikkula and colleagues# found that the group receiving Open Dialogue required fewer days of hospitalisation (an average of 36 days) than the comparison group receiving treatment as usual (an average of 117 days). Furthermore, they found improved employment status, with 83% of the intervention group studying, working, or job seeking in contrast to 30% in the comparison group.
 
Hospitalisation is often traumatic for patients, costly for health systems, and is preventable. The humanistic Open Dialogue approach, including Peer-supported Open Dialogue, has the capacity to reduce the alienation of service users and their families by avoiding paternalistic decisions and interventions. For many users and families, contact with mental health services can be very disruptive, confrontational and even traumatising. It is very likely that families that are met by an open and genuinely listening approach will start to make better use of health care services, with improved outcomes for patients and less utilisation of expensive hospital resources.