The Foundation for Excellence in Mental Health Care, with the dedicated support of major donors, began funding pilot projects in 2012 for adapting the Finnish Open Dialogue model to the culture and system of care in the United States. Preliminary outcome data sets are too small to draw conclusions about the U.S. programs’ efficacy, but qualitative data on participant and clinician satisfaction with the practice methods argue for further investigation.
To that end, the Foundation is now reviewing RFP submissions for its competitive grant Expanding the Science and Practice of Open Dialogue: An international collaborative multicenter research project to evaluate the effectiveness of Open Dialogue in various mental health care contexts around the world.
Last week in Psychiatric Services, Kim Mueser asked Is More Rigorous Research on “Open Dialogue” a Priority?, to which we reply, unsurprisingly, “Yes.”
Dr. Mueser’s commentary highlights the need to move the science of Open Dialogue practice beyond the small, insular group of developers, advocates, and early adopters and into the mainstream.
Historically, this would have been done with federal dollars, resources which have typically been required to establish an Evidence Based Practice. Unfortunately, federal dollars aren’t available the way they were when the original EBPs were established.
That is why independent, competitive funding from the Foundation for Excellence in Mental Health Care is so important and timely. Seed funding for innovative thinkers is also often the catalyst for those thinkers acquiring other funding to advance science and practice.
Excellence board member and lead of the first U.S. pilot project, psychiatrist Chris Gordon, writes, “My own experience remains that the mode of care in Open Dialogue is vastly more humane, person-centered, and toxicity-minimizing than standard care. We have experienced great satisfaction and enthusiastic endorsement from most (but not all) individuals and families we have served, but we have seen less impact on psychosis, and more need for the use of medications, than were reported by the originators of Open Dialogue in Finland. This may in part be due to the fact that we rarely see people who are completely new to the mental health system; most people we serve come to us already on antipsychotic medications. Still, at times, psychosis can remit and Open Dialogue makes space and time and opportunity for such natural resolution, and helps people avoid getting stuck in an enervating mental health system. So it’s great for much, much better informed consent and collaborative treatment design, and it’s the process I’d want myself for someone I love – if the team includes a competent psychiatrist who appreciates that medicines sometimes can be very helpful.”
Called “Voices for Choices”, this project aimed to create free and accessible training resources for individuals to advocate for themselves or a loved one at risk for involuntary treatment and for individuals and communities to advocate for system change; to increase advocates’ ability to connect and organize potential allies, and to measurably increase participants’ sense of empowerment as effective agents of change at the community level and with legislators and government agencies. These resources include videos, a handbook and one-on-one mentorship.
The first and unexpected outcome of the grant award was a major donation from an individual inspired by the project. That donation significantly improved MindFreedom’s infrastructure, including staff, capacity for volunteer coordination, and a website revamp.
This Excellence-funded project honors everyone’s potential to be a leader, even those in the back wards of the most restricted psychiatric facilities. It connects people with lived experience of mental health challenges with peer mentors, equipping them to change the system of care in their communities. Sarah Smith at MindFreedom International is the project coordinator.
The first two in a series of recorded webinars are now available online featuring panelists David Oaks, Jim Gottstein, and Emily Cutler in the first and Adrian Bernard, Caroline Mazel-Carlton, and Hilary Melton in the second, presenting their findings from years of working with people in distress.Read More
The team at the Hearing Voices Research and Training Project has been accomplishing great things! The trainers continue to crisscross the country offering multi-day trainings for new facilitators of Hearing Voices peer-support groups, as well as technical assistance after the training to help new groups get up and running. The team also offers a monthly networking call for US group facilitators and a weekly online support group, attended by voice hearers across North and South America. For more information, or to discuss bringing a facilitator training to your community, contact Caroline Mazel-Carlton, Training and Outreach Coordinator: firstname.lastname@example.org.
And since there are still too many communities around the country where the Hearing Voices approach remains unknown, the Project has started awarding mini-grants to community groups to support outreach programs in their local areas. The creativity and diversity of these projects is exciting – look out for upcoming events in Atlanta, Seattle, and Palo Alto. A date for applications for another round of mini-grants will be announced soon.
The Project’s research team is equally hard at work – seeking out the experiences of people around the country who have participated in HVN peer-support groups. The goal of their study is to identify the precise characteristics that make these groups so effective for so many people. With a clearer evidence base, the researchers hope to foster wider acceptance of the Hearing Voices approach among clinicians and other mental health professionals in the US. Dozens of voice hearers around the country have already sent in their responses; if you or someone you know has participated in an HVN group and not yet completed the survey, please check it out at: https://www.ourvoicesraised.org/
And finally, as part of the overall goal of raising the visibility of the Hearing Voices approach across the United States, the Project’s collaborative team of voice hearers, peer workers, and researchers are creating a short film, offering a powerful introduction to the approach through the stories of people whose lives have been changed by participating in HVN groups. Stay tuned for more information, available soon!Read More
Following the successful release of the documentary, Kings Park: Stories from an American Mental Institution, filmmaker Lucy Winer has teamed up with critically acclaimed author and historian, Nancy Tomes, PhD, to create a groundbreaking digital learning site aimed at the mental health care community, with special focus on those going into the healthcare profession.
Believing in the power of personal narratives to shift attitudes and inspire positive change, the site is called Unlocked: Stories of Public Mental Health Care. Rooted in the wealth of first-person narratives Lucy has filmed over the years with people who, like herself, had firsthand experience of Kings Park State Hospital, the site puts a human face on the past and its impact today.Read More
(Westchester, NY) – The New York State Psychiatric Institute (NYSPI) at Columbia University, in collaboration with the Mental Health Association (MHA) of Westchester is conducting a study to evaluate the feasibility of offering Social Network Meetings to individuals enrolled in New York State’s first episode psychosis program, OnTrackNY. The study is supported by a grant from the Foundation for Excellence in Mental Health Care.
These Social Network Meetings are derived from the Need-Adapted Treatment and Open Dialogue models and view psychotic disorders as heterogeneous, requiring individualistic treatment. These models integrate an individual’s social network throughout the entire treatment process and provide a consistent treatment team throughout the person’s recovery.
This study is open to all English speaking OnTrackNY clients (ages 16-30) and family members of their choosing.
Over the last three months, researchers have enrolled three individuals and their families into the social network arm of this the study. All of these participants have been offered at least one social network meeting and our first set of participants have had regular social network meetings since enrolling in May.
The study team is exploring ways to increase enrollment and will be focusing enrollment efforts on individuals who are newly entering the OnTrackNY program. The study team hopes that by offering social network meetings within the OnTrackNY program that individuals will receive enhanced social support allowing them to make greater strides toward reaching their recovery goals.
Lisa Dixon, MD, MPH
Edna L. Edison Professor of Psychiatry at the Columbia University Medical Center
Director, Division of Behavioral Health Services and Policy Research & Center for Practice Innovations
New York State Psychiatric Institute
1051 Riverside Drive, Box 100, Room 2702 New York, NY 10032
Follow me on twitter @lisabdixon
Editor, Psychiatric Services
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(Portland, OR) – The first North American trial of a 36-ingredient micronutrient formula is underway at Oregon Health & Science University (OHSU), The Ohio State University (OSU) and at University of Lethbridge in Alberta, Canada. In only three months of recruiting, the Micronutrients in ADHD Youth (MADDY) Study has enrolled 40 participants among the three sites, nearly one-third of our target number. All three sites are actively recruiting eligible children to participate. The children must be off of psychotropic medication for at least two weeks prior to starting the study to meet entrance criteria. The study is supported by a grant from the Foundation for Excellence in Mental Health Care.
Children, ages 6-12 years of age, who have ADHD and some irritable mood symptoms are participating in an 8-week randomized controlled trial. During this phase, they will receive either the active product or a matching placebo. Neither the participants’ families nor the clinicians will know which one. After 8 weeks, all the children are eligible to receive the active product for a further eight weeks. We are collecting data on the children’s mood and behavior at baseline and comparing their reports at the end of the treatment. We are also collecting blood, urine, stool, hair and saliva to begin looking at the biological basis for why some children benefit from taking the micronutrients and others do not. The MADDY Study is based on the research from Dr. Julia Rucklidge’s lab in New Zealand in which she found that the children with ADHD and irritable, angry moods reported the most benefit from the treatment.
Several of the families who have completed the initial 8 weeks report significant improvements in their child’s functioning. While we don’t know which pills they were taking (active or placebo), it is encouraging to hear the positive stories of improvement in mood and attention, reduced anger and an ability to get along better with friends. We hope to complete MADDY recruitment by early 2019.
Jeanette Johnstone, MFT, PhD
Licensed Psychologist and Clinical Researcher
Department of Psychiatry, Division of Child & Adolescent Psychiatry
Oregon Health & Science University
(503) 494-3700 voice mailRead More
At its best, motherhood is a bittersweet agony of self-sacrifice and letting go. At its worst, her child dies and a mother enters a new world of never letting go, carrying the weight of an unrightable wrong. The miracle of beauty from ashes comes when her love grows up through the grief and continues to give life.
In 1956, Alice Bolstridge gave birth to a beautiful, joyful boy she named Alan. In 2015, she laid him to rest. In between, they walked together through the trauma of a prolonged childhood illness and a lifetime of seemingly intractable mental and emotional challenges that grew from it.Read More
(Wilsonville, OR) – The Foundation for Excellence in Mental Health Care is pleased to announce the awards for this year’s Expanding the Science and Practice of Recovery-Based Mental Health Care and Supports grants. These one-year grants of up to $100,000 were selected for their vision and promise to effect cultural and system change, care innovation, and “slow psychiatry”, especially as these impact the lives of children.Read More
(Morro Bay, CA) – Despite numerous obstacles and severe withdrawal effects, long-term users of psychiatric drugs can stop taking them if they choose, and mental health care professionals could be more helpful to such individuals.
While 1 in 6 Americans take a psychiatric medication for serious mental illness, there is little research on people’s experiences coming off of them. In the first large scale study in the U.S., Live & Learn, Inc., in partnership with researchers at UCLA, UCSF and New York University, began to fill this knowledge gap. Study findings are available online today in the journal Psychiatric Services, published by the American Psychiatric Association.Read More