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January 7, 2019 by Foundation for Excellence in Mental Health Care

More Rigorous Research on “Open Dialogue” Is a Priority

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.”

 

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