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December 12, 2019 by Christopher Gordon, MD

Open Dialogue at Advocates


Open Dialogue is alive and well in Massachusetts.  Since 2011, when Advocates was the first recipient of funding support from the Foundation for Excellence in Mental Health Care, Advocates has been providing Open Dialogue services in two programs based in Framingham, Massachusetts.

Advocates is a full-service, not for profit provider of services and supports to people with psychiatric conditions, developmental and other cognitive disabilities, substance use conditions, and other life challenges, offering residential supports, outpatient and emergency services, among other supports, all dedicated to the idea that everyone, regardless of diagnosis or disability, can live a full, challenging and rewarding life of their own design, given the right supports.

With the initial support from the Foundation for Excellence in Mental Health Care, and with additional support, particularly from the Department of Mental Health, Advocates was able to train 35 staff members at the preeminent training site for Open Dialogue in the US, the Institute for Dialogic Practice under the direction of Dr. Mary Olson, currently affiliated with Yale University.

We then launched two programs – one for young people experiencing early episode psychosis, called The Collaborative Pathway; the other for people receiving services from the Department of Mental Health, whose difficulties had become or were at risk for becoming more chronic, called  Open Dialogue in Behavioral Health Services.  With support from the Cummings Foundation, and ongoing support from the Department of Mental Health, both programs have been delivering Open Dialogue Services for nearly ten years.

Open Dialogue is an approach to working with psychiatric and emotional distress which views psychiatric, psychological and emotional symptoms as meaningful and important, and seeks to provide supports to people and families in distress by involving their families and networks of support as critical resources for understanding, support and recovery.

Open Dialogue uses family/network meetings, often in the family home, as a platform for understanding what is going on, and for designing treatment paths that emphasize mutuality and shared decision making. Open Dialogue incorporates other psychiatric modalities, including hospitalization and/or medications as needed and as appropriate, but compared with standard care, there is an effort to use lower doses or delay the use of antipsychotic medications when safe to do so.  Long term outcomes, especially in the area of functional recovery (i.e., the ability to work or be in school) have been encouraging.

Open Dialogue often is very well received by people receiving services and by their families.  People report that the services are much more inclusive, transparent, and empowering than some forms of standard care. Staff, too, have strongly endorsed the program, with many reporting their work in Open Dialogue is some of the best work they have ever done, and that if they or a loved one were faced with psychosis, this would be their preferred treatment modality.

Since 2011,  the Advocates programs have served over 80 individuals and their networks of support, and have provided over 1300 Open Dialogue network meetings, making Advocates the most experienced provider of Open Dialogue services in the United States.

This progressive, holistic and deeply humanistic approach to helping people and families in psychiatric distress would not have been possible without the pioneering support of the Foundation for Excellence in Mental Health Care, and the unwavering support and partnership of the Department of Mental Health, and other generous funders—as well as the visionary leadership and administrative support of Advocates’ leaders themselves: our CEO, Diane Gould;  Beth Lacey, Senior Vice President for Community Services; and Brenda Miele Soares, the VP for Behavioral Health Services, whose administrative genius made the project possible in first place.

Advocates continues to rely on grant support to provide this service, so we ask your help in funding these programs through the Collaborative Pathway Fund at the Foundation for Excellence in Mental Health Care.

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