Early psychosis – 85% success rate, mostly without antipsychotic medications!

May 5th, 2014

Recently Jaakko Seikkula & Markku Sutela from Finland were in Australia to conduct training in Open Dialogue. I did not learn of it until later, but the webpage was very interesting and I encourage you to read it. http://www.sfnsw.org.au/Research—Publications/Open-Dialogue-Program#.Uy4oU4XQ42r
They talk about the approach developed in their region of Finland, which is primarily one of family therapy, for all new cases of (non-affective) psychosis. They have been doing this for approximately 25 years and have the data to show they are getting superior results. I have not yet read all the pdf attachments, but it seems antipsychotics were used in only a third of cases, and about half of those were able to cease the medication.

All staff including psychiatrists are trained in family therapy, and the problem is not defined in a way that pathologizes or stigmatizes people. Rather psychosis is explained as an answer to a very difficult life situation. The main “intervention” is to see the client at home with family and create open dialogue so that everyone can talk and be heard. Any type of abuse or violence is interrupted.

I am pleased that things such as these offer an alternative voice to the usual idea that there is something wrong with people’s brains. Family therapy literature has written at least as far back as 1980 that it can resolve psychosis without medication. However, it’s been drowned out by the dominant story of chemical imbalance, genetics etc, making psychosis and schizophrenia seem like a medical condition.

In brief two thirds of people do not receive any antipsychotic medication at all, and of the remainder, about half receive it for a limited time. Essentially about 15% of people remain on medication and have ongoing disability. The remainder recover well; in fact the employment rate is higher than the general population!

The population in this region do not understand why other places dislike psychiatrists. There is no stigma. When people begin showing symptoms, they contact their mental health service within 3 weeks on average. Then the bulk of these problems are resolved. And since a diagnosis of schizophrenia can only be made if symptoms exist for longer than 6 months, very few new cases of schizophrenia are diagnosed. Schizophrenia is disappearing.

In contrast, in Australia there is significant stigma about having a ‘mental illness,’ and so it can happen that people may wait a year or longer before seeking help.

Will psychiatry worldwide still claim that schizophrenia is a medical condition, when so much is remedied without medication? And will this approach filter into Australia slowly or quickly?

Individuals and families should take heart that for most people a very good recovery is achievable. As practitioners I hope we can help to get this message out to others. There is nothing special about the region to explain their results. It is a somewhat poor area, and used to have a high incidence of schizophrenia, but now has the lowest in the western world; (the rest of Finland using traditional methods remains unchanged.)

There are 2 clips below (8 mins & 3 mins) from the link above.

Information from film-maker Daniel Mackler’s website

In the far north of Finland, a stone’s throw from the Arctic Circle, a group of innovative family therapists converted the area’s traditional mental health system, which once boasted some of Europe’s poorest outcomes for schizophrenia, into one that now gets the best statistical results in the world for first-break psychosis. They call their approach Open Dialogue.

Their principles, though radical in this day and age of multi-drug cocktails and involuntary hospitalizations, are surprisingly simple. They meet clients in crisis immediately and often daily until the crises are resolved. They avoid hospitalization and its consequential stigma, preferring to meet in the homes of those seeking their services. And, perhaps most controversially, they avoid the use of anti-psychotic medication wherever possible.


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