The Comprehensive Open-Dialogue Approach in Western Lapland: II. Long-term stability of acute psychosis outcomes in advanced community care

Abstract

An open dialogue need-adapted approach was applied in Finnish Western Lapland by organizing three-year family therapy training for the entire staff, and by following the outcomes. Three inclusion periods of first-episode psychotic patients were compared. In a two-year follow-up of two consecutive periods during the 1990s (1992–3 and 1994–7) it was found that 81% of patients did not have any residual psychotic symptoms, and that 84% had returned to full-time employment or studies. Only 33% had used neuroleptic medication. A third inclusion period, covering 2003–2005, was organized to determine whether the outcomes were consistent 10 years after the preliminary period. Fewer schizophrenia psychotic patients emerged, and their mean age was significantly lower. Duration of untreated psychosis had shortened to three weeks and the outcomes remained as good as for the first two periods. It is therefore suggested that the new practice can be related to profound changes in the incidence of severe mental health problems. This is supported by the large number of local inhabitants participating in treatment meetings for crises. Professionals had learned to make early contact in the event of crisis, and by this means prevent problems from developing into more severe cases.

Keywords:

• first episode psychosis
• community care
• need-adapted approach
• open dialogues

Notes

*Altogether 31 patient contacts were registered, but four were excluded because of only one treatment contact occurred and no possibility for verifying psychotic experience was realized. None of these responded to contacts for follow-up.

**All suicides took place in 1995 when a suicidal epidemic emerged in the province.

*pair comparison between API and ODAP^2003–2005.

**pair comparison between ODAP^1994–1997 and ODAP^2003–2005.