Presentation at Think-tank conference Crossroads of Change, Trieste 17 th October 2016

Transcription

1 Presentation at Think-tank conference Crossroads of Change, Trieste 17 th October 2016 Kari Valtanen, Med Lic, Specialist, Child and Adolescent Psychiatric Services Päivi Köngäs-Saviaro, Med Lic, Specialist, Chief of Psychiatric Department, Western Lapland Healthcare District, Finland

2 WHERE DO WE COME FROM AND WHO WE ARE?

3 Outpatient care: Tornio psychiatric policlinic Keropudas Hospital crisis policlinic General hospital psychiatric policlinic Adolescent psychiatric policlinic Child psychiatric policlinic 22 beds at Keropudas hospital Psychiatric outpatient clincs in muncipalities Kemi, Simo, Keminmaa, Tervola, Ylitornio

4 Western Lapland health care district

5 ORIGINS OF OPEN DIALOGUE Mental health reform 1978 Treatment meetings since 1984 principle no 1: You are not allowed to talk about patients or families when they are not present Systematic research of the approach since 1988 development of OD-principles Systematic family therapy training for the entire clinical staff since 1989 (continuing) Family therapists ~ 70% of the personnel + other therapeutic trainings

6 Immediate help in crisis situations Help adapted to each patient s and family s specific and changing needs Psychotherapeutic attitude in all treatment contexts An effort to understand what has happened and what is happening to the patients/clients and their significant others This principle should be an underlying motive during the whole treatment process Originally applied to treatment of psychotic crisis, later on to any mental health crisis.

7 DIALOGICAL PRACTICE Collaboration Tolerating uncertainty Aiming on dialogue Listening to every voice Polyphony Reflective talk Open decision making SERVICE DELIVERY SYSTEM Need adapted & integrative treatment Immediate help Family & network included as resource Team/pair work Flexibility Responsibility WORLD VIEW Listening, relating and responding to others On all levels of system and organization Co construction of realities Relational & contextual identities

8 OPEN DIALOGUES IN TORNIO 5 YEARS FOLLOW UP % used antipsychotic drugs 81 % no remaining psychotic symptoms 81% returned to full employment Seikkula, J., Alakare, B., Aaltonen, J., Haarakangas, K., Keränen. J. & Lehtinen, K. (2006). Five years experiences of first episode non affective psychosis in Open Dialogue approach: Treatment principles, follow up outcomes and two case analyses. Psychotherapy Research, March 2006; 16(2):

9 State employment agencies School counsellors, teachers, school nurses Alcohol and drug clinics The social insurance institution (KELA) WORKING TOGETHER, NOT SIDE BY SIDE Police Non govermental associations etc. Health centers in municipalities Collaborating with our partners together with the patient & family Child welfare Municipal social services Municipal mental health units Invitations, not referrals

10 Why open dialogue works? Immediate response Social network included as resource Need adapted, integrated care Focus on dialogue and working together Avoiding hospitalization (Psychotic) crisis seen as contextual experience

11 Focus on the person Family and network are considered as resources, not as objects of the treatment Difficult crisis might be the first time to speak about together about the unspoken experiences and different understandings Response is need adapted to fit the special and changing needs of every patient and their social network The same team should be in charge and responsible of the whole process regardless the place of the treatment (outpatient/hospital)

12 THE TREATMENT MEETING No prior planning, no chairperson Introducing ourselves Two times Why each participant is present Telling what we know already Being public or transparent F.i. The school nurse told me that. What is the history of this meeting? How would you like to use this time?

13 THE TREATMENT MEETING Discussing with the family and the network about the themes important to them Reflecting the themes No separate reflecting team Decisions and plans if possible or needed At least the next meeting Who will be present No long term plans