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Additional Studies of Alternatives to Hospitalization

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Exciting new paper by one of the developers of Open Dialogue

Dr. Jaakko Seikkula points out that the Open Dialogue is not just a technique of therapy, it is a way of life... Becoming Dialogical: Psychotherapy or a way of life? Published in the Australian and New Zealand Journal of Family Therapy, Volume 32 Number 3 2011 pp. 179-193 (PDF, 116KB, 15 pages)

Daniel Fisher writes for Robert Whitaker's blog, about the parallels between the Principles of Open Dialogue and Recovery and proposes a new synthesis of the two: "Dialogical Recovery" to take the place of the monological medical model... [Click to view full article]


Finnish Open Dialogue: High recovery rates leave many psychiatric beds empty

My Reflections on the Finnish Open Dialogue Project
By Daniel Mackler

In June of 2010, I visited Western Lapland in Finland for two weeks. My goal was to make a documentary film on the Open Dialogue project. Although the film is now complete, and I feel it tells their story fairly well, there remains a lot that I left out — things I somehow, for one reason or another, couldn’t capture on camera.

I want to share a few of those missing things here. Click here to read the full article. [Visit Daniel Mackler's website]


Open Dialogue Resources on the Web

The Open Dialog method has the best reported outcomes for any method of assisting those who are beginning to show “psychotic symptoms.” Rather than relying primarily on medications, it aims to facilitate dialog throughout a person’s close social network. Click here for a list of links compiled by Ron Unger, LCSW.


Open Dialogue Approach: Treatment Principles and Preliminaryy
Results of a Two- year Follow-up on First Episode Schizophrenia

Jaakko Seikkula - University of Jyväskylä and Tromso
Birgitta Alakare - Western Lapland Health District and University of Oulu
Jukka Aaltonen - University of Jyväskylä
Juha Holma - University of Jyväskylä
Anu Rasinkangas - University of Jyväskylä
Ville Lehtinen - STAKES, National Research and Development Centre for Welfare and Health, Helsinki.


As part of the Need- Adapted Finnish model, the Open Dialogue (OD) approach aims at treating psychotic patients at their home. Treatment involves patient’s social network and starts within 24 hours after contact. Responsibility for the entire treatment process rests with the same team in both inpatient and outpatient settings. The general aim is to generate dialogue to construct words for the experiences, which exist in psychotic symptoms. As part of the Finnish National Acute Psychosis Integrated Treatment multicentre project (API project), three comparisons were made: 1) patients from the initial phase of OD (API group, N=22) were compared historically with patients from the later phase of OD (ODAP group, Open Dialogue in Acute Psychosis, N=23)). 2 and 3) The API (N=22) and ODAP (N=23) groups, both in Western Lapland were compared separately with schizophrenic patients (Comparison group, N=14) from another API research center who were hospitalized and received conventional treatment. Compared to the Comparison group, the API patients were hospitalized for fewer days, family meetings were organized more often and neuroleptic medication was used in fewer cases. The ODAP group had fewer relapses and less residual psychotic symptoms and their employment status was better than in the Comparison group. ODAP group had shorter hospitalization than API group. It is suggested that OD, like other family therapy programs, seems to produce better outcomes than conventional treatment, given the decreased use of neuroleptic medication.

Click to view - Open Dialogue Approach: Treatment Principles and Preliminary Results of a Two- year Follow-up on First Episode Schizophreniaa (PDF, 205KB, 27 pages)

Ethical and Human Sciences and Services, 2003, 5(3), 163-182.
Used by permission Springer Publishing Company, Inc., New York 10012


Soteria and Other Alternatives to Acute Psychiatric Hospitalization
A Personal and Professional Revieww



The author reviews the clinical and special social environmental data
from the Soteria Project and its direct successors. Two random assignment studies of the Soteria model and its modification for long-term system clients reveal that roughly 85% to 90% of acute. and long-term clients deemed in need of acute hospitalization can be returned to the community without use of conventional hospital treatment. Soteria, designed as a drugfree treatment environment, was as successful as antipsychotic drug treatment in reducing psychotic symptoms in 6 weeks. In its modified form, in facilities called Crossing Place and McAuliffe House where so-called longterm "frequent flyers" were treated, alternative-treated subjects were found to be as clinically improved as hospital-treated patients, at considerably lower cost. Taken as a body of scientific evidence, it is clear that alternatives to acute psychiatric hospitalization are as, or more, effective than traditional hospital care in short-term reduction of psychopathology and longer- social adjustment. Data from the original drug-free, home-like, nonprofessionally staffed Soteria Project and its Bern, Switzerland, replication indicate that persons without extensive hospitalizations (<30 days) are especially responsive to the positive therapeutic effects of the well-defined, replicable Soteria-type special social environments. Reviews of other studies of diversion of persons deemed in need of hospitalization to "alternative" programs have consistently shown equivalent or better program clinical results, at lower cost, from alternatives. Despite these clinical and cost data, alternatives to psychiatric hospitalization have not been widely implemented, indicative of a remarkable gap between available evidence and clinical practice. J Nerv Ment Dis 187:142-149, 1999


1 Soteria Associates, 2616 Angell Avenue, San Diego, California 92122.
Clinical Professor of Psychiatry, School of Medicine, University of California at San Diego.

2 Soteria House staff, with Mosher L, Menn A, Vallone R, Fort D (1992). Treatment at Soteria House: A manual for the practice of interpersonal phenomenology, Unpublished Monograph Published in German as: Dabeisein---Das Manual zur Praxis in der Soteria. Bonn. Psychiatrie Verlag, 1994.

Click to view: Soteria and Other Alternatives to Acute Psychiatric Hospitalization - A Personal and Professional Review (PDF, 210KB, 15 pages)

187:142-149, 1999

Madness Radio interview with Voyce Hendrix Inside Soteria House

Inside Soteria House with Voyce Hendrix, original clinical director who worked closely with Loren Mosher. Soteria House was a non-medication, non-diagnostic label and voluntary residence treating severe psychotic breakdown. Voyce discusses how Soteria was different than mainstream facilities and describes the healing results it had.

Soteria House Website - Commemorates the work of Loren Mosher, founder of the Soteria Project.


Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies


1University of Jyva¨ skyla¨ , 2University of Oulu, 3Western Lapland Health District, 4Western Lapland Health District, and 5Tampere University Hospital

(Received 18 January 2004; revised 10 June 2004; accepted 12 July 2004)


The open dialogue (OD) family and network approach aims at treating psychotic patients in their homes. The treatment involves the patient’s social network and starts within 24 hr after contact. Responsibility for the entire treatment process rests with the same team in both inpatient and outpatient settings. The general aim is to generate dialogue with the family to construct words for the experiences that occur when psychotic symptoms exist. In the Finnish Western Lapland a historical comparison of 5-year follow-ups of two groups of first-episode nonaffective psychotic patients were compared, one before (API group; n!/33) and the other during (ODAP group; n!/42) the fully developed phase of using OD approach in all cases. In the ODAP group, the mean duration of untreated psychosis had declined to 3.3 months (p!/.069). The ODAP group had both fewer hospital days and fewer family meetings (pB/.001). Nonetheless, no significant differences emerged in the 5-year treatment outcomes. In the ODAP group, 82% did not have any residual psychotic symptoms, 86% had returned to their studies or a full-time job, and 14% were on disability allowance. Seventeen percent had relapsed during the first 2 years and 19% during the next 3 years. Twenty nine percent had used neuroleptic medication in some phase of the treatment. Two cases from both periods are presented to illustrate the approach.

Click to view - Five-year experience of first-episode nonaffective psychosis in
open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies
(PDF, 215KB, 15 pages)

Psychotherapy Research, March 2006; 16(2): 214"/228


Practice Guidelines: Core Elements in Responding to Mental Health Crises

Individuals experiencing mental health crises may encounter an array of professionals and nonprofessionals trying to intervene and help: family members, peers, health care personnel, police, advocates, clergy, educators, and others. Their approaches in assisting those in crises often vary widely, contributing to the potential for ineffectual responses. Developed by a diverse expert panel that included individuals with mental illnesses, providers, public officials, and advocates, the guidelines presented here define appropriate responses to mental health crises across various situations and environments.

Click to view - Practice Guidelines: Core Elements For Responding To Mental Health Crises (PDF, 384KB, 26 pages)


Texas Crisis Alternatives Project

Toprac MG, Sherman PS, Holzer CE, et al:

Texas Crisis Alternatives Project: Cost-Effectiveness of 9 Crisis Residential Modalities: Final Report. Houston, Texas Department of Mental Health and Mental Retardation, 1996

Summary: This study compared hospitalization with a complex set of eight different crisis alternative programs in Texas and reported lower cost for the alternative programs. These authors found that most individuals who received alternative care did just as well, if not better, than those who received the usual hospital stay. Read the full text of the study [Click to read executive summary of the study] (PDF, 68KB, 12 Pages)