The UK’s current psychiatric system has been heavily criticised for being more coercive than caring, a one-size-fits-all approach that silences the voices and visions of patients. The system is also notorious for alienating family members, who are often excluded and left in the dark. Psychiatrists such as Russell Razzaque decry the system’s obsession with medication, saying that the whole treatment system seems to revolve around pills, resulting in a genuine disservice to patients. While medication has its place, without significant changes to the way we treat mental health, psychiatric care in Britain could continue to flounder.
Enter the Finnish approach to mental health, known as ‘open dialogue’. This approach involves the rapid response of family and friends alongside mental health professionals in a safe space to provide a collaborative sounding board, asking open-ended questions in a less interview-like environment. The approach encourages reflection amongst those present, turning to each other during the meeting to share what they’ve heard. If there are concerns for a patient’s safety, options such as hospitalisation and medication can be discussed in front of the patient, in contrast to more traditional psychiatry practices whereby decisions are made behind closed doors.
The Finnish approach grew out of western Lapland in the 1980s, at a time when Finland was in an economic depression and experienced high rates of mental illness. The approach focuses on creating consistent support networks alongside family relationships. A study in 2006 demonstrated significant long-term benefits, showing that after five years, 86% of patients with severe mental health conditions had returned to work or education, while just 17% were taking medication, and an average of 14 days were spent in hospital. In contrast, a similar five-year study in neighboring Sweden showed that only 38% of patients had returned to work, with 52% taking medication, and an average of 110 days spent in hospital.
While Finland has significantly better results than the UK, Dr Russell Razzaque believes that the open dialogue approach could transform the way we treat mental health. With a trial underway in the UK with early results promising, Razzaque hopes that open dialogue could potentially provide the solution he’s been seeking, to replace the current medical approach to mental health with a more relational, patient-centric one. However, critics of the Finnish approach argue that rapid response could potentially delay effective treatment. The trial may reveal whether the open dialogue approach can overcome this potential problem, but there are already significant hopes within the profession that this approach represents a major step forward for mental health treatment, both in the UK and beyond
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