Research: Open Dialogue approach may reduce drug treatment in young people

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New research from Finland has suggested that mental health services based on the Open Dialogue (OD) approach to mental health may reduce psychotropic drug treatment in young people.

The research was the first study focusing on the long-term dispensation of psychiatric medication to all adolescents whose treatment commenced under Open Dialogue-based mental health services within a predetermined timeframe.

It suggests that the iatrogenic risks of long-term psychotropic treatment can be minimised by reducing the amount of medication prescribed, which may be a factor in the promising outcomes in treatment strategies such as the OD approach.

Open Dialogue as a therapeutic modality began in Finland, so it’s not surprising that this latest research, carried out over ten years, comes from there. In the Finnish Western Lapland region, the entire mental health service were re-arranged on the basis of the OD approach. Within OD, psychiatric medication is used in a need-adapted manner. This means therapeutic activities are planned and carried out flexibly and individually in each case so that they meet the real and changing needs of the patients as well as of their family members. Medication is rarely initiated at the beginning of the treatment contact.

The paper notes that:

“Antipsychotics are prescribed for children and adolescents for many indications, despite a lack of scientific data on their effectiveness and safety.. Particular concern has been expressed concerning the increased off-label prescribing of second-generation antipsychotics for behavioural, anxiety, and sleep problems.

When antipsychotic treatment is considered necessary, it should be closely monitored and as brief as possible. A particularly concerning aspect involves the impact of these medications on the cognitive, social, and physical development of children and adolescents, given that the side effects may interfere with patients’ activities in their educational setting, peer networks, and recreational settings. Concerns have also been raised concerning possible overdiagnosis and overmedication and polypharmacy.”

OD is one of the methods of treatment posed as an alternative, or at the very least a parallel therapeutic intervention, located outside of biological interpretations of mental health. It is grounded in a familial and social networking approach to understanding and responding to emotional distress or mental illness as an initial presentation. 

In Ireland, at least in relation to mental health services delivery and care processes, OD as a transformatory process emerged in or around 2008 and as a form of interdisciplinary community communications towards service improvement began to have traction within research and service development. 

As a feature of some of these early explorations the possibility of integrating OD as a multidisciplinary team approach to working with people, families and social networks began to emerge in in Irish mental health services. As a slow burner and beginning in West Cork, there has been a slow though expanding engagement by services with the OD therapeutic approach – so far in West Cork, Meath and Mullingar, with a few other teams dipping their feet into the possibility of adopting the approach. Perhaps not as widespread in it’s growth as other jurisdictions, this approach is taking root but with the evidence base growing, it should be seen as a part of mental health services, rather than a novel addition where funding allows.

Given the concern in Ireland about the use of medications in youth mental health services, it is incumbent on decision makers to look at options that move away from an over-reliance on medication and polypharmacy practices.

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