Summary of the Leonardo Project
All over Europe, mental health care system requires full integration with local community structures, which is why a shift from hospital-based inpatient treatment to outpatient and community treatment is needed. Patients, their families, social networks and members of the therapeutic teams should build relationships founded on equal rights and joint decisions. There is an urge for mental health centres and institutions to provide care in compliance with psychotherapeutic approaches and methods, as well as to cooperate with social services and self-help movements established by users and their relatives.
The following project fulfills the European needs for change from mental health care system relying on hospitals-asylums to psychiatric services based on local community. In the European Commission and WHO documents the process was described as Deinstitutionalization (DI).
„The Open Dialogue Approach” (ODA) is one of the most effective therapeutic methods in the world in the treatment of psychosis, focused on work with a patient and his/her social network. It was created in the 1980s by Professor Jaakko Seikkula (psychotherapist) and Brigitte Alakare (psychiatrist) and their team at Keropudas Hospital in Finland. They developed a family-centered, need-adapted approach aiming at an immediate intervention in the early stage of crisis. The treatment is perceived as a process integrating various therapeutic modalities. As a result, individual and group therapy, family and social network support and a patient’s effort to use his/her mental resources have become an alternative to long-term hospitalization.
The outcomes of a two-year research conducted in Finland show that patients diagnosed with schizophrenia, treated with ODA, were hospitalized for much shorter periods of time (14 days per patient) than patients who received other treatment. During the assessed periods, neuroleptics were used in only 33% of cases in the first group in relation to 100% of cases in the control group. Each time, families of the patients were actively involved in the treatment process, participating, on average, in 26 meetings in two years. As a result, the process of recovering and regaining full employment in ODA patients was much faster than in other cases (only 24% of OD patients relapsed comparing to 71% of patients in the group treated in a traditional way). Within 5 years as many as 86% of ODA patients returned to the previously performed activities – i.e. studying, working or job searching – and 82% of them did not experience any persisting symptoms.
The promising results of Open Dialogue treatment and the fact that more and more world institutions and organisations were inclined to implement the approach as a regular therapeutic practice contributed to a project devoted to disseminating ODA in Europe. The initiative had come from the Polish foundation (the current coordinator of the project) representing families of the individuals affected by mental disorders. Ten organisations and medical care providers from Finland, Denmark, Norway, Germany and Austria were invited to take part in the project. Among them, there were both the institutions which had already had some experience of OD practice and those which had just started to use this approach. That is why, the transfer of knowledge, experience and good practices between partners was possible. It also provided a possibility of further work to develop the Open Dialogue Approach and promote it all over Europe.
In the framework of a two-year project, there were seminars, workshops and conferences organized for professionals, families and individuals with the experience of a mental health crisis in each of the 6 partner countries involved. It was an opportunity for people of different professions (such as psychiatrists, psychologists, nurses, social workers) and representing different institutions (hospitals, counselling centres, community treatment teams; national, regional and local administration offices) to explore the new way of thinking about the treatment process of mental health disorders and diseases. Conferences, seminars, workshops and courses were held to prepare caregivers to work in ODA. Furthermore, in order to train ODA professionals in the future, handbooks for course participants and trainers were produced. In Poland, Austria and Germany mobile teams were also created, offering follow-up therapy for patients after hospitalization. Every partner in the project published an article on ODA, contributing to a wide promotion of the approach across each country.
The mobility of professionals was also the essential aspect of the project, which developed further into study visits. It allowed for sharing the experience and best practices of the visited partner country, broadening knowledge of the visitors. Partners could also participate in prestigious international conferences, which gathered specialists from all over the world, and had a possibility to present and discuss about their success.
The abovementioned achievements would not be possible without the European partnership, aiming to continue cooperation and perpetuate the results gained so far.
Thank you very much to Everyone who was involved in this!