Welcome to the Open Dialogue Washington website. This website has been designed to support the development of the Open Dialogue approach from Western Lapland in the Washington region and also the US more broadly. The Open Dialogue approach is developing in several locations internationally, offering hope of a more effective way of organising mental health services and being with people in times of crisis, with less emphasis on medication and hospitalisation and more emphasis on community and meaning (for further detail on the approach and outcomes please see below).

Our first initiative has been to bring in international trainers to run an Open Dialogue foundation training programme. The first training commenced in July 2019.

What is the Open Dialogue approach?

The Open Dialogue approach is both a philosophical/theoretical approach to people experiencing a mental health crisis and their families/networks, and a system of care, developed in Western Lapland in Finland over the last 25-30 years. In the 1980s psychiatric services in Western Lapland were in a poor state, in fact they had one of the highest rates of the diagnosis of schizophrenia in Europe. Now they have the best documented recovery outcomes in the Western World. For example, around 75% of those experiencing psychosis have returned to work or study within 2 years and only around 20% are still taking antipsychotic medication at 2 year follow-up.

Remarkably, Open Dialogue is not an alternative to standard psychiatric services, it is the psychiatric service in Western Lapland. This has afforded a unique opportunity to develop a comprehensive approach with well-integrated inpatient and outpatient services. Working with families and social networks, as much as possible in their own homes, Open Dialogue teams work to help those involved in a crisis situation to be together and to engage in dialogue. It has been their experience that if the family/team can bear the extreme emotion in a crisis situation, and tolerate the uncertainty, in time shared meaning usually emerges and healing/recovery is possible. Open Dialogue has drawn on a number of theoretical models, including systemic family therapy, dialogical theory and social constructionism.

What is the response of Open Dialogue being practiced in the US?

In Tacoma, WA, work has begun to develop the Open Dialogue approach. One ARNP professional reports:

“In an Open Dialogue meeting, I observed the person of concern receive understanding and support that would not have been likely otherwise. Everyone listened attentively as he described his unusual experiences, and they responded honestly. Important bonds were rebuilt during this dialogue. Since the two Open Dialogue meetings we organized for him six months ago, he has been making steady progress in recovery. I believe this researched method brings about breakthroughs, and empowers the person of concern to take the best actions. Providers, family members and friends are more able to be fully supportive. It makes sense that implementing Open Dialogue across settings is a very wise use of mental health dollars. My hope is that Washington State will try this out, and see just how effective it is.”

– Christine Karczewski, ARNP.