A model of treating posttraumatic disorders in the Open Dialogue Approach (ODA) exemplified by the Community Mental Health Centre (CMHC)

Abstract

Purpose: The aim of this paper is to present current views on the meaning of trauma and its treatment by the use of Open Dialogue Approach (ODA). Authors broadly define trauma as mental crisis that urges an immediate and comprehensive care. Views: Open Dialogue Approach with its demand on development of professional mental health structures not only meet the requirements imposed on community mental health centre (CMHC) as a core of the National Mental Health Program, but it seems to be exceptionally useful in the context of therapeutic work with traumatized patients and with people in a mental crisis. One of the main aspect of currently carried out mental health reform is the liberalization of hospital beds for those who are in severe mental crisis, substantially the raise od hospital standard for patients admitted to psychiatric hospital and to offer an ambulatory, easily accessible (local) ways of dealing with mental health problems. Conclusions: At the core of the ODA lies a broad understanding of traumatic experience and broad perception of its symptomatic and processual consequences issuing mental crisis, which requires a fast, diverse and coordinated care. ODA may be defined as an integrative and community-oriented model of mental health service that follows constantly changing patients' needs. Available mental health structural frame-if well-coordinated-seems sufficient and could adequately respond to patient needs in the recovery process. Further prospective and methodologically well designed studies measuring method's treatment outcomes and cost-effectiveness should be conducted.

The use of Open Dialogue in Trauma Informed Care services for mental health consumers and their family networks: A scoping review

“…Wallner and Klapcinski's (2018) Polish paper specifically explored the perceptions of trauma and its treatment using an Open Dialogue approach. This narrative review established that Open Dialogue had specific application to community mental health that were also working as Trauma Informed Care services.…”

“…Attempts have been made to explore the use of Trauma Informed Care within different treatment settings however articles making comparison with Open Dialogue are rare. Wallner and Klapciński (2018) (Hopfenback, 2015). Becker-Blease (2017) suggest that ambiguity exists concerning how Trauma Informed Care principles are understood by mental health clinicians and implemented into clinical practice.…”

“…Attempts have been made to explore the use of Trauma Informed Care within different treatment settings however articles making comparison with Open Dialogue are rare. Wallner and Klapciński (2018), in their review article noted high numbers of individuals presenting to Polish mental health services with trauma histories and proposed that the inclusion of Open Dialogue within a Trauma Informed Practice model may be an appropriate means through which to meet an individual's clinical needs. Interestingly, Trauma Informed Care specific training has been reported as being included in Open Dialogue training programmes (Hopfenback, 2015).…”

From Mental Health Industry to Humane Care. Suggestions for an Alternative Systemic Approach to Distress

“…Its main principles are: 1. the provision of immediate help—an initial network meeting convened within 24 h of first contact; 2. social network perspective—all key members of the social network are invited to the first meeting (including important people or officials who are not part of the family); 3. flexibility and mobility—no exact treatment plans are made during a crisis, methods are adapted to each case and change in response to current needs; 4. responsibility—the staff member who is first contacted is responsible for organizing the first meeting and the whole team is then responsible for the entire process; 5. psychological continuity—the same team is responsible for the treatment; 6. tolerance of uncertainty—for the first two weeks, frequent (daily) meetings are necessary to build a sense of security and avoid premature conclusions and decisions about treatment, especially regarding utilization of drugs; 7. dialogism—the goal is to foster a dialog that will increase patient’s sense of agency and allow development of a new understanding of the situation [ 102 , 103 ]. This approach corresponds to the framework regarding diagnosis presented earlier, and though it was developed as an intervention for psychotic disorders and is successfully used in these cases [ 104 ], it is safe to assume that it could be appropriate and beneficial in most other situations or diagnoses [ 105 ].…”

Przez kwasową psychiatrię do kwasowego komunizmu. Renesans psychodeliczny w psychiatrii jako szansa na zmianę paradygmatu

“…w podejściach psychodynamicznych). Wyniki badań potwierdzają skuteczność takiego podejścia (Seikkula et al 2006;Seikkula i Arnkil 2018) i choć dotyczą one psychoz, to nie ma powodu przypuszczać, że nie mogłoby ono znaleźć zastosowania także w odniesieniu do innych ("lżejszych") stosowanych aktualnie kategorii diagnostycznych (Wallner i Klapciński 2018) opieki psychiatrycznej w ramach kwasowej psychiatrii, a więc psychiatrii, która nie patologizuje jednostek, nie narzuca z góry przyjętych prawd i rozwiązań, a umożliwia twórcze eksplorowanie nowych obszarów, angażując w to równocześnie otoczenie społeczne. Z kolei badania i praktyka związane z poziomem biologicznym znalazłyby najlepsze zastosowanie w projektowaniu usług pozwalających na bezpieczne odstawianie leków -proces ten jest bardzo słabo zbadany, psychiatrzy właściwie nie wiedzą, jak leki prawidłowo odstawiać (Horowitz et al 2021;Framer 2021).…”