This paper reports how, at the outset of a crisis, a psychiatric hospital admission team in Finland has experimented with openly discussing treatment decisions in the presence of and with patients and members of their families and social network. The paper aims to clarify the coevolving process between the family and hospital and reports some results using this approach.This paper describes the change in a psychiatric hospital in Finland from a traditional individually orientated treatment approach to a family-and network-centred one. The development of family-centred treatment began at Keropudas Hospital in 1981 and by 1984 joint treatment meetings for the patient, the family, the staff and other professionals were part of our standard practice (Seikkula and Sutela, 1990). In these meetings a systemic view of the family and our understanding of the psyche of the psychotic patient were integrated. Treatment meetings also provided an opportunity to organize the treatment resources of the staff working as a team. At the same time, we realized that the healing capacities within a patient's social network could become a valuable part of the whole process.
The boundary of the hospitalThis paper proposes the opening of the traditional boundary in psychiatric treatment between the treatment team and the patients and their families. Traditionally, the boundary of the hospital team has been a closed one and the patient's family has not had any place in treatment plans and decisions.After opening the boundary, patients and their families can participate in the discussions and planning of treatment.* Senior Psychologist, Keropudas Hospital, 95410 Kiviranta, Finland.