Download Greek Subtitles for Ανοιχτό Διάλογο (Open Dialogue) Video

what for you what is the most important thing about open dialogue the first thing what I I find myself thinking now if you ask this tomorrow there would be another thing that would come first to my mind but today what comes curs to my mind is that uh everybody's uh voice is uh [Music] important I decided to travel to the north of Finland to visit the Land of Open dialogue the place that is getting the best results in the world for the treatment of psychosis wow what's the most important it's how we work yeah Co research of of problems or dilemas or traumas they get better results than anywhere in the United States and I was curious how they did their work I think it's it's not the you know the the treatment system system per se but but I think it's more like a political [Music] thing I want to see you we aim at at at the democratic system where people can have their say about their own treatment and that we are kind of try to be on the same same level with people and being uh equal with them I'd read some of their research and their data were undeniably impressive but somehow I just felt that seeing them in person would be a whole different thing hey him you can you can look up here up here I I can see your it's something that happens between people the sister of the patient the patient himself or the nurse oh wait hold on we have to get the repor to bring their understandings bring their skills and knowledges we we we are not professionals who who had has had to know everything right away you know we don't go there like a specialist and after one hour we tell family what's wrong with you it's a kind of two-way connecting um it's not me treating somebody but it's something um I risk myself when I enter into a conversation who are they what are they like is their Fame Justified but perhaps most importantly to me how would they feel about me a foreigner an American a psychotherapist myself filming them okay no don't look at the camera look at them and say you can talk to them this is open dialogue this is real open this is real we have the idea of hearing people and creating something together based on that [Music] before I left home I had the opportunity to speak with Robert Whitaker an acclaimed medical journalist who has been bringing the Finnish open dialogue results to the attention of American Psychiatry it was he who made it clear to to me that their outcomes for psychosis were not coincidental rather that they resulted from a well-designed and well researched program so when I go to Western lap land in Finland what do you think my mission should be well first of all I think it's just a chance to observe um there's so many different people involved in the finish story do you have an entire Therapy Clinic here but just one room yes and that's why we can't we don't have room to meet patients here and we don't want to meet patients here because this is Hospital yeah we don't want to say to people who have crisis that oh welcome to mental hospital so we can talk here it it it was an interesting thing because when I first came here I was thinking I think they work very well with the mental health system and they're even integrated into the mental health system but I kept waiting to find out where is the mental health system okay do do you understand yeah yeah and then what I realized yeah it's this this is the mental health system yeah yeah and I thought that's that's actually fascinating uhoh oh uhoh somebody's calling when someone calls when someone needs help we triy to arrange help for him or her rri way we don't I don't say to a phone that uh maybe we can meet uh after two weeks and then we have time I think I have to find but do you have to you're attached that's okay oh I'll turn off the camera you're going to be privy to a form of care that really is getting the best outcomes in the developed World by far that's a part of our you know uh basic rules when the phone calls you have to answer it take the responsibility for for what comes from there that it is interesting how many many many of my interviews have been interrupted by the telephone here yeah yeah because I I think that's that's a question of you know being being uh like available to people and and and serving the population not not hospital patients but people outside hospital I'm sorry I have to answer you go you never know what what comes from the telephone it could have been a mother being worried about her child or or something and and then I would have have to start organizing things you never know I mean it's so different there okay I mean if you look at the outcomes people recovering there they're not here and so many other countries so basically the world has a chance to sort of break out of this mindset it's hand the world psychiatric system and do something better and so you're talking about the capacity the the opportunity to tell a story that literally could alter millions of lives if societies would change and learn from uh the Western lap land success so that that could have happened right right there yeah yeah I'm very pleased that it didn't happen because I have to be at the at the town at half past two but oh in cam yeah I guess what I'm trying to tell you Dan is that um I really think there's opportunity here yeah at the Town mental health office I have a patient there with with a nurse from from there we are working together with with the patient H so you're meeting with a nurse and with the patient yeah so that phone is a big responsibility yes middle of the night also yes does that make sense yeah it makes sense and I'm just I'm wondering are there any psychiatric survivors in Western Lapland I mean what do they think of this method I mean are there people who are criticizing this open dialogue method and what do they think in Finland I wonder there are some psychiatric survivors in Finland uh but more you know in the other areas do the patients prefer that you meet in their home or do they prefer to come to the hospital most of people says Welcome to our home but there are people who don't want us to go there and then we meet here or or some other places we have you know Center of City we have a other poin there yes in Tor in the town and there are rooms more rooms and we can have a point meeting to and so you give the the patient the choice yes yes but most places have have adopted the Western right the US model of I've gotten people who bought my other movie Finland and Helsinki and they're telling me Finland sucks for Psychiatry I remember first coming here first coming here uh it must have been 19 65 or something you came here in 1965 what you were 10 years old yeah but that's how sinky that's not Western Lapland so it's like they were like yeah my brother or I or you know you know my child were locked up in a hospital and injected with the same drugs that we're using over here yeah yeah actually outcomes for schizophrenia as a whole in Finland are very poor and that actually that actually sort of shows that it's not just the culture people say ah Western you know Finland they do think there a it's a much different Society well there are outcomes where they have adopted the medical model and by the way Finn doctors are being bought off by the psychi by pharmac companies too uh their outcomes suck right I was singing in a Boy Choir for the patients in the hospital yeah yeah we made a a trip here and and and had a small concert here and I was I I remember being quite not shocked but but surprised that that there would be also these kind of places in the world I mean one of the interesting things here is this is known as a valley in Finland this West s that actually has a lot of medical problems okay and it may do everything have everything to do with the temperature the light uh maybe changing economic opportunities so it's actually a society that's been under a lot of stress for a long time so you came here was it very different from what it's like now yeah very different it was uh very worn out hospital and and very uh in a bad shape in many ways and and just chronic patients and and smelling bad and everything so it was a scary experience so for them to and you know sort of reverse this one part of psychotic outcomes it's not coming as the society as a whole is having this great Easy Life they're doing it in spite of all those difficulties I remember it quite we coming here with right here yeah strange singing in the lobby there is at the [Music] do although I went to Northern Finland to study them I quickly discovered that they were also studying me so much so that a finished newspaper poolan sanomat discovered that an American documentary filmmaker had arrived in the area they wanted to interview me which I found ironic considering that to the rest of the world they are the famous ones I came to Finland to torneo specifically and kemi because they have their open dialogue method for psychosis where did you hear uh of that method it's famous it's famous oh yeah so yeah and I mean there what it is is I've heard of it in the United States okay I've heard of it in conferences in Scandinavia I have friends in England who know about it but mostly through the work of psychologist yako secula the idea of living in Toro started when I moved there for being a clinical psychologist 1981 so quite long time ago almost 30 years uh 30 years 30 years ago yeah and we were a small group of people and uh we all had an interest that we want to have a family to become involved in the treatment of severe mental health problems he's a professor at the University in U vascula mhm so before I came here I interviewed him and I'd met him at several different times in different countries I I remember some meetings that were not for help for the people and in which we actually acted quite stupidly yeah early on early on yeah yeah so you made mistakes early on yeah we made mistakes like what his research showed that for treating people with psychosis they get the best results statistically in the world we still thought of the treatment that we are the therapist we have to make plan we have to have some aims and we use for instance these open meetings as an intervention to have change within the family so I was a psychotherapist in New York City for 10 years what what happened was that that we didn't realize in the beginning but while we open up the door for the family and for the client to be there for the paent to be there from the very beginning it it's the case that uh that uh they really take a very decisive and active role in the process the the patient does yeah and the family does they affect from the very beginning how to do what to go on what are their needs and and we still try to to think that we are the healers we have the intervention we have to do that part of my special interest is showing that people diagnosed with schizophrenia and psychosis can recover fully without medication okay so the confusion was that you thought you were the the experts the healers the one who have to make the decisions yeah and what you found is that they wanted to take an active part also so they were treating themselves as the healers and the decision makers and they would be the on who made the decisions and the interventions so there was conflict yeah a very much conflict about it here they do that work okay this is the work and it's very uncommon now we think that it's no longer a question that we are sitting together for making decisions and making plans for the future but we are sitting together to understand more most places in the world this is funny what what that I'm talking slow slowly is it better though yeah it's better yeah and and in this we aim at generating dialogue and this actually becomes the most important aspect no longer thinking that the aim of the meeting is to have solution the solutions comes a PA of self evident process that is opened up will be focus on how do we manage to have all the voices heard so the purpose is the purpose is dialogue and as a consequence of the dialogue the solutions happen yeah to change start to happen [Music] immediately the open dialogue approach is based on several fundamental principles the basic one perhaps not surprisingly involves open dialogue a non secretive nonh Hier archical conversation that values everyone's voice in the treatment especially the voice of those called clients likewise therapists work in teams where they speak and reflect openly with one another about their thoughts and feelings right in front of clients and their families although these principles sound reasonable enough in actual practice they are a profound departure from almost every mental health model I have observed in in the United States when you decided to become a nurse did you think you would become a therapist also no they called me and asked me can I come to summer job here and so I came at one summer and I'm still here 11 years now really so you liked it yeah was that may maybe in maybe first year I I think thought that I'm not sure about this and I Tred to maybe I try to check out different kinds of work in anesthesia and surgery but I'm very pleased that I stayed and what was difficult the first year you know that dialogue what I like about this is is just that you can like how do you say in English ball around with ideas with you can what what you know bounce idea bounce bounce ideas yeah with your colleague and and what with the family and right in front of the client yeah yeah and with them not not about them but but with them you know talk with barana about something and then ask ask the patient that but what do you think about what we were talking about and yeah we sit down and there was a patient maybe a wife or someone from the family and uh couple of nurses doctor and we start to talk about the situation I thought that okay what what are we sitting here we know what what is going to be and what what is going to happen we have to take this person in the W and what what why why why why are we sitting here and discussing still but uh until you understand that this discussion there there's meaning when I wake wake up in the morning it it's very good when I I I see my timetable my my calendar that I I have for example five clients or maybe six today and I have um Team I have someone who can work with me it's very good idea it's feel it's make me feel good the thing that we are sharing the work all the time is that we are ventilating it all the time as well mhm so the the thoughts are kind of uh they are in in a movement all the time it's very helpful when you can share your thoughts and your uh feelings with someone in in that treatment situation you can reflect the first meeting with the patient uh patient can be wor first a little bit um you know why why two workers but when we explain it and when we start working and discussing together so it's he or she finds out that it's good and sometimes we are three for example when when we have a new patient psychotic uh with her or his family then we of take three therapists there are many things it's hard to say to client clients this well I'm thinking about this and I'm feeling like this it's easier for me for example to talk to you or you and hey I'm wondering and I'm feeling that or that way during our discussions during our treatment meetings it is the first time when the patient can tell his or her own experiences that kind of experiences that somebody can say that they are psychotic experiences and others are listening and hearing it I do sometimes meet people just by myself but I think it's Getting Thinner it's it's giving much less options it's it's um it's much smaller audience for the for this new understandings this is the way how we usually work that we go we can look each other in the eyes and we turn ourselves a little bit in the middle of a therapy session yes so in the middle of a therapy session when you're with a client or with a family you do this with each other you're going back and forth and talking to each other yes yes and then then we can ask hey how how do you felt how does it felt and what did you listen how did you heard this our discussion so it's almost like you're doing supervision with each other yes in the middle in the middle of a therapy session that's it that's I think that's that's how we would describe we have much more options when when when we are more people um and then it's also possibility just to listen while some some other people are talking and and listen to yourself so I think it's in many ways it's very useful and and it's very important that we reflect about things and issues what family bring up to the situation yes it's very important I consider us more or less as visitors in people's lives people allow us to visit their lives but we are not the most meaningful people in in this person's life it's more more important that my client will be understood by his family members or those people around him and so that's how he or she become heard understood [Music] valued uh as a person but it's a different kind of supervision because you can't you have to do it in a way that's also therapeutic for the family and the client isn't that it yes so you have to make sure everything you're saying is going through the lens like this is the lens the lens of being therapeutic yeah so you have to be more respectful you know like in supervision I think you can say this is that father is so narcissistic when it's private supervision you know but you can never say that in open dialogue because it's rude does that sound right yes yes it's it's very well I think so think yeah and it also seems like people here like each other yeah yeah I'm actually when you say that I think that's one big thing that this is a small area and and if we have a 100 people working here working cras cross with with each other so people know also each other quite personally you know they can become friends and then and talking other about other things also than than work and I think that's makes it easy for for us to to work in the way we [Music] work I ended up spending 2 weeks in Northern Finland and became friendly with many of their clinicians while talking off camera I learned that several to my surprise had little experience working in a non-open dialogue system to the degree that many appeared to underestimate the international significance of what they were doing so your whole professional experience has been in this open dialogue system yes but I have a a experience on meeting in a different area a conference no like a bti that has G the different PR yeah and uh a different area with outside of your regular work area and because we are Outpatient Clinic that we treated him at at home but when he goes to another place he goes to hospital and we go to meeting to to so you went there yeah how was that I didn't like it what was it like um there was a nurse and a doctor from that hospital and us two nurses and the patient and she a two nurses from your system here yeah and uh and we we discussed with the patient and and nurses we um uh reflect oh you did open dialogue yeah and try to speak openly on the what we have done and and what we think of situation and so on but during the meeting the um doctor just listened and and when he had heard enough he said okay thank you I've heard enough and goes away didn't say anything well so didn't do open couple of questions but she doesn't participate on the on the dialogue was that strange for you yeah and I okay you go and you talked about this with the other nurse from your system here yeah we thought when we talked afterwards that with the another nurse that when the doctor goes away and said that okay that's enough for me him and left it f i felt that and she felt that that what what were what we were there [Music] about I was very curious how clinicians in Western lap approached the subject of neuroleptics that is antis psychotic medication from what I have observed and studied the use or nonuse of neuroleptics is probably the most important factor correlated with recovery from psychosis but before the essentials of the Fin's relationship to medication came to light I found it important to explore some background not just on neuroleptics but on the Fin's conception of the very meaning of psychosis so most places most places in the world when they have a person with psychosis yeah they put them on very heavy medication immediately is that like all over the world or just in the western part uh it's definitely in the western part of the world but it's shifting okay to all over the world and there is research showing that people with psychosis do better in third world countries what they did is they compared schizophrenia outcomes in uh poor countries of the world specifically India Nigeria and Colombia to uh rich countries Us and other European countries quote the developed countries developing versus developed now in each study they found that outcomes at the end of two and five years one was a two-year one was a 5year study were much much better in the poor countries of the world especially in India and Nigeria by the way okay and it was so dramatic they said that living in a developed country is quote a strong predictor that she'll never fully recover from a psychotic or schizophrenic break all of us could have psychotic problems it's an answer to a very difficult life situation and when I deal when when I face with a situation which is very stressful for me so I can start to hear voices for instance and what happens in those voices or or or or those experience that I have they can include something that previously has happened in my life we have to listen we we we really have to listen and um let them talk what has happened and we can't know maybe some stories are so um crazy maybe crazy what is the right word um we have to ask more about hallucination and we have to ask more and try to understand what has happened we don't say that you can't you don't you can't speak we have no right to say that that is impossible because we really don't know it's it's not only that we are talking that um we have an open dialogue system but uh we dialogue have to really be open so one of the things they hypothesize The Who researchers is well maybe what the difference is is that people in the poor countries are better at taking their anti-yo medications they're they live in a different environment where they follow doctor's orders better and so they looked at medication usage so the hypothesis was more medication usage would be associated with better outcomes and they're hypothesizing that the meds should alter the long-term course of schizophrenia psychosis it's a valid hypothesis that's what you'd expect drugs to do if you're going to find them useful is to alter the course but what they find they found that in the poor countries of the world only 16% of the people were regularly maintained on antis psycotic medications whereas of course that's the standard of care in the uh developed countries so here in this in this study we found good long-term outcomes much higher recovery rates associated with not maintaining people on medications very seldom very very seldom I I've been prescribing anti psychotic medicine and usually what is the reason for so seldom prescribing it well I don't actually I think I prescribe very seldom any medication so that's one point that's one point in the first meeting it's very nonone understandable I cannot understand how what what what what does it mean I'm very confused but later on step by step I start to realized that actually she is speaking of something that has happened in her life and this may be the first time ever it become possible to have some words of those experiences it's in a way a kind of metaphorical way to speak of things that you that beforehand did not have any words to speak about it psychotic meaning making is meaning making and I want to uh have dialogue around meaning making and I don't think we should medicate psychotic meaning making oh by the way the who invest instigators eventually then did like a 25e follow-up study of the patients in the poor countries and it's really remarkable I I don't remember the statistics exactly but somewhere between roughly 70% of the patients in that initial cohort of schizophrenia patients diagn in Indian Nigeria diagnosed a schizophrenic by Western doctors not local doctors so by Western standards 20 25 years later were working asymptomatic they just weren't schizophrenic anymore there weren't psychotic anymore and for that reason it's very important actually extremely important for us to take it seriously to start to listen what what is what what are her words and and and step by step she perhaps have more and more words to her to to to her experience there's some kind of dilemma in your in your life and and in your emotional life and when you start to work with that dilemma the symt can go away as [Music] well I learned during my time in Western lap land that open dialogue practitioners view the concept of psychosis very differently from how most people view it in the United States in America psychosis is generally viewed as a problem residing in a particular individual's brain which is why treatment so often involves pulling people out of their regular lives hospitalizing them and giving them brain altering medications in Western lap land however they conceptualize psychosis as a problem arising in the space between individuals that is a problem occurring within relationships thus their treatment seeks to engage social networks rebuild relationships ship and if at all possible avoid putting people through the alienating and stigmatizing experience of hospitalization why do you prefer to not put people in the hospital if if the whole um psychosis or um situation goes over without coming to hospital so if they're able to work it through without going to the hospital yes it's much better for the patient and family they don't have history of mental hospital I remember one family in early 90s that they had a son about 20 five 26 years old and first he came into the hospital for some days most of the times that need be in hospital is because they need shelter or place to be that it's safe enough to the patient that he don't or she kill herself or or is so um psychotic that needs a safe place to be another big reason if someone hasn't been sleeping let's say for a week and they need a place where to kind of uh feel safe so we can create those circumstances to their homes as well if we do the cooperation and and work together with the family and afterwards we asked the family what they think they said that it was very hard when they son was in the hospital and also it was very hard to treat him at home but it was much more easier at home so you can create you can work out those kind of issues in in their home yeah and we can go there every day we can be there let's say uh we can have a treatment meeting and then one nurse can stay there during the evening shift like all night long yeah with the with the with the family with the family in the home yeah and they said that it was wrong decision to come into the hospital at all H so that just avoids the need for hospitalization then yeah and when we are home there are more possibilities to have the conversations about the situation very often these relatives comes to help for but it's very difficult then if we talk about adolesence and see he has psychotic symptoms and see or he has have has parents it's very typ difficult that parents live on SI leave and they can support at home and we meet every for instance every day uh during these first days weeks first days always when we are treating at home I think it's very important to have treatment meetings very every day day in the beginning and continue as long as POS as [Music] needed although I would ideally prefer a mental health system for psychosis that avoids neuroleptics entirely the Finish open dialogue clinicians employ a selective use of medication model that comes closer to my idea than any major program I've seen in the United States for that reason I found their point of view riveting and in many cases based on such common sense that I wondered why it wasn't being utilized more widely in the Western World now I ask about your documentaries when it comes out what it is I'm not sure yet I don't know you just doing I'm making the movie first to just to show people in the world that that there are better treatments than the conventional treatments so here in the United States where we've really embraced the drugs for life form of care we see a um explosion in the number of people quote disabled by mental illness and we see all these other problems in terms of people dying early Etc and low employment rates decreasing employment rates and here where they've used this drugs in a selective manner what do they find the exact opposite so what should we do obviously we should go to which is what you're going to do we should go to Western lap land if they'll have us and try to figure out what they're doing and emulate it quite quite a many people psychotic people who come to us they get some kind of medication but it's for a short period of time to get over the worst and and then we discuss it all the time so I think it's more of a a minimizing the medication and which type of medication are you talking about uh well I'm not expert in in those but but not so much about you know neuroleptics but but more of a you know sleeping pills or some anxi litics we used it during the first week because the situation when they call us so we we will see them uh in the first 24 hours and the situation is usually so that person hasn't been sleeping for a week or two it's always here that we just consider that's how many tablets we give we don't prescribe a box of tablets but we think maybe for for one or two days use two or four tablets so that's the most common that they use in a short term just four or five days or so to get sleep and so but in some cases uh they can use uh neuroleptics but it's also a shortterm and in small doses in the beginning of the treatment we we have to it's my opinion I have to avoid netive medication and but but then if it's needed if it's needed in any let's say in one year of all the patients that you see that have psychotic issues what percentage get put on neuroleptic medication about one 30 30% yes so 70% don't ever get neuroleptic medication some sometimes there are situations that patient need medication also netic medication there can be so kind of situation here's a question I have mhm we were upstairs in that staff room MH and I was playing with a pen did you see that no I was playing with this really nice pen I said someone left their really nice pen here then I turned it over and it said squil yeah so I thought it's even invaded this place yeah yeah and then I see the people are using the mouse pad that says um yeah affects her yeah but how how we talk about that medication and we have to be careful that that those does are appropriate that there are no side effects well of course they come here as well to talk about the medication to doctors they do yeah and they bring good food many times and pancakes and stuff and uh also we we are going to have a a day for stuff next autumn and so we have invited person from the druck com company to come and tell about sok and then they are going to pay our lunch how do you feel about that it's okay for me because we are just listening them is that it though yeah it's quite usual for us to discuss a lot about medication ation also with the psychiatrists when they're prescribing medication to some patients then I would quite often ask why do you prescribe this what do you hope would happen would there be another and you say this right in front of the client yeah because I think it's it's quite it's fair yes just just fair to to say what we are what our you know prejudices on and what our thoughts are in front of the client yeah well actually bir she's our doctor in Poly Clinic and she said that she's not going to call them she she she doesn't do that right so but one of our nurses went to the educational days and she asked because we said okay because we get a free lunch right so take it I remember two patients I prescribed and tried to tell how to you had to take this medication but they didn't never do that and they are quite well so you prescri so there even cases where you prescrib the medication they don't even take it yes and Tred to tell them that they have to take to take it and they didn't yes they didn't and they are getting well anyway anyway against your advice yes I wonder this mhm if a patient if you feel a patient needs neuroleptic medication later in the treatment do you consider that a failure [Music] no no there are so many other ways to help there are [Music] so um useful ways which have I think um improves the agency of people much more than um than medication it it seems to me if a person needs neuroleptics it means they did not recover right yes but I have also some so kind of experience is that the patient have got NE medication later but uh but see or he needed uh it some months one two years or only a small dos and after that they didn't need it I could bring up the idea as um as a as an option as a something we could have dialogue about around think about possible uh advantages possible disadvantage um possible effects possible side effects but if I find a lot of other ways to work there so I don't even have to bring this option there and usually when we work there are so many options that we don't get into this point of thinking about medication if the patient have medication we don't Ender treatment and you don't end the treatment no no because we continue treatment so so far as they use medication for instance neptic with the purpose of helping them stop the medication or I don't understand yes yes helping stop yes it's not either either or it's either medication or not medication but it's thought to be one part of the treatment if needed if if needed so it's such a complicated thing who decides what's needed you know jointly in the meeting in the joint meeting is it's it's it should be decided in the joint meetings and do you ever have different staff members with different opinions absolutely yeah and that's advisable that if staff members have different opinions that they would could be openly spoken about so that one staff members could have an idea perhaps the antipsychotic medication is not needed here and perhaps the other meas person have an idea perhaps the medication would be good and it's very important to have an open discussion about [Music] it a fascinating thing I discovered in Western lap land was that their clinicians were not unlike so many of my more Progressive colleagues in the United States afraid of getting in trouble for the work they did this I realized was because the fins were not working in a mental health system that constantly suggested they were breaking the standards of care and causing harm to their clients the irony I found in this is that in the United States we who use anti psychotics almost ubiquitously for psychosis get terrible results and actually are causing an epidemic of harm but in the Western World almost everywhere it's medication and medication is considered the best treatment and if a therapist or an organization does not use medication they're considered dangerous okay it's considered bad treatment it's very very difficult to survive as a person with prescribing powers and not put people on antipsychotic medications and if you're even if you're a therapist without um prescribing Powers you're expected to work within that model of of of drug based care and it shows really the extraordinary capacity of uh a storytelling partnership within in the United States that really has extended its influence and that is born of the drug companies and academic Psychiatry along with nami to tell us a in essence a false story and and incorporate that belief in the sort of a real uh profound way are you at any risk with your medical license because of the way you work here um haven't gotten so far away from a medical way of working no I think um um no like let me ask you this do you take a lot of Risk by not putting people on neuroleptics right away uh what do you mean by taking uh risks could you lose your license if I don't do what if I don't tell people that I think that there should be medication yeah of course not where did you come there what's that idea but that you could lose your license yeah well I dealt with that every day if I if I was working in different contexts it would be quite difficult um but over here where where the whole personal uh the whole Personnel the whole staff whole staff yes they are very well trained a most of the people have family therapy trainings um the whole supply of services is is based on on these ways of working so you're not at risk here no not at all no really because me you couldn't get in trouble no so me as a nurse so I I will what about Bita couldn't she get in trouble for what she does no why because uh she can um everything is based on the uh results of treatments so everybody here knows that you don't need a neur leptic in the beginning to to heal people's situations and your system has research to prove it yes yes yes yes and there are lots of studies going going on around so I think it's it's um giving a lot of solid ground for the [Music] work let's now look at the numbers what actually are their results it was after all a cursory review of their outcomes for psychosis that Drew me to Northern Finland in the first place and these same outcomes that are causing the world to take note their adoption of this selective use of meds really came out of a national finish study where they were testing sort of psychotherapeutic care they had six sites in the study three sites did not initially put people on the meds the other three did and everybody gave them psychotherapeutic care T was one research site in which the antipsychotic medication was not started in the very beginning but it was decided that first we have to see how much this very strong psychosocial intervention is helping and the antipsychotic medication is used only if if if it's uh not helping enough and the thought was an experimental sites is that if people started needing the drugs you could put them on okay on the whole the experimental sites three had a little bit better outcomes two it was the people who in those three experimental sites that were never exposed to meds in the two-year study that had the best outcomes all right that fits with what we know before but there's one other key thing there was really only one of the three sites uh that really after the end of six weeks tried to keep people off meds okay the other two to basic reverted to the old standard of care and put people on meds that was in Western lap land so not only did they watch the progression of people getting better after 6 weeks some they kept it going during 5 years time it happened that oneir of the clients used antipsychotic medication two dirs did not need this is in your program yeah any any antipsychotic medication at five and half part of the medication could be discontinued as well half what could be discontinued stopped of so so of the one3 that did take medication half of those people were able to discontinue their medication yeah yeah so now you're down to at the end of five years one out of six people yeah is still on medication and only one and three ever took it at all yeah yeah yeah and what did that evolve to there that evolved to a form of care where uh they now have a the best outcomes in the Western World by far how do they use meds well about only about a third of their first episode psychotic patients um are ever exposed to medications okay at the end of five years so you take 100 first episode psychotic patients in Western Lapland 5 years later only 33 will have ever had a single dose of antis psychotic medication and only about 20 of that 100 will be on the drugs continually okay so that was already that's is a very different compared with the mainstream idea very distort that so m iotics medication should be used in any case every case every case yeah now what are their outcomes at the end of 5 years roughly 85% of their first episode psychotic patients are asymptomatic and either working or back in school so only about 15% have become sort of chronically ill and on Finland disability whereas in the United States if you have a first psychotic break or if you have a first schizophrenic break you're basically told we'll to stabilize you and then go on disability that's the expected course of the 85 % who recovered after 5 years what percentage of that 85% was on medication and what what percent was off medication actually I have not looked at that path most of them did not use medication most meaning more than 50% no 90% there there is an assumption of course that once someone has schizophrenia they always have schizophrenia and you don't see it that way no I think it is only the name for something and you can get quite healthy afterwards without medication without medication this tells us of something else that's possible radically possible radically possible and by the way they've been doing this for 20 years now basically or 18 years so this isn't a fly by night study not a fly by night and they've done study after study after study this is the best studied cohort of patients in all of Europe really [Music] we study our own work study quite carefully what we are doing and and what works and what doesn't work I don't see this as very radical ideas I don't know maybe somebody would see this as radical ideas but from my perspective it's it's not very radical ideas and it's very important that we believe I believe in that uh the situation can change so you do see people with psychosis yeah recover here get well without medication yeah yeah not easily not easily get better but but getting better what makes you believe because I have seen many many many patients and their families that that they survived so kind of situations and I I don't know I don't well I I believe I have seen that you can recover from The psychosis without heavy medications and without hospitalization so that's just the way that I think so you believe that people can recover yeah not only believe I I I think it's true I I've seen [Music] it as my two weeks in Finland Drew to a close I realized there was one final point that kept striking me again and again and that was that the open dialogue approach was not an alternative mental health system here it was the primary mental health system here over the past three decades they had set an example by converting a traditional psychiatric system with a huge bustling hospital and poor results into something quite the opposite there's one other thing that's really extraordinary that's happened in in Western LA and and speaks to the possibility there but not many people like you kind of people come here and do this kind of job so I think this is very interesting for us too to know how uh interested someone in someone is about this because for us I don't I think we you never are they are never proud of anything in the 70s and all 60s 7s probably I think into the and even into the 80s this area of of Finland had one of the highest incidences of schizophrenia in all of Europe so fins are never proud of what anything like you're very well well I noticed this when I'm interviewing people here they won't talk about how good their results are the results are written on paper and I'm asking them and they always make it sound less less less and I say make yourself sound good do you know what I mean I like they're very modest and humble yeah then they Institute this change and they Institute this therapy called open dialogue with first episode psychotic patients guess what happened schizophrenia is now disappearing from this region they're down to two cases per 100,000 a 90% decline in schizophrenia there and why because their first episode cases aren't becoming chronic so the number of First episode cases is staying the same all right so they still have this problem of psychosis in society but because they have this form of care that doesn't make people chronic schizophrenia is disappearing this point cannot be emphasized enough and is worth explaining a according to the definitions of mainstream Psychiatry people can only be diagnosed with schizophrenia if their psychotic symptoms persist for longer than 6 months thus if they recover from psychosis before that six-month Mark which is what so commonly happens in Western lap land as the result of open dialogue they never get labeled with schizophrenia in the first place they took a risk by letting me come in here with my camera do you know what I mean M like to let a foreigner come in with a camera and interview all their staff and to talk with their patients it's like a lot of places they don't want someone with a camera coming in it's it's honest way to do work I think and I I think that um when someone comes into psychiatric uh Polyclinic is and is in they are in their CR crisis I think that we are what's the word obligated into that we have to be honest this has to be a fair deal because yeah because otherwise it it can't heal anyone like what if they said they could say this this would be much more common because I had some places that I wanted to go to that said you can come you can come for 6 hours you you can talk to two therapists no conversation with patients and we need to see everything that you are going to put in your movie before you put it in I think our system is our people are working very hard and they are I can trust them and they are very reliable and and responsible and that kind and very good trained people they know what they are doing and you know what also this was very interesting I didn't know if they would let me come here because I'm a stranger I'm a foreigner they don't know me very well so I was emailing with yako secula M and he said I said to him well don't worry I won't make I'll be very nice and I will ask respectful questions and I won't make your program look bad he said no he says you go in there he says you ask whatever you want and he says you don't try to make us look good he says you make it real you make it honest do you understand that M and I said this is really interesting I said good for him he's got courage here's a here's something that I think people might could have size open dialogue for they say but having so many different therapists there must be very expensive well how how come in the long run we save money with meeting in teams because I think it's more efficient you don't have to meet so many times this area is quite poor and they try to save money all the time and that's why it is it is not so easy to tell that it is very good work for long run and how to prevent problems in the long run and you know I think at least in Finland the the people who decide about money they don't look beyond their nose who pays for all this it's state paid system so it's free for the clients so it's a state paid system it's free for the clients yeah it's free for all the clients for you can have hundreds of meetings for two years and it's all free all free yeah when we are working in in a team and meet people with their you know wives husbands amilies then we don't have to meet them so many times for some reason I think because we can get the different points of view or or opinions more quickly we can have kind of more uh wide discussion about things all the time there is lack of money mhm and we should have more nurses psycholog assistant some some not so many but some more when we meet a patient we sent sent a bill so kind of Bill to the municipalities right and they pay for it but taxes we all paid for I think so so your taxes pay for it is not important I I think it is I try to tell our staff members that they don't have to worry about it it's my worry about the money is it's funny I haven't figured out where brigita's office is yet well nobody knows her office is at kopas right but she's never there right cuz she's working she sees clients right that's what everybody says it's hard to find her there because she's she's on on the ward or she's talking to someone or she's out in the community somewhere yeah it's very interesting to have a hospital leader yeah who is actually doing non-administrative work yeah I think so too and and I appreciate that for very much I think that's very important for our work that that also our our you know our highest Chief is is in in the clinical work and and working with us side by side it's it's so valuable I I think it's and rare [Music] before I ended I wanted to hear people's final Reflections on open dialogue I only wish I could have added in client Reflections which I couldn't because of the systems confidentiality agreements but if I can summarize what I heard from clients off camera and heard repeatedly it was the opposite of the frustration rage alienation betrayal and hopelessness so often expressed in the United States here I heard expressions of satisfaction mutual respect togetherness trust and hope which incidentally and by now for me not surprisingly were the same things I heard from the staff some people think that this is my work life and this is my personal life but in a way I don't see the difference because I think that uh it has to I have to have I need to be with those same values in both places in at home and at work as well yeah can I get you to find my paper so I could use this yeah sure will you sign it too okay up about 85% that basically recover right their unemployment rate is lower than the background rate for Ault Finnish population as a whole so they're doing better in terms of employment than the general finish population overall in terms of working that's right so that's really extraordinary so I just feel yeah you can see that this is the one who I interviewed this morning who said this is no no no not her she's the one who is um he's f p yeah she says oh my God to get know patience family and meet the whole family to hear the voices from the whole family I think that's the most important and and then this is the man yako secula every year between five to to 7% of the population participates in in in in these open meetings and now this has been going on for more almost 25 years or more than 20 years so it means a big part of the people in the area has at least sometimes be participated in this open meetings she's the head psychiatrist she runs the whole organization I liked when I came to work here in in kobas hospital I liked most the teamw work it was much it was so nice to talk to people and not to know everything and not to know answers always she's a um well she's a nurse and a family therapist I have I have taught many times that I like to move all because of my private life so you would like to move to yes because of my private life but but but I haven't done it because I like to uh I like the way of working here he's a a psychologist it's a place where you can be inspired over and over again by the people you are working with and and and by your colleagues and and now you're a part of it too [Music] he [Music] B [Music] I've have seen people in ki you have noticed it is much so sorry can I ask you want me to turn this off yes [Music]