Life after integrated and dialogical treatment of first-episode psychosis: long-term outcomes at the group and individual level

Abstract

This research (comprising studies labeled Study I, Study II, and Study III) aimed to evaluate the long-term outcomes of the family-oriented and need-adapted Open Dialogue approach (OD) in the treatment of first-episode psychosis (FEP). Quantitative and qualitative data, based on an average follow-up time of 19 years, were derived from the Western Lapland research cohort; this included all persons (N=108) who received treatment for FEP over three inclusion periods within the catchment area in which OD was regionally implemented. Study I used case note-based information to analyze specific patterns in the use of mental health services under the OD treatment system (N=65), in the decades following FEP. For Study II, the mortality rates and long-term use of services among the cohort members (N=108) were gathered from national registers. The results were compared with a matched comparison group, comprising all Finnish FEP patients with a 19−20 year follow-up whose treatment was initiated outside the catchment area (N=1763). Study III included information gathered via in-depth life-story interviews with 20 members of the cohort. Thematic narrative analysis was used to interpret how the people themselves viewed mental crises and OD as part of their life stories. The results indicated that the practice in the catchment area had followed the principles of OD, even if there was variety in long-term treatment patterns. Compared to other FEP treatments, OD was associated with a significantly decreased need for mental health services, and with better maintained work capability at a 19-year follow-up. The standardized mortality ratio was lower under OD, but in both groups, the premature mortality rate was high, and there were no significant differences in suicide rates. The service users themselves emphasized support from their close networks, and also their own actions in the gradual process of surviving, thus reflecting a tendency to associate mental crises with actual life events. The results of this thesis suggested that with gradual developmental efforts towards collaborative treatment approaches at the community level, it is possible to help people to maintain their agency and social functioning, accompanied by a decreased need for mental healthcare, decades after FEP. However, due to the observational nature of the study, more research is still needed on the effectiveness and transferability of OD.