Recovery-Oriented Research Funded by Mental Healthcare Foundation

Inspired by Robert Whitaker's 'Anatomy of an Epidemic,' the grants will aid investigation of care models that have helped patients overseas
The Lund Report

November 21, 2012 -- The Wilsonville-based Foundation for Excellence in Mental Health Care – started last year to support a new model for mental health research – has awarded a $100,000 grant to research whether the Finnish “open dialogue” model can be implemented in the United States, and is both offering and seeking funds for other related grant projects.

The open dialogue therapy model was developed and implemented in Finnish Western Lapland at the Keropudas Hospital to help people who show symptoms of early psychosis. Instead of being hospitalized, prescribed medication and released back to the community – as is common with mental health patients in the U.S. – patients become part of a team which includes at least two clinicians, as well as members of their family or group of friends. The patient is included in every discussion relating to his or her treatment plan, and the practice – which is nearly 30 years old – emphasizes not the eradication of symptoms, but healing from the episode.

Research shows that mental health patients who use the open dialogue model have higher rates of employment and better long-term mental health outcomes than those who use more traditional models of care.

The foundation's open dialogue grant will support Dr. Douglas M. Ziedonis, MPH, at the University of Massachusetts Medical School in developing a clinical practice training manual and an organizational change manual to guide clinicians in adopting the practice. It will also determine what tools will be necessary to help clinicians in this country practice the open dialogue model – including which cultural factors need to be considered.

The foundation is also fundraising for additional research into how the model can be used to treat specific populations (such as transitional youth).

“We think we need to figure out once and for all, can this be replicated in the United States or not?” said Gina Nikkel, PhD, the foundation’s President and CEO. “There has not been enough emphasis on how trauma informs mental health challenges. Quite often, people will have trauma issues in their late teens, early 20s, and they'll be diagnosed with mental illness.”

If clinicians can offer better support for survivors of trauma, the long-term outcomes for people who suffer it can be improved, she said.

The foundation is also working on raising money for Hearing Voices, a program to research the phenomenon of hearing voices -- a psychosis symptom that often persists even after the patient is prescribed antipsychotic medications. Hearing Voices therapy groups across the country use a peer-to-peer approach to help patients live with or even make sense of what the voices are telling them.

While there are small numbers of Hearing Voices groups in the U.S., the model hasn't been implemented in any organized way. The fund will support the implementation of Hearing Voices groups throughout the U.S., as well as deeper research on the phenomenon of hearing voices itself.

The foundation – which includes clinicians, researchers and people who've experienced mental health challenges – was catalyzed by the publication of Robert Whitaker's Anatomy of an Epidemic, which reviews decades of research on the efficacy of psychiatric drugs, and criticizes the current understanding of mental illnesses as diseases that must be medicated for life.

“What we've learned is that we don't know very much about mental illness,” Nikkel said. “A lot has been written and a lot has been wrong.”

The foundation touts a recovery model – used in contrast with “ illness model” -- that suggests mental health patients can recover from acute mental illness rather than being considered a lifelong patient, and was created to fund research for better outcomes.

It raises funds both from the general public through its website, and from donors who can make larger gifts for its research projects. Nikkel said the foundation has accepted funds from psychiatrists, business owners and people who've experienced mental health challenges, but not from pharmaceutical companies or the healthcare industry.

“It's really a way, as public money becomes less and less in mental health care, we wanted to tap private philanthropy,” she added.

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