OWe launched Mad in America Continuing Education (MIACE) in 2014 with one specific goal: to provide an alternative to CEU and CME presentations, many of which are sponsored by pharmaceutical companies, which featured programs promoting the merits of psychiatric drugs and model of disease that psychiatry had adopted. when the DSM-III was published. Bob Nikkel, who served as Oregon’s commissioner for mental health and addictions from 2003 to 2008, spearheaded this effort for us and served as executive director of MIACE until his retirement last summer.
You can see that under this leadership, MIACE featured courses taught by psychiatrists, psychologists and peer community leaders who spoke about the need to rethink the model of illness and embrace alternative models of care .
Over the past two years, we have also held a series of “town halls” on Dialogic Therapies, which have been co-sponsored by several other organizations. Kermit Cole and Louisa Putnam, founding board members of MIA and trained in Open Dialogue Therapy, played a leading role in the development of these Town Halls. We have also developed a public meeting on psychiatric drug withdrawal in collaboration with the International Institute for Psychiatric Drug Withdrawal.
These two efforts – webinars and town halls – serve a different purpose. Continuing education courses were designed as “educational” presentations, with CEU credits offered. Dialogical town halls were designed to create a discussion on the subject. With this experience as a guide, we are now moving forward with a webinar that combines both elements: educational objectives combined with a discussion that emerges from a panel presentation. On Wednesday, we will be hosting a zoom webinar with this dual purpose titled: What is “Peer Supported Open Dialogue”?
However, as we “commercialized” this first program, we failed in one notable way. We did not emphasize that this webinar was designed to be the first in a series on this topic. As a result, we have been criticized for the fact that the first panel is made up of the developers of a ‘peer-supported open dialogue’ effort in the UK, with no peers on the panel. It’s an understandable criticism, and so it’s critical that we present our larger goals with this series.
First, a bit of personal background.
In my book Anatomy of an Epidemic, I wrote that there was a long body of evidence showing that long-term, regular use of antipsychotics increased the chronicity of psychotic disorders (and led to other harms), and that a pattern of optimal use would involve the selective use of the drugs, with two principles guiding this selective use: no immediate use with first-episode patients to see who could recover without drug exposure, and for those who were exposed to the drugs, effort to minimize their long-term use.
As part of my research for the “solutions” chapter, I came across research published by Jaakko Seikkula regarding outcomes in northern Finland for patients treated with Open Dialogue therapy, which involved a pattern of selective antipsychotic use. Their results were a “proof of principle” that could be drawn from over 50 years of scientific studies: it was a use of antipsychotics that produced significantly better results.
Since then, Open Dialogue approaches have been developed and adapted to local environments in the US, UK and many other countries. I confess to personal disappointment with elements of this adaptation, as the emphasis has often been on “dialogical” practices, with much less emphasis on the selective use of antipsychotics. In fact, in many coping practices, the selective use of antipsychotics has been ignored and left out of the equation.
Another adaptive element, but this one is fortunately the case, has been ‘open peer-supported dialogue’, with peers being an integral part of the dialogical team. There was no active peer movement in Northern Finland when the practice of Open Dialogue was developed, and so the integration of peer expertise into the dialogic mix was new to the practice and, perhaps to be, essential to its effective adaptation in our current system.
The Parachute Project in New York, which began in 2012, created mobile response teams that were trained in both open dialogue and intentional peer support, with the teams made up of both mental health and people with lived experience. This program, unfortunately, has stopped working.
However, in the UK the development of peer-supported open dialogue has continued and there is a study, known as the ODESSI trial, of the effectiveness of these services within several National Health Service Trusts from the United Kingdom.
Kermit Cole, who was the founding editor of Mad in America, is now taking the helm of our MIA webinars, and he envisioned us presenting a series of presentations that would “explore how the principles and practices of POD (sustained open dialogue by peers) are essential to implementing the inspiration of Open Dialogue in an intrigued but skeptical and increasingly desperate world. Kermit believes POD can even inspire and empower social media to deal with crises dialogically without needing to access the psychiatric system.
The first panel – this is Wednesday’s presentation – was initially made up of three people who played a leading role in creating this UK effort: securing funding, developing training protocols and evaluating its effectiveness . We thought having these three people – NELFT psychiatrist Russell Razzaque, family therapist Val Jackson and Professor Mark Hopfenbeck – to discuss the origin, development and future of POD in the UK would be a good way to start the series.
The following panels in this series will feature teams – largely peers – from the UK and Project Parachute who will talk about their experiences and their views on the future of POD.
With this series project in mind, we did not think to include a peer in this first panel, but instead decided to present the institutional origins of the British effort. We’ve since heard from a number of people who registered for the webinar, and others, that this was a blatant error on our part.
Personally, I think the mistake we made was not to make it clear that this was a first in a series, and that the series would follow a chronological path, one that told how the British effort took root and grew, and that the following panels would showcase the views and expertise of their peers.
Maybe that plan was flawed. However, I hope this blog will make our intentions clear, and MIA readers will now see the larger plan and join us in this exploration of peer-supported open dialogue. We are happy to announce that Charmaine Harris, part of the POD team, will be joining the panel on Wednesday as a co-host.
After the webinar, the zoom meeting will remain open to anyone who wants to come on screen and chat. Several panel members will also remain during this period.
Mad in America hosts the blogs of a diverse group of writers. These posts are designed to serve as a public forum for discussion – broadly defined – about psychiatry and its treatments. The opinions expressed are those of the authors.