While Congress debates measures to expand the reach of mainstream psychiatry to the severely psychotic, an alternate kind of mental health care is taking a very anti-mainstream direction. It is focused on nonmedical, holistic recovery, rather than treating symptoms, overmedicating, or involuntary restraint. Three quarters of people put on medication for psychosis stop taking it within 18 months because of side effects or other issues. There is a vacuum of need to help the severely ill, so these programs are proliferating.
A program called Open Dialogue at Advocates in Framingham, Massachusetts, uses this alternative approach to treat psychosis. This program involves a team of mental health specialists who visit the affected people at home and talk about the problem with them, without immediate labeling or medication. People should be evaluated by a psychiatrist before starting any alternative program.
At a support group for those who hear voices, the other members of the group get to address the voices of others directly. The hearing voices groups are led by a person who hears voices, sometimes accompanied by a therapist. The setting is very non-psychiatric, and such groups have tripled to more than 80 in 21 states. The Hearing Voices network is not anti-medication. Many people who attend the group have prescriptions, but many have reduced their dosages. Not everyone benefits from airing their voices.
There are Open Dialogue-like programs across Europe with have allied with health clinics, with hearing voices groups widely available. In America, only a scattering of medical clinics work with voices groups.
The first study of the Open Dialogue program in the U.S. was published in the Psychiatric Services journal. Nine of the 14 young people in the program for a year after a psychotic episode were still in school or working. Four are doing well without medication, while the others continue on anti-psychosis drugs. Insurance covered a quarter of the costs. These results are encouraging for the future of mental health treatment.
Carey, Benedict. “An Alternative Form of Mental Health Care Gains a Foothold.” Health. The New York Times, 8 Aug 2016. Web. 11 Aug 2016.