The association between Open Dialogue to young Danes in acute psychiatric crisis and their use of health care and social services: A retrospective register-based cohort study.

BACKGROUND: Although most mental disorders have their onset in early life, the mental health needs of young people are often not addressed adequately. Open Dialogue is a need-adapted approach that mobilizes psychosocial resources in a crisis struck person's social network. Open Dialogue is organised as a series of network meetings and seeks to promote collaborative integrated care, and a non-directive psychotherapeutic stance. Its effectiveness for young people has not previously been assessed. OBJECTIVES: The aim of the study was to examine whether a Danish Open Dialogue approach directed at young people, who sought help from Child and Adolescent Mental Health Services, reduced their utilisation of psychiatric and other health services, compared to peers receiving usual psychiatric treatment. DESIGN: A retrospective register-based cohort study. METHODS: Using clinical and national register data, a cohort of patients aged 14-19 years (n = 503) enrolled from one region during 2000 to 2015 were compared to a matched comparison group from two other regions using propensity scores. Utilisation of psychiatric health services, GP services, and social markers were assessed after 1, 2, 5 and 10 year of follow-up using logistic and Poisson regression models. RESULTS: Patients receiving Open Dialogue intervention had more psychiatric outpatient treatments at one year of follow-up (RR = 1.2, CI: 1.1-1.4) than the comparison group, but not at subsequent follow-ups. Recipients of the intervention had fewer emergency psychiatric treatments (1 year follow-up: RR = 0.2, CI: 0.1-0.5; 10 years follow-up: RR = 0.5, CI: 0.3-0.8) and less use of general practitioner services (1 year follow-up: RR = 0.90, CI: 0.82-0.99; 10 years follow-up: RR = 0.85, CI: 0.78-0.92). There was no significant reduction in the number of psychiatric hospitalisation contacts or treatment days. CONCLUSIONS: Open Dialogue was significantly associated with some reduced risks of utilising health care services. These mixed results should be tested in a randomized design.

Adapting and Implementing Open Dialogue in the Scandinavian Countries: A Scoping Review.

Open Dialogue is a resource-oriented mental health approach, which mobilises a crisis-struck person's psychosocial network resources. This scoping review 1) identifies the range and nature of literature on the adoption of Open Dialogue in Scandinavia in places other than the original sites in Finland, and 2) summarises this literature. We included 33 publications. Most studies in this scoping review were published as "grey" literature and most grappled with how to implement Open Dialogue faithfully. In the Scandinavian research context, Open Dialogue was mainly described as a promising and favourable approach to mental health care.

The efficacy of psychoeducation on recurrent depression: a randomized trial with a 2-year follow-up.

BACKGROUND: The efficacy of psychoeducation is well documented in the treatment of relapse prevention of schizophrenia, and recently also in bipolar disorder; however, for recurrent depression only few controlled studies focusing on the efficacy of psychoeducation have been conducted. AIMS: This randomized study tests the efficacy of treatment-as-usual supplemented with a psychoeducative programme for patients with recurrent depression, treated at Community Mental Health Centres (CMHC) in Denmark. The primary outcome measurements concern was decline in consumption of psychiatric inpatient services and decline in Beck's Depression Inventory (BDI). METHODS: Eighty patients were randomized, either to the psychoeducative programme (consisting of eight sessions, each of 2 hours duration) and 2-year outpatient follow-up (42 cases), or only to 2-year outpatient follow-up (38 controls). The patients were monitored during 2 years after randomization. Data were collected from interviews including BDI, drug treatment and social measurements, and register data concerning use of psychiatric services. RESULTS: At 2-year follow-up, a significant reduction in the consumption of psychiatric inpatient services and in BDI was found; however, it was uniform for case and control patients. Drop-out/non-compliance was significantly more frequent among patients randomized to the control group. Furthermore, during follow-up the case group got a significant stronger attachment to the Labour market than the control group. CONCLUSIONS: The primary hypothesis could not be confirmed. Secondary outcome measurements concerning drop-out/non-compliance and attachment to the Labour market were significantly in favour of cases.

Clinical outcome of assertive community treatment (ACT) in a rural area in Denmark: a case-control study with a 2-year follow-up.

AIM: The aim of the present study was to evaluate the effect of assertive community treatment (ACT) in the Tønder Region, South Jutland, where the first Danish ACT team was established to treat patients with severe and persistent mental illness (SMI). METHODS: The study compares outcome over a 2-year period between recipients of ACT and standard community mental healthcare. RESULTS: The study included 86 cases and 88 controls. At the time of recruitment, the cases and the controls did not differ significantly in demographic details and eligibility criteria. At the 2-year follow-up, the ACT patients showed a significant reduction in admissions, bed days and day hospital days, and a significant increase in the number of consultations compared with the controls. Adherence to outpatient services was higher in the ACT group. No significant improvements in psychopathology were found after 2 years, but a significant improvement in met needs and fewer unmet needs, indicating better functioning, occurred. Clients' satisfaction with care (Client Satisfaction Questionnaire, CSQ) was significantly higher among ACT patients than among controls. CONCLUSION: The treatment of these patients in this ACT service has yielded promising results, suggesting that ACT treatment may be a useful intervention for SMI patients. However, large, rigorous, randomized control trials with ACT are needed in Europe as the existing evidence mainly comes from American studies.