Adapting Open Dialogue for Early-Onset Psychosis in Latvia: Barriers and Facilitators

Open Dialogue (OD) is the Finnish crisis intervention approach based on an open dialogue involving various professionals and a trusted person of the patient. This publication has demonstrated both clinical and economic benefits from the implementation of the principles of OD. The implementation of this approach was started in Latvia in cooperation with Dr. D. Ziedonis from the Department of Psychiatry, University of Massachusetts Medical School (today working at University of California San Diego), by translating into Latvian “The Key Elements of Dialogic Practice in Open Dialogue” and carrying out expert consensus panel discussions on the barriers and facilitators of the approach. The obstacles are linked with the lack of education in family therapy, lack of resources, possible problems of cooperation among professionals, and the existing standard practice where there are no active home visits in crisis situations. At the same time, positive elements that are close to Latvian psychiatry can be observed in the OD approach, for instance, the importance of a clinical conversation and listening to the points of views of family members encourage psychiatrists in Latvia to use this approach. The setting of OD could be community-based mental health centres as well as inpatient psychiatric departments dealing with acutely psychotic patients. OD can be a valuable addition and alternative in the case of new psychotic patients when treatment with medications is not efficient, and the patient is not favourably disposed to the use of medications, but nevertheless is seeking help.