At Grady Health System, a public safety-net hospital in Atlanta, mental health clinicians are charting new territory. They’re integrating Open Dialogue (OD), a treatment model rooted in a collaborative and egalitarian approach, with Coordinated Specialty Care (CSC), which emphasizes multidisciplinary support for patients experiencing early psychosis. The result is a hybrid model that challenges the entrenched hierarchies of the American healthcare system—often at the cost of significant professional tension.
In an empirical article published in the journal Social Science & Medicine (SSM) – Mental Health, led by co-first authors Melissa Uehling of Emory University and Jen Van Tiem of the Iowa City VH Health Care System, researchers explored the experiences and meaning-making of the clinical staff that was integrating Open Dialogue (OD) with coordinated specialty care (CSC). Clinicians across the treatment teams felt that learning these models profoundly impacted their professional and personal growth. However, working in these alternative clinical practices majorly contradicted how clinical care was set up in the hospital. Many clinicians considered working in these alternative ways as resisting hierarchy and contributing to systemic changes within their healthcare organization.
The integration of OD and CSC at Grady Health System represents more than just a new way of treating psychosis—it’s a microcosm of the broader struggle between innovative, patient-centered care and the rigid, hierarchical structures that dominate American healthcare. While clinicians report personal and professional growth from engaging in these alternative practices, the friction between these models and conventional medical protocols raises questions about the future of such integrative approaches in the U.S. Can these humanistic, dialogic methods genuinely take root in a system designed for something entirely different?
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Open dialogue is the best treatment modality the West has ever come up with in the field of what you call ‘psychosis’ but the truth of what you call psychosis, which can only be discovered by someone going through it and observing and understanding without interpretation or prejudice. puts away the very idea of a treatment modality, for the solution is awareness and love. Awareness IS love, so really the solution is this awareness, is this love. And our diseased societies and minds will never understand this on a social level, because that society is and must break down. Blessed are those who stand with both feet in the real, which is the actual, the real life, the world. Everyone else stands on mere ideas, opinions, hopes, conclusions, theories and dreams, unable to see that these are the mere magots of a confused social history that today feast on and destroy our hearts and minds, hence producing the phenomena you call a psychosis, amongst other things, like addiction, suicide, and all the other indications of struggling consciousness and life. Mother Nature never had these struggles. These struggles are our own hearts and minds snarled up and destroyed by the historical products of it’s social history. Thus we get destroyed by the magots we created and dismissed through judgement without any understanding. The dead will judge the living. And then the dead will reveal that it is life, and expose the living as the dead.
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No matter how many capital letters you string together, the “mental health system” isn’t about health. It’s about jockeying for power (and money) more than anything else.
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I find that this is exactly right Birdsong. There are many problems and stupidities in psychiatry and the mental health system at all, but their common root seems always to be egoistic or ‘professional’ (which is still egoistic) interests that end up turning the people they are supposed to be helping into cash cows for their grifts, or as raw material for career development and for trying to promote themselves as some kind of expert or commentator or some such nonsense. And given that ‘mental health treatment’ purports to be help when it’s manifestly harm in disguise, there seems to be absolutely nothing worth saving in the system whatsoever. If we spent all that money on eliminating poverty and dependency on destructive or abusive relationships of all kinds including with employers, we wouldn’t merely be ‘managing’ (ineffectively of course) the problem of mental health: we would help to eliminate some of the causes of this suffering which include poverty, racial and other forms of discrimination and judgement, and also destructive and abusive relationships of all kinds including with psychiatry itself. These are some of the many social traumas but seem to be low hanging fruits. Anyways, your comments are always incisive, no matter how brief. By the way, that snake you wanted to decapitate: was it psychiatry? Perhaps I missed the reference in the article.
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Thank you, No-one. I highly value your opinion.
Psychiatry is by far the world’s biggest ego-driven scam and psychotherapy amounts to spiritual cannibalism, imho.
And yes, it’s long past time for psychiatry to toss its caduceus.
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Open Dialogue in US mental healthcare? Alas, Open Dialogue has arrived on the scene a few years too late, don’t you think? There is no infrastructure to roll it out in a profit making medical model. And it will never meet the rising tide of every form of dysfunction, corruption, degradation and destruction that characterises every aspect of American social, economic and political life today. Even a discussion of this important issue lacks gravity when considered in isolation form the total social context absolute disorder and degeneracy in the United States, and this is from someone who has gone through psychosis, addiction, homelessness and the equally dysfunctional, grim and evil Mother Country of the UK. Obviously politically you had a criminal president who manifestly had something totally demonic operating in him as he almost managed to make the country go insane and wild with conspiracy theories and lies that would have passed as extreme even on a mental ward a few decades ago, a wildness that almost managed to overturn US democracy while he was there, and may yet do so. This is followed by the most grosly incompitant president of the United States there ever was. Can you name another less competent? You will probably know American history better then me but I can’t think of a single one. Regardless of the fact that he is all strategy and no politics, it is not in any way prejudice to hope of a POTUS that there’d be able to finish a sentence correctly once in a while, or ascend a short flight of stairs without falling flat on his face, or avoid confusing Zelenskii with Putin in a globally broadcast public address all the while giving us the impression that he is an animated corpse with a microchip in his brain being controlled by someone like Hillary Clinton telling the lips what to say. And to paraphrase Margarette Thatcher, she obviously makes a shit backseat driver.
And in the society at large, there is the rise of the extremism, delusion and obviously evil intent among the whole of the right, which is building unholy alliances with white evangelical Christianity as well as big money and neofascist movements both in society and within the extreme right media, there are record suicides in America, and always gun shootings including mass shootings are on the increase: there has been an absolutely astonishing rise in DISABILITY due to mental health, not mere diagnosis, and there has been a comparable rise in drug and alcohol deaths as well. Perhaps the same is true of homelessness and child poverty and divorce and things like that, but I haven’t got the figures, but the point is American society is one total process, and if you abstract parts in isolation you miss the whole significance of the issue at hand. American celebrity and mysic culture is the escape from what is for the masses, but also another profitable grift for the greedy and powerful, and it is always in their interests of all economic producers to produce more of less quality, which is another factor destroying the quality and health of everyone’s life, in every supermarket, major restaurant, every new cell phone contract, in every bank and on every customer service telephone line, everything in life seems to put more and more demands on customers, more and more automation in place of people, more and more security and technical barriers to things that used to be easy including voting, and less quality ingredients in foods and goods or cheaper materials etc etc etc, and the loss of nutrients in soils owing to climate induced drought and the dumping of organic waste in landfill locking away nutrients potentially for millenia, and no-one is noticing these attrocities, just as the lead poisoning scandal seemed to shock the whole world far more then the domestic citizenry that is so socially conditioned that all this horror is normalised. I’m sorry, but even the second coming couldn’t save this basket case of a country. It’s a society tearing itself apart with no hope in hell of avoiding it’s own self-destruction, and unfortunately, that perception alone has gravity in America. But when we remember the whole world is joining the great big circus of insanity that is America and is tearing itself apart just as surely, then we can begin to relax, because you are finally becoming aware of the catastrophy of it all. So I fear Open Dialogue might have come too late for America and the whole world.
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