Birgitta Alakare's research while affiliated with University of Oulu and other places

... This eventually led to reorganization of the entire mental health care system to support a more reciprocal response to psychological crises, later known as the Open Dialogue approach (OD) (Seikkula et al., 2006). By emphasizing shared decision-and meaning-making processes, the primary goal in OD is to guarantee both continuity of care and an immediate need-adapted and social networkoriented response, regardless of the diagnosis (Bergström et al., 2022;Seikkula et al., 2011). In naturalistic and register-based cohort studies on all people receiving treatment for FEP within a predetermined inclusion period in the Western Lapland, OD demonstrated promising treatment outcomes, especially with regard to the longer-term social functioning (Bergström et al., 2018;Seikkula et al., 2011). ...

... In Finland, where OD was developed, network meetings are embedded in a specific reorganization of the entire help system, according to the following basic organizational principles Seikkula et al., 2011;Beeker et al., 2021) immediate help in crises, ideally within 24 h , involvement of the social network through network meetings from the beginning of the treatment , flexibility and mobility with regards to the needs of the network in terms of frequency, location and participants in network meetings (Bergström et al., 2021), responsibility for the organization and implementation of the entire treatment process by the treatment team and (von Peter et al., 2019) psychological continuity or ensuring the continuity of relationships and common understandings over the entire course of treatment. Thus, OD as an approach depends on structural principles that enable its implementation, which may require a substantial re-shaping of the mental health care system in which it is embedded. ...

... There is evidence that in the short term, antipsychotics improve quality of life, functioning, and disability, reduce psychopathology, the severity of illness, compulsive behavior, and improve cognitive insight (Verma et al., 2020). However, in a 19-year follow-up, moderate and high cumulative antipsychotic maintenance treatment within the first five years after first-episode psychosis was consistently associated with a higher risk of adverse outcomes (continuing use of antipsychotics, psychiatric treatment, disability allowances, mortality), as compared to low or zero exposure (Bergström et al., 2020). The present case aligned with the idea of intermittent use. ...

... Psychotic experiences are extremely difficult to make sense of, as they occur in the context of an altered state of mind, or delusional reality (57), and are experienced as alien or disjoint from the intersubjective sense of self (56). Decades after the homicide, those who have been able to find an explanation for and meaning in their psychotic episodes seem to recover more successfully (76). ...

... The literature shows that early family involvement in mental health treatment has a number of advantages such as clarifying the problem, defining it in the language of the patient and family and mobilising their psychological resources so that they can increase engagement and agency in the process of recovery (Garavan 2013;Hartman and De Courcey 2015;Seikkula and Alakare 2014;Ulland et al. 2014). For instance one study showed that involvement of the family at first contact with psychiatric services significantly reduced rates of unnatural-cause mortality in patients with schizophrenia compared to those with no family involvement (Reininghaus et al. 2015). ...

... It was developed over a 30-year period in Western Lapland, Finland to tackle their entrenched problems of overuse of hospital beds and medications, and covering a large area with few resources. The research on the population receiving this approach showed radically better outcomes [40,41]. Ongoing studies are occurring to see if these results can be replicated in large urban areas such as London and for a range of mental health conditions [42]. ...

... In their systematic review of narrative studies, Rhodes and De Jager (2014) found that participants mentioned professionals in their recovery journeys, but also noted family and community as being even more vital to their recovery. Indeed, the wider community is already being utilised in many contemporary therapies for serious mental illness, such as Multisystemic Therapy for young offenders (Littell et al., 2021), Multi-Family Therapy for anorexia, psychosis, and mood disorders (Asen & Scholz, 2010), and community-based Open Dialogue Treatment for acute psychosis (Bergström et al., 2017. Though it would not be advisable to recommend parkrun running and volunteer participation as a sole treatment, perhaps clinicians could view it as a community-based initiative that could augment service-users' ongoing care plans. ...

... Eltern-Säugling-Kleinkind-Psychotherapie), oder auch systemischen Ansätzen zur Krisenintervention (z.B. Offener Dialog oder Systemische Psychiatrie) getan [29,30]. Es fehlt jedoch an umfassenden Outcome-Evaluationen sowie Implementierungsstudien zur Förderung dieser und anderer systemischer Versorgungsmodelle. ...

... It is not the intention of this paper to describe Open Dialogue in detail; readers interested in a mental health nursing perspective on Open Dialogue are referred to Buus et al. (2017, Ong et al., 2019, or to Bellingham et al. (2018), published in this journal. However, for context, Open Dialogue is founded upon seven need-adapted principles described by Seikkula et al. (2001aSeikkula et al. ( , 2001b: ...

... Open Dialogue (Seikkula et al., 1995) is both a therapeutic approach and a way of organizing mental health services developed in Finland, which explicitly targets social networks. The aim of Open Dialogue is to promote a greater shared understanding of service users' problems, a greater sense of agency, collaborative decision-making, and the network's mutual support in the long term (Seikkula et al., 1995(Seikkula et al., , 2006Seikkula et al., 2001aSeikkula et al., , 2011. This is done through the enactment of the principles of (1) immediate help, (2) social networks perspective, (3) flexibility and mobility, (4) responsibility, (5) psychological continuity, (6) tolerance of uncertainty, and (7) dialogue and polyphony (Seikkula et al., 1995). ...