By EK Wills
Being a talker, my ears always prick up when I learn of ways we connect that help us in life.
I read that a… ‘study of people living in Alameda County, California, for example, showed that people who had close friendships and marriages lived longer than those who didn’t. This was true independent of such factors as diet, smoking, and exercise.’ (The Relationship Cure)
And this week I learned, that for many years, a hospital in Finland has almost radically treated their psychotic patients with predominantly talk therapy.
This takes the form of dealing with interpersonal relationships in the therapy structure. Many studies have been conducted since its inception and the statistics show that they are getting better results than the rest of the Western world using less medication (Jablensky A, 1992. Psychol Medicine, Supp 20, pgs 1-95, WHO) and less hospital admissions.
The model appears to centre around supporting people and their families to deal with situations at home rather than put them in hospital. This is facilitated by staff, who attend the homes, and can even stay in the home if necessary.
They are available in shifts, as are our nursing staff in hospitals in the Western model. Home visits are conducted in pairs, as is done in our community mental health care settings. This makes it more of a hybrid of the two.
The big contributor to it's success appears to be that all members of the team, including the patient, collaborate on treatment. This means that a couple of team members, be they nurses or doctors, act as family therapists and discuss treatment openly with patients and their families to jointly direct treatment.
This is reflective of the psychotherapy approach to enabling the patient to understand what is happening for them and to gain insight through their own analysis. However this model extends this to the patient’s family so they can also understand and be involved: this is facilitated by a therapist in a safe space.
Of course, there will be times that safety requires admission and/or medication but there is not a sense of fear involved that drives this. Clinicians are not afraid to employ treatment that is not seen as mainstream because they do not fear losing their licence for ‘deviant’ practice.
The rest of the West appears to have generated a litigious environment where documentation prevails to ensure best practice.
Recently, one of my patients became rapidly unwell which resulted in someone getting hurt. There was much concern for the safety of everyone involved but one of the first suggestions made was to contact my indemnity to get guidance.
Luckily, there has been much support from management for the teams involved but there is a general fear in the system that this could come back to blame an individual if an error is involved.
In the Western world, there is no room for weakness and no tolerance for it. Of course, public safety is paramount but it seems we are quick to appoint blame rather than generate support for each other and learn how to help others more.
Maybe we should have an open dialogue around focusing on interpersonal relationships rather than containing risk in society.
Comments