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Roots & Branches: Thoughts on Education and Outreach

By Nick Luchetti, MS Senior Clinician/Education Coordinator

Many recent developments in the mental health field have important implications for the relevance of our work to mainstream concerns. The current fascination with mindfulness-oriented psychotherapeutic approaches is one obvious example. Another encouraging recent development is the reemergence of a belief that recovery from psychosis is possible. This renewed optimism regarding recovery is largely due to a trend toward identifying and treating psychosis in the earliest stages — a movement that has been termed ‘Early Intervention.’ Often heralded as the most significant development in the care of severe psychiatric disorders since deinstitutionalization, this movement has caused several important shifts in both theory and practice. These shifts bring the mainstream world of treatment into an unprecedented alignment with the Windhorse approach.

Recent research has convincingly demonstrated that delayed treatment is one of the greatest contributing factors to the development of long-term psychotic suffering – and the accompanying human and economic toll. It now appears that chronicity is largely a function of failed treatment. Responding to this evidence has led many to a renewed interest in psychosocial interventions as treatment alternatives to medications in the early stages. In addition, the related attempt to identify early indications of difficulty has shifted the focus of concern to the subtle subjective changes that typically precede overt behavioral changes. This attention to subjectivity has caused the field to explore alternative paradigms to the objectifying behaviorally oriented medical view. One of the benefits of this renewed interest in psychosocial treatment and the inner life of those who suffer is that it appears to be having a humanizing effect on the field at large.

Needless to say, this shift away from the medical model has major implications for our position in the treatment world. We are no longer in a polarized and somewhat antagonistic stance to the dominant paradigm. As a result of these developments we now are in the fortunate position of offering a form of care that is increasingly being valued and sought by the traditional mental health field. This repositioning is especially true given that the mindfulness orientation, which has always been fundamental to our work, has now also been embraced by the mainstream.

Historically, we have served many who meet us after having already been through several, less than satisfactory, attempts at treatment. In light of the research on early intervention it has become increasingly clear that truly fulfilling our mandate to provide compassionate care would require that we make a more pro-active effort to intervene at the earliest stages where making connections can best improve long-term prognosis. Given that we have much to offer this developing movement in the way of environmental and relational mindfulness, developing our services to include early intervention would allow us to contribute to an important emerging trend while fulfilling our core values and mission as an agency.
One innovative approach to early intervention, the Open Dialogue method developed in Finland, has documented impressive recovery rates largely by facilitating the communication of the social network of those at risk. Over the past few years, some of our Northampton clinicians have been studying the dialogic skills associated with Open Dialogue with many of its pioneers at the nearby Institute for Dialogic Practice, under the direction of Dr. Mary Olson, the U.S. expert on this approach. We now have some of the most experienced and besttrained personnel in the dialogic skills involved in this innovative approach. The dialogic practices we are learning have proven to be particularly compatible with our work of recovery and they are gradually being integrated into many aspects of our treatment. As we move forward, we will find ways to fully utilize this work for its expressed purpose as an approach to early intervention.

Of course the earliest intervention possible is prevention, and there has been an equally exciting and related movement toward prevention of disorders by addressing underlying causes. Some of this work has occurred within what has come to be known as the Mental Health Literacy movement. This movement attempts to assist in diminishing the incidence and progression of psychiatric conditions through public education. Related to these public education initiatives are attempts to address root causes of psychiatric disorders such as the modern epidemic of social disconnection and loneliness, which appears to be growing – even as we enjoy unprecedented levels of digital connectivity.

One of our hopes for the next phase of development at our agency is to continue this exploration of how we might offer help at the earliest stages of mental suffering. It is exciting to imagine what a mindfulness-oriented and dialogic-informed approach to the early stages of psychological suffering might look like. We are currently positioned to develop new prevention and early intervention services which can simultaneously diversify our offerings, and position our agency within a revolutionary and emerging mainstream treatment movement, while allowing us to better meet our mandate to provide compassionate care to those we serve.