After the Open Dialogue: a Within-Area Comparison of Treatment, Experiences, and Outcomes in Western Lapland 20 Years after Service Fragmentation.

Abstract

This within-region service comparison examines the long-term sustainability and outcomes of the Open Dialogue (OD) approach in routine psychiatric service in the Länsi-Pohja Hospital District, Finland (Western Lapland catchment area). Originating in the 1980s, OD emphasizes immediate response, social network involvement, continuity of care, and dialogical practice. While OD was implemented district-wide by 1990, the municipalization of outpatient services in the late 1990s led to fragmentation. This study compares treatment processes, user experiences, and outcomes between services that remained under hospital district governance and a previously municipalized unit recently reintegrated into the district. Data were drawn from the PSILEAPS project, including surveys of 117 service users and their staff conducted between 2022 and 2023. Follow-up data was collected in 2024 by reviewing case records to determine whether service users remained in treatment 1-2 years after the survey and whether treatment ended by mutual agreement. Descriptive analyses used inverse probability weighting to account for baseline differences. Findings indicate that hospital district-run units delivered more OD consistent care, with greater family involvement and use of home and network meetings. In hospital district-group these elements were rated more positively by users and staff, and treatment in this group was associated with mutually agreed treatment endings at follow-up. Despite shared origins and similar intake systems, structural differences associated with the development of distinct treatment cultures and outcome patterns. Beyond structural reforms and access to services, maintaining the core principles of OD may depend on organizational stability and sustained support for a certain treatment culture.