Earlier this year Crystal Gonzalez, 25, started hearing voices. “I forgot that this is reality,” says Gonzalez, who lives with her mum and sister in the South Bronx, in New York City. Gonzalez has been diagnosed as bipolar, and as having a borderline personality disorder, histrionic personality disorder and obsessive compulsive disorder (OCD). Since the age of 14, her trips to the psychiatric ward had been routine.
She is not alone, mental distress is related to one in every eight emergency department cases in the US. This translates into nearly 12m visits every year, according to the Agency for Healthcare Research and Quality, an independent thinktank. Spending on these patients was $38.5bn (£24.9bn) in 2014, double what it was in 2003.
Earlier this year, Gonzalez’s therapist told her about another option to hospital. She went instead to a Parachute NYC respite centre – one of four across New York’s five boroughs. It is at the heart of a radical approach to psychosis that is attempting to end the cycle of hospitalisation across the city and is about to piloted in the UK.
Established in early 2013 by the New York Department of Health and Mental Hygiene (DHMH), the Parachute programme’s approach is “open dialogue”, in which a team of therapists and social workers encourage patients and their families to develop their own route to achieving recovery. Practitioners say the approach rejects hierarchy, encouraging equal and open dialogue between everyone in the group. It isn’t about getting “better”, but learning to live with acute distress and developing ways of managing it.
Open dialogue was developed in the 1980s in western Lapland by the Finnish psychologist Jaakko Seikkula. Within a few years, this remote area of northern Europe went from experiencing one of the worst incidence rates of schizophrenia in Europe to having the best documented therapeutic outcomes in the western world. One study showed that after two years of starting therapy more than 80% of participants had no noticeable psychotic symptoms. –Joe Sykes, The Guardian, October 20, 2015