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- [00:00]
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BetterHelp Advertiser
Again,
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BetterHelp User / Arsh Manning (Vuori Advertiser)
BetterHelp bad matching with my therapist was
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BetterHelp Advertiser
very quick and easy.
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BetterHelp User / Arsh Manning (Vuori Advertiser)
I just filled out a couple of questions. Before you know it, I was matched with a therapist.
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BetterHelp User
I just felt like a weight just was lifted off of my shoulders and I felt like it was a good match from the first time we talked.
- [00:43]
Roisin Kelly
BetterHelp is there to meet people at their needs, giving them a space to feel safe.
- [00:48]
BetterHelp User
There is a stigma about therapy, but with BetterHelp, I meet people where they are, wherever you are. That's where BetterHelp begins. Visit betterhelp.comrandompodcast to get started.
- [01:04]
Luke Jones
From the Times and the Sunday Times, this is the story. I'm Luke Jones.
- [01:16]
Roisin Kelly (on location in Finland)
I'm just in Torneo, which is a city in Finland's Lapland region, and it's right on the border of Sweden. There's no border control, no security. There's just a few cameras. You can literally just cross over and you're in Sweden.
- [01:31]
Luke Jones
Roisin Kelly, a journalist at the Sunday Times, traveled to northern Finland in May.
- [01:37]
Roisin Kelly (on location in Finland)
Usually the lake here would be completely frozen over and, you know, everything would be covered in snow. But we're here in May, and I'm told it's actually unusually warm for this time of year. It's quite mild. There's a quiet place, just sort of lots of kids playing and people out for walks, walking their dogs, going about their business.
- [02:02]
Luke Jones
There's not much around, but Rasheen isn't there for sightseeing. Torneo is the birthplace of an innovative treatment for mental health conditions called Open Dialogue. Designed in the 80s, it's proven very effective in this corner of Finland, lowering hospitalizations, boosting employment, and reducing the need for antipsychotic medication.
- [02:26]
Roisin Kelly (on location in Finland)
One thing I will say is you don't really see people roaming around on the streets here. Can't really see anyone who, you know,
- [02:37]
Roisin Kelly
looks like they might be in need
- [02:38]
Roisin Kelly (on location in Finland)
of help in terms of mental health or homelessness. It feels very sort of safe and peaceful.
- [02:49]
Luke Jones
Is this what our own struggling mental health system needs, with more and more patients and less and less money to go around? Just as with saunas, chair design and how best to pickle a herring. Could Finland have the answer? The story today. Lap plans miss Mental health lesson. How'd you end up in Finland?
- [03:26]
Roisin Kelly
Well, I had been reporting on the Nottingham inquiry, which I'm sure most people know. Valdo Callicane was a paranoid schizophrenic who tragically murdered three people in Nottingham.
- [03:40]
Inquiry Narrator / Reporter
The inquiry started with an outline of the early hours of the morning on 13th June 2023. It was 4am when Barnaby Webber was attacked first. Then Grace O' Malley Kumar was stabbed repeatedly as she tried to help Barnaby. The first phone call to police was three minutes later. An hour later, Valdo Callocane attempted to break into Seeleyhurst house or hostel on Mappoli Road. Just minutes later he attacked the caretaker, Ian Coates, and then stole his van.
- [04:11]
Roisin Kelly
I'd done interview with Emma Weber, who was one of the victim's mothers and had been following the inquiry about how this ended up happening. And it just sort of, it was quite shocking, all of the different failings and different ways that this was allowed to happen.
- [04:31]
Luke Jones
And what were those, the failings that they identified?
- [04:33]
Roisin Kelly
There were various sort of step by step failings by authorities, but the biggest ones that stood out were a kind of a lack of joined up care. So Callicane's family, when they gave evidence at the inquiry, gave an impression of sort of starting from scratch.
- [04:50]
BetterHelp Advertiser
There's a sense of hopelessness that comes with a lot of this. You know, you pass on information or you don't know what's going on or all the signaling that you're sort of receiving from services is that essentially unless something happens, nothing changes.
- [05:13]
Roisin Kelly
And the multiple times he was sectioned or under the care of mental health services, it was almost like they were speaking to a new person every time or, you know, they weren't receiving much information about his care because of patient confidentiality.
- [05:28]
BetterHelp Advertiser
Because when I call normally they don't give me much information until they speak to him. And then that was one thing that used to frustrate me because you had
- [05:36]
Roisin Kelly (on location in Finland)
been given permission to have the information and this. Yes.
- [05:40]
Roisin Kelly
Callicane's mother, Celeste said that she had inquired about depo medication, which is an injection in severe cases of psychosis schizophrenia that doctors will give. She says that that was just kind of refused or skipped over at the time. And then it also came out in the inquiry that Valdo Callocane hadn't been given that treatment because he had said he was afraid of needles. But what also came out is that he had had his COVID 19 vaccinations, which obviously were administered with needles, as
- [06:16]
Roisin Kelly (on location in Finland)
far as you're concerned. And if anyone had ever asked you, did VC ever have an issue with needles?
- [06:21]
BetterHelp Advertiser
No.
- [06:22]
Roisin Kelly (on location in Finland)
You'd raised depo yourself. So by raising it, you didn't think he had any concern or fear or difficulty with that?
- [06:29]
BetterHelp Advertiser
No, because he had all his vaccines. So I was the one that had taken into the vaccine.
- [06:32]
Roisin Kelly (on location in Finland)
So.
- [06:35]
Roisin Kelly
So there was this sort of question over who's in charge here or who's giving the care here. And I would say what came through the inquiry multiple times with multiple different authorities. So mental health services, social services, police, was this sort of passing on of responsibility or just disjointed communication? So it was a big point of discussion in the office and, you know, in the papers at the time, in the news at the time. And I just started thinking, why does our mental health care system seem so sort of ineffective and is there anywhere in the world that is doing it better or differently or, you know, has a different approach to us that that seems to be working or that they think is working?
- [07:23]
Luke Jones
And that's not necessarily from a public safety point of view, because it's not necessarily the case that if you are suffering with psychosis or the rest, that you are going to be especially violent, as was in the case Balder Cullocain. But just to help people who are having a difficult time with their mental health.
- [07:37]
Roisin Kelly
Yeah, exactly. You know, incidences of violence, of that level of violence or that type of violence in the community from mental health patients are actually very rare. But, you know, when something of that scale happens, it was, you know, obviously such a talking point. It was such a tragic event. When you look at all of the evidence from an inquiry like that, there are big questions over how our services are working. As I was thinking, you know, what are other countries doing? I just started researching online, having a look at different approaches to mental health care. And one that came up a lot in sort of research papers or, you know, was referenced a lot in scientific articles, was something called open dialogue.
- [08:26]
Luke Jones
So this open dialogue approach, where did it come from? Where did it start?
- [08:30]
Roisin Kelly
So in the 1980s, in Torneo in Finland, there was a hospital, it's now closed down and it was called the Karapudas Hospital. It was a psychiatric hospital.
- [08:43]
Roisin Kelly (on location in Finland)
We're just at Karopudas in the city of Torneo, sort of down a really quiet road, can just hear the birds cheeping. What is this old, quite bleak looking white building just across from the hospital, it's not in use anymore, it closed down about three years ago, I think. But just across from there there's another, again, quite bleak looking white building and this is kind of like little houses all adjoined. And early on, back in the 70s, the staff from the hospital, so psychiatric nurses, doctors would live in here with
- [09:32]
Roisin Kelly
their families and they were mixing people with, say, learning difficulties or learning disabilities, with schizophrenics. And basically the psychiatrist working on the ward just thought that what they were doing, which was diagnosing and medicating and keeping people in hospital, wasn't working. And so they thought we need to have a different approach here. And they thought it was worth experimenting with, involving family members, involving whoever a patient trusted. So that could be a friend, it could be their mum, and from the get go, having this open dialogue, open conversations about how the person was feeling and, you know, why they were feeling that way. And instead of just giving them medication, they would explain why they were giving the medication and what might happen from the medication. Essentially what one of those psychiatrists told me is that whenever there's an incidence of psychosis or mental illness, one of the biggest contributing factors that will make that escalate is a feeling of isolation that the patient often has. And so by creating this network of people and involving them from the beginning, the hope was that they could sort of de. Escalate the situation.
- [10:55]
Luke Jones
So if that is working with me now, say I'm the patient, how does it work? The way this approach works now, I always have consultations but with another sort of trusted party of my choosing, like a parent or a partner or whatever.
- [11:08]
Roisin Kelly
So yeah, so let's say the sort of process begins at a crisis point, which would be, you know, psychosis or hearing voices, that, that kind of peak moment where somebody realizes or someone close to them realises that they are having a mental health crisis. So your first port of call is the hospital, like it normally would be, within 24 hours, like a team is assembled and that would consist of firstly, obviously psychiatric nurses, then you know, a close or trusted family member or friend. So that could be a partner, a parent, a neighbour, even depending on your situation, a counselor that may person has been to before, if it's a teenager, maybe a teacher from their school. And the point of that is that all of these people from the beginning know what the situation is.
- [11:58]
Luke Jones
They're not relying on briefings from somebody or someone later emailing them and saying,
- [12:02]
Roisin Kelly
well, this is where we got tomorrow. Exactly. And, and you know, obviously there are logistical limitations to that. So it's not the case that you, every week have a meeting with everyone who's in that network. It's the case that maybe every week you have a meeting with your psychiatrist or your psychiatri nurse and your trusted family member is there too. And then if you are a young person or a teenager, every month you have a meeting with your psychiatric nurse and your school teacher to, you know, talk about how what's going on has affected you at school, or. The point is basically just having this network of people who are ready to help and know about this, they know about the situation and they can then communicate with each other to take steps to help the patient.
- [12:50]
Luke Jones
Essentially, logistics aside, what are the drawbacks with that? I mean, because you must surely get points where maybe a partner no longer wants to come or they break up or they have their own issues, or a teacher doesn't seem to be the best person or. I mean, there must. That group must be fluid.
- [13:05]
Roisin Kelly
Yeah, yeah, it is. And this is the point, I suppose, of having the network is that you're not solely relying on one person all the time. And I would say it is a flexible approach, so it can be adapted to a person's needs. It's all about the patient.
- [13:17]
Luke Jones
And is this across Finland?
- [13:20]
Roisin Kelly (on location in Finland)
No.
- [13:20]
Roisin Kelly
So this is the thing. It's in Chemi, Antonio in Lapland is where it's predominantly used. And that's because it's where it was invented for a start. And so the practitioners there, it's what they're trained in. So if they go to college or university in those areas, that's what they're taught. If they work in a hospital there, that's what they're taught. There was, you know, some talk when I was in the hospital in Kemi from staff who are concerned that government budget cuts are trying to push them towards a different system of care.
- [13:55]
Luke Jones
Because people are expensive.
- [13:56]
Roisin Kelly
I mean, it's what we see everywhere is that the people at the top with the spreadsheets essentially see time as money. And so they see having talking sessions etc with people as not a good use necessarily of finances or of people's time, because on paper, it's much quicker to get through 20 patients a day as opposed to five. That is a challenge that they're facing. But I think the thing that can be taken from open dialogue is it doesn't have to be strictly applied in its purest form. I think there's elements to take from it.
- [14:33]
Luke Jones
Yes. And if they were to bang on the door of the person with a spreadsheet and say, but look, we're having all these amazing successes. I mean, who would they point to? Who did you meet? Who would be a good example?
- [14:43]
Roisin Kelly
So at the hospital in Kemi, I met a couple called Sara and Henry. They're in their 30s. Sara has quite a few diagnoses, but essentially she had a traumatic event when she was younger. That has given her complex ptsd. And, you know, she told me that at her lowest point, she just couldn't get out of bed. I couldn't control myself. I couldn't speak or move. I don't know. Now you probably have to tell me who was there and how it went. She couldn't do anything. You know, she was like a shell of herself. Obviously, that has a massive impact on her family. So on her husband Henry. They also have a teenage son. But she, you know, started the open dialogue process, and she's done it as an inpatient, so in hospital, on the ward, but also as an outpatient when she's at home. She told me that she trusts the psychiatric nurses because they don't just tell her, you know, go and take this medication. They play games with her and talk to her, and they go out for walks when she's on the ward. And that makes her trust them and makes her have faith in her treatment. She doesn't resent being treated, if that makes sense. A lot of mentally ill patients see being in hospital as, you know, everyone's against them or trying to do something to them. And also, I think a big thing that can be taken from that particular example is Henry, Sara's husband. So he's not suffering from a mental illness, but his wife is, and that has a huge impact on him. So, you know, Sara will have said at the beginning that, yes, her husband can be in the network, and that means that whenever he's, you know, they're at home, and maybe he recognizes a pattern of behavior with her and he's worried that she's on the verge of a breakdown or an episode. He can call her psychiatric nurse and tell them that he's worried.
- [17:07]
Luke Jones
If I, as a spouse, have experienced a difficult situation or something like that, I have always received help and been able to talk to the nurses and things like that.
- [17:22]
Roisin Kelly
And, you know, tell them about the impact it's having on him and maybe his mental health or the impact it's having on their child. And that means that mental health worker will say, okay, let's get a meeting together, you know, with Sara there, too, and let's Talk about this and see what we can do. And they'll go to their home rather than make her go to the hospital necessarily. And I think, you know, when you've worked on things like the Nottingham inquiry and when you've read through all of those witness statements, you wouldn't hear that anywhere from the family of a mentally ill person here.
- [17:55]
Luke Jones
So has anyone else picked this up outside of Lapland even?
- [17:59]
Roisin Kelly (on location in Finland)
Yeah.
- [18:00]
Roisin Kelly
So open dialogue has been applied in, I think it's over 30 countries in various forms, so not maybe not exactly as they use it in Torneo and then in Japan, it's mandated in all prisons as a type of rehabilitation therapy. And then kind of the big talking point in the healthcare community here at the moment is there's a big trial that's been going on for the past two years. It's the biggest, most significant trial of open dialogue that's ever been done because it's on over 500 patients and it's completely randomized and it's across five NHS trusts. I have had conversations with the people behind the study and the results do look really promising.
- [18:45]
Luke Jones
So how did we end up with the mental health system that we have? And could open dialogue be the solution? More for machine in a moment.
- [19:00]
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- [19:44]
BetterHelp User / Arsh Manning (Vuori Advertiser)
a better help Ad matching with my therapist was very quick and easy. I just filled out a couple of questions. Before you know it, I was matched with a therapist.
- [19:51]
BetterHelp User
I just felt like a weight just was lifted off of my shoulders and I felt like it was a good match from the first time we talked.
- [19:58]
Roisin Kelly
BetterHelp is there to meet people at their needs, giving them a space to feel safe.
- [20:02]
BetterHelp User
There is a stigma about therapy, but with better help, I meet people where they are, wherever you are. That's where BetterHelp begins. Visit betterhelp.comrandompodcast to get started.
- [20:31]
Luke Jones
Roisin, you are telling us about open dialogue, this Finnish approach to treating people with severe mental health conditions. You said how it is being tried in different places. Big pilot here in the uk. Before we get into that, I mean, how would you describe the state of mental health care in the uk?
- [20:50]
Roisin Kelly
So the official sort of data says that, you know, NHS funding is going up, but actually over the last three years the mental health section of that has decreased, so more money's being taken out of it. Beds are constantly full like they are, you know, across the nhs, as we always hear about. I think a lot of people here would say as well that, you know, we tend to immediately give a diagnosis and prescribe some pills as opposed to looking at other ways or engaging more with the people who need the help. So behind the study that's going on is Russell Razak. He's a consultant psychiatrist and he describes mental health care in the UK as being like a formula one pit stop.
- [21:40]
Russell Razak
We're treating the health service as if it's sort of like a manufacturing line where, you know, different, you put different people on different conveyors or the other metaphor I use is a bit like a formula one pit stop where you come into the pit stop and there are 50 different people come around you and all do different things, but there's no one who's kind of carrying you all the way through.
- [21:59]
Roisin Kelly
There's no sort of shared end goal. It's just people kind of sticking a plaster over things so that you can get on your way as opposed to everyone having this shared idea of where you're going to go to and how they're going to make things better for you.
- [22:16]
Luke Jones
And I guess what does that all mean for the patient at the centre of this? They just get sort of more ill or continue to be ill. Yeah, I
- [22:24]
Roisin Kelly
think if the continuity of care isn't there, as we saw with Callocain, and you're being prescribed medication and you're not taking it. People who, who don't want to take their medication because they believe it's harming them in some way, you know, those people, yes, they will get more ill because they're not taking their medication. And then also there's the kind of longer term picture in society in the sense of just making people's lives better and their outcomes better. So that includes things like having to live off of the welfare system, not being able to get a job or go to school or, you know, because they're longer term plan isn't in place. It's just sort of here's your pills.
- [23:09]
Luke Jones
So, in terms of open dialogues, future and trial in the UK at the moment, what's actually happening, a very significant
- [23:16]
Roisin Kelly
trial is coming to its end. It was going on for two years. It's called the Odyssey trial, which is open dialogue development and evaluation of a social network intervention for severe mental illness. So that went on for two years, was a randomised control trial with 500 patients. So some of them received traditional treatment, others were receiving open dialogue. There was five NHS trusts involved, I believe, which is Northeast London, Kent and Medway, Barnet, Enfield and Haringey, Camden, Islington and Devon. And those results are due to be published any day now, which will hopefully give it the gravitas to be presented to the NHS and to be presented to hospitals as a reason to use the approach. I haven't seen the results, but I've been told about them. From what I was told, they're very promising. Obviously, the caveat of how that would be rolled out nationally is a question
- [24:16]
Luke Jones
a bit like some of the concerns that you mentioned about being in Finland. It is gonna take people. It's gonna take people's time and therefore money. And if there's one thing we all know the NHS does not have, it is money.
- [24:27]
Roisin Kelly (on location in Finland)
Yeah.
- [24:28]
Roisin Kelly
And it's also, I think. I think we see this in smaller scales than the NHS too, but it applies to most things, is that when something requires a complete overhaul, it can just feel so overwhelming that we just don't want to do it. And, you know, one of the things that Russell said to me, actually, which I thought was interesting, is that there's nothing to back up the way that we do mental health care here.
- [24:53]
Russell Razak
This is the thing. We have evidence basis for particular treatments. Right. Or we don't have the evidence base for a whole model of care.
- [25:00]
Roisin Kelly (on location in Finland)
Yeah.
- [25:00]
Russell Razak
So the model that we use at the moment, the way we arrange things, isn't really evidence. We don't have any trials showing that you should arrange your services this way. They just evolved into this way of arranging. So open dialogue is both an intervention and a whole model of operation for the service. It's two things.
- [25:15]
Roisin Kelly
There's nothing that formed this system apart from. It's just how we ended up doing it. And we've just been doing it like that. And a lot of people who work in the NHS will tell you that it's not working, but until the big bosses at the top want to overhaul it, it's not going to happen.
- [25:29]
Luke Jones
And if you put that forward and actually make that. And even with the promise of lower cost in the future because you're treating people more effectively and then they require less time and care. In the long run, it surely must require a lot of upfront cost.
- [25:45]
Roisin Kelly (on location in Finland)
Yeah.
- [25:45]
Roisin Kelly
I mean, I don't know the exact sort of figures, but there is also then the trade off that if you have less people in hospital beds, that's a good sign that's going to save a significant amount of money. A lot of it before that is there's a resistance to change and, you know, this wouldn't necessarily have made any difference, but in 2013, the NHS Trust in Nottingham did try open dialogue and dropped out of a pilot pretty quickly. People have told me that the staff who were trained in it really believed in it and therefore then left that trust when it dropped the pilot, because they really believed in it, so they wanted to go elsewhere to trusts that were piloting it. And I think when staff really believe in something and they're the ones treating the people every day, you know, they should be listened to. But again, it comes back to people looking at spreadsheets and, yeah, overhauling an entire system is a massive job. I did reach out to Nottingham NHS Trust to ask why they dropped out of the trial, but I didn't get a response.
- [26:50]
Luke Jones
And one of the lessons, I guess, as well, is that Finland haven't even fully adopted it. So it's clearly a challenge.
- [26:56]
Roisin Kelly
Yeah, that's true. And, you know, as I said before, open dialogue. Staff at the hospital in Kemi are concerned that government cuts are pushing them in a direction of box ticking, you know, filling in a form every day of patients they spoke to and how many people they got through. And, you know, that's the sort of trend that we see across the world at the moment in terms of governments trying to save money. We could still take elements of it, even if not the whole thing. You know, if you just look at NHS waiting lists for counseling even. And that, I think, is where you can see how things escalate. If you are somebody who feels maybe you're not at your top level crisis point, but you feel awful, you're not going to sixth form or college or work because you feel so depressed and you can't see a way out and you try to get counseling on the NHS and are told you have to wait three months or however long it is, of course you're going to escalate in that time. So I think there are elements that we can take from it. Even if we're not deciding to, you know, overhaul the entire NHS mental health care system.
- [28:03]
Luke Jones
And just finally, I guess from your perspective, not only reporting on this and what's being tried and hopefully will be effective in parts of Finland, but then also the Nottingham inquiry and the various examinations of how difficult mental health care is here in the uk, do you look at all that and are hopeful or do you think, well, we're just all sort of fumbling around in and no one's really going to grip this?
- [28:25]
Roisin Kelly
I think when something as awful as Nottingham has happened, we would hope that people would be open to looking at ways to change the system, tweak the system, improve it, you know, on a national scale. What makes me feel hopeful is that there are people who are bothering to get this trial done because essentially until you have a really significant trial like this, hospitals or, you know, NHS bosses, they won't even look at something because you don't have the trial results. The results will be published in a scientific journal. I think some places might start the steps to implement change. So I think the fact that, you know, there are consultant psychologists of really senior level who really believe in this and want to make an changed the system, I think that's something we can all have hope in.
- [29:24]
Luke Jones
Sunday Times journalist Roisin Kelly. The story@thetimes.com is our email address. Should you have thoughts, should you have experience of this kind of thing, maybe work in mental health or use some of the services here in the uk, let us know that is it from us today. The producer was Michaela Arneson, the executive producer was Taryn Siegel. Sound design was by Ivan Easley and theme composition was by Maliceto. I'm Luke Jones. See you soon.
- [30:12]
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- [30:41]
Luke Jones
What's going on?
- [30:42]
BetterHelp User / Arsh Manning (Vuori Advertiser)
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