A new approach to care for people experiencing a mental health crisis, emphasising continuity and community, can reduce hospital admissions and improve satisfaction with care, finds a study led by a University College London (UCL) researcher.
The study published in The Lancet Psychiatry is the first randomised controlled trial of Open Dialogue, which is both a treatment method and a way of organising mental health services.
Open Dialogue is a person-centred, network model that brings together patients, clinicians and members of a person's social network to plan and review care during and following a mental health crisis. Developed in Finland in the 1980s, it is already in use in some NHS trusts and is gaining considerable international interest, but evidence of its efficacy remains limited.
A core part of Open Dialogue is the use of regular network meetings, where the patient and members of their social network (which can be family, carers or friends) meet with two Open Dialogue practitioners, who then remain involved in the patient’s continuing care after the crisis. The meetings focus on developing a shared understanding of the individual’s mental health issues, seeking to increase personal agency and the development and maintenance of supportive relationships.
The ODDESSI trial of Open Dialogue included 494 participants who were either offered Open Dialogue or treatment as usual* after presenting in crisis to a mental health service in England.
The researchers found no impact on the primary outcome of the trial – time to first relapse following initial recovery.
But there were promising findings on secondary outcomes of the trial. Those treated with Open Dialogue had more than three times higher odds of never being admitted to psychiatric inpatient hospital care, relative to those receiving treatment as usual, and lower odds of re-referral to crisis care over the study’s two-year follow-up period. The researchers say these findings suggest that Open Dialogue may help to reduce NHS costs.
Open Dialogue was also associated with improvements in self-rated recovery, health-related quality of life, and satisfaction with services.
The study was funded by the National Institute for Health and Care Research and led by a UCL researcher in collaboration with North East London NHS Foundation Trust (NELFT – the trial sponsor), King’s College London and international co-authors.
Lead author Professor Steve Pilling (UCL Psychology and Language Sciences) said: “Our results are encouraging, as we found that Open Dialogue can reduce hospital bed usage and improve people’s satisfaction with their treatment and experience with mental health services. But we did not find any difference in time to relapse, an important measure of mental health treatment efficacy.
“People experiencing a mental health crisis can often end up getting seen by a number of different mental health teams, which can be frustrating and at times disjointed. Open Dialogue seeks to reduce movement between teams, thereby supporting the delivery of care that is collaborative and patient-centred.
“There is more work to be done to fully establish Open Dialogue’s clinical effectiveness, refine its methods, and better understand the mechanisms underpinning its effectiveness.”
The use of Open Dialogue in the study did not include family interventions, which are routinely used in Open Dialogue in Finland, or other forms of psychological interventions which are known to improve outcomes for a range of mental disorders. The authors also note there was less involvement of family or friends in network meetings than intended and relative to other applications of Open Dialogue. The benefits seen in this trial may, therefore, have been a result of improved mental health team functioning, but the researchers say that more work needs to be done to understand how Open Dialogue works best, and how to refine it for use in the UK setting.
The researchers are now working on expanding access to Open Dialogue across the UK while continuing to track efficacy of the approach with a particular focus on reducing the use of in-patient beds.
Co-author Professor Russell Razzaque, Consultant Psychiatrist at NELFT and Professor of Relational Psychiatry at SOAS, said: “Mental health services are under enormous pressure, with many people stuck in a revolving door of crisis care and hospital admissions.
“Too often care is disjointed, families are left out and not enough time is spent on forging a deep and lasting therapeutic relationship in our services. The ODDESSI trial shows that when care is built around relationships, mutuality, continuity and shared decision-making, people report better recovery, better quality of life and better experiences of care, while at the same time making far less use of inpatient or crisis services.”
Rachel Banister, who co-founded Mental Health – Time for Action after years of struggling to access the right support for her teenage daughters, turned to Open Dialogue, where she finally found an approach that worked. She said: “As a mum, all I have ever wanted is to be able to support my daughters, but for years I felt completely shut out of care and didn’t know how to help. Decisions were made about our family without us, and my daughter saw countless professionals – having to repeat her story again and again, which was often retraumatising.
“Open Dialogue has completely changed that. For the first time, we were all in the room together, being listened to and heard. It allowed us to be honest, to be upset, and to start understanding each other in a way we never had before.
“We feel stronger as a family and no longer carry things on our own. In six months, one of my daughters has gone from being socially isolated, unable to work and relying on benefits, to completing her A-levels and securing a university place 120 miles from home - something we once thought would never be possible.”
* Treatment as usual in this study involved the functional team model currently implemented throughout English mental health services, where treatment may involve multiple separate teams.
The Lancet Psychiatry
Randomized controlled/clinical trial
People
Open Dialogue versus treatment as usual for adults presenting in crisis to mental health services in England (the ODDESSI Trial): a multisite cluster-randomised trial
26-Aug-2026