Dr Russell Razzaque: What Scandinavia can teach us about the future of mental health care

Dr Russell Razzaque, consultant psychiatrist and co-lead of the ODDESSI trial - one of the largest randomised mental health studies of its kind - sets out why its forthcoming results could mark a turning point for mental health care in the NHS.

Too often in mental health care, people find themselves trapped in a revolving door.

They move between services, repeat their story to different professionals, and navigate systems that can feel fragmented at precisely the moment they need stability most.

Meanwhile, the people closest to them - family, friends, and loved ones - are often left on the sidelines, unsure how best to help.

For decades, we have designed mental health services around treating individuals. But what if recovery depends just as much on relationships?

That question sits at the heart of Open Dialogue - an approach to mental health care first developed in Finland, now used widely across Scandinavia and increasingly adopted in more than 30 countries around the world.

At first glance, the concept can seem almost deceptively simple.

Bring people together. Talk openly. Make decisions collectively.

When people hear about it for the first time, the response is often the same: “Isn’t that just common sense?”

In many ways, it is.

But within modern mental health services, adopting this approach requires a fundamental shift in how we think about care itself.

The current system built around the individual

For generations, mental health care has largely followed a model centred on the individual.

A person is assessed, diagnosed, treated, and referred between teams as their needs evolve. Each transition often means telling deeply personal experiences again and again, while continuity of care becomes harder to maintain.

In trying to provide specialist support, we have often unintentionally created fragmented care.

At the same time, those who know a person best can become disconnected from the process entirely. Families and loved ones may feel excluded, uncertain how to help, or in some cases seen as part of the problem, when in reality they are often the most important people to help long-term recovery.

Traditional approaches have helped many people and continue to play an essential role. But too many individuals still find themselves returning repeatedly to crisis services, caught in cycles that suggests something needs to change.

What is Open Dialogue?

Open Dialogue starts from a different assumption: mental health challenges do not exist in isolation, so care should not either.

It is not a therapy model. Rather, it is a fundamentally different way of organising care around the relationships that shape a person’s life.

At its centre are what we call network meetings, which bring together:

• The patient
• Their chosen support network, including family, friends, or others they trust
• Usually two trained practitioners, often a clinician alongside a peer support worker

These meetings are not traditional appointments. They are ongoing, transparent conversations where:

• The patient decides who is present
• The patient sets the agenda
• All discussions and decisions take place openly in the room
• Clinicians become participants in a shared conversation, rather than distant experts making decisions separately

Crucially, medication, therapy, and other interventions still have a place in some cases. Open Dialogue is about providing the network of support for long-term understanding and recovery.

A different role for clinicians

In Open Dialogue, clinicians are still essential but the hierarchy with the patient is flattened. 

No clinician, however experienced, can fully understand an individual’s life in the way they and those closest to them can.

Open Dialogue asks professionals to move away from being sole decision-makers and instead become part of a wider process of shared understanding.

In this model:

• The patient’s lived experience becomes central
• Families bring vital context and knowledge
• Clinical expertise sits alongside, rather than above, the perspectives of others involved

This is not about reducing the role of clinicians. It is about recognising that recovery is often relational, not simply clinical.

Why this matters now

Across parts of the world, evidence increasingly suggests that relational models of care can improve long-term recovery, reduce dependence on crisis services, and strengthen the wellbeing of both patients and the people around them.

When support networks are actively involved, recovery becomes something shared rather than something carried by the individual alone.

At NELFT, we are currently leading the ODDESSI trial in partnership with UCL and four other NHS trusts, testing whether Open Dialogue can be delivered effectively at scale across NHS mental health services.

Spanning two years and involving 500 participants, it is one of the largest randomised mental health trials ever conducted.

As the results are set to be published, we are approaching a crossroads.

Will we continue refining a system built around individuals, or begin to embrace one built around relationships.