A major national study sponsored by  North East  London NHS Foundation Trust (NELFT) has found that Open Dialogue, an innovative approach to mental health care, can reduce hospital admissions and improve people's experience of services following a mental health crisis.  

The findings, published in  The Lancet Psychiatry , come from the ODDESSI trial, the first large-scale randomised controlled trial of Open Dialogue. The study was led by Professor Steve Pilling (UCL) and funded by the National Institute for Health and Care Research (NIHR).  

Open Dialogue is a person-centred approach that brings together individuals,  clinicians  and members of a person's support network, including family members,  carers  and friends, to plan and review care together. The model places a strong emphasis on continuity of care, shared  decision-making  and supportive relationships.  

The trial involved 494 participants who presented to mental health services in crisis and were offered either Open Dialogue or treatment as usual.  

While the study found no difference in the primary outcome of time to relapse following recovery, it  identified  several important benefits for people receiving Open Dialogue.  

Participants receiving Open Dialogue were more than three times more likely never to require admission to a psychiatric inpatient unit during the two-year follow-up period. They were also less likely to be  referred back  to crisis services and reported improvements in recovery, quality of life and satisfaction with care.  

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.”  

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.”  

As trial sponsor, NELFT played a key role in supporting and overseeing this nationally significant programme of research in partnership with UCL, King's College London and NHS organisations across England.  

The findings add to growing evidence that approaches which prioritise relationships, continuity and collaboration can improve people's experiences of mental health care while potentially reducing demand on inpatient and crisis services.  

Researchers are now continuing to explore how Open Dialogue can be refined and implemented more widely across the UK.  

Read the full paper in The Lancet Psychiatry.