Open Dialogue: Development and evaluation of a social network intervention for severe mental illness (ODDESSI)

Background

In the NHS there are significant problems in providing care and support for people in a mental health crisis. More people are admitted to hospital than should be, leading to a shortage in psychiatric beds. In principle, community-based crisis teams are effective in managing crises in people’s homes. However, they are not as effective as they could be in preventing hospital admissions due to limited resources and the provision of short term crisis management.

Developed in Finland, Open Dialogue (OD) is a new method for working with people in crisis which works with the service user from initial crisis and beyond, organising treatment and longer term care to prevent crises recurring. In contrast to crisis teams, OD places a greater emphasis on working with the service user, their families and friends, and others (for example healthcare professionals or local community members) to form a network of support. Peer Support Workers (PSWs) are key members of each OD team and each team has at least one PSW to support other team members and assist service users to develop and maintain supportive social networks. There is some evidence from Finland to suggest that OD is an effective way to help people in crisis, but no high quality scientific studies have been undertaken to confirm this.

This research is a five year programme of work to address this evidence gap with five related work packages which aim to investigate whether current NHS services can be re-organised to implement OD and assess whether OD is effective for treating people in crisis.

Work Packages

• Development

Adapt, refine and establish the OD intervention for use within existing NHS services (crisis and continuing community care) and assess the implementation of OD and the development of the PSW role. The end result will be a protocol acceptable to clinicians and service users.
 

• Feasibility

Assess the feasibility of conducting a full multicentre cluster randomised controlled trial (RCT) of the OD model.  
 

• Multicentre cluster RCT

Comparing Open Dialogue to usual NHS crisis and longer-term community care (TAU) to determine its clinical and cost-effectiveness, with a total of 644 participants.

• Currently Recruiting

If you are interested in taking part please contact R&D team by email: R&D@nelft.nhs.uk.

• Process evaluation

To assess adherence to the OD intervention, fidelity to the OD model and to Crisis Care in TAU, OD team function, intervention process, comparison of treatment process in control and intervention groups, staff experience of delivering OD (including PSWs) and training.
 

• Service user and family experience of OD

Explore service user, carer and practitioner experience of OD.

Objectives

This programme has four objectives:

• To develop a protocol acceptable to clinicians and service users for the delivery of Open Dialogue (OD) for the management of mental health crisis
• To assess the clinical and cost-effectiveness of OD
• To understand the experience of service users, carers and staff of OD
• To develop a model of OD that can be implemented in routine NHS care.

RADAR

RADAR (Research into Antipsychotic Discontinuation and Reduction) is a research programme led by Dr Joanna Moncrieff and funded by the National Institute for Health Research (NIHR) that aims to provide new evidence on the effects of a gradual programme of antipsychotic reduction and discontinuation in people with long-term schizophrenia and similar conditions. This will support patients and clinicians to make better informed choices about long-term medication.

Background

Schizophrenia is common and costly. The recommended treatment is long-term antipsychotic medication, but many people still find life difficult. Although antipsychotics are effective at reducing psychotic symptoms and relapse in the short-term, they can also have dangerous and unpleasant side effects. Finding alternatives to long-term drug treatment is a priority for patients and services.  

Aims

The proposed research aims to test the effects (benefits and harms) of a gradual programme of reducing and discontinuing antipsychotic medication in people with long-term schizophrenia and similar conditions. We want to know whether this approach can help people to function better in their daily lives. Some other evidence suggests this might be the case. We also want to know how it affects the chances of having a relapse.  This study will be the first with this group of people that uses a gradual and flexible method of medication reduction, and that follows people up over the long-term.

Objectives

1. To develop a protocol for a gradual and supported strategy of antipsychotic reduction and discontinuation and to design a trial to evaluate this strategy.
    
2. To develop a recruitment strategy for a trial of a gradual and supported strategy of antipsychotic reduction and discontinuation in community mental health services.
    
3. To compare the guided strategy of antipsychotic reduction and discontinuation with continuous, maintenance antipsychotic treatment in a six-month internal pilot trial.
    
4. To conduct a trial in people with multiple episode schizophrenia or related conditions to evaluate the risks and benefits of the antipsychotic reduction and discontinuation intervention. 

For further information, please contact the RADAR programme manager, Nadia Haynes Nadia.Haynes@nelft.nhs.uk

Contact Us: 

You can get in touch with us by emailing R&D@nelft.nhs.uk.