Open Dialogue
Open Dialogue is both a therapeutic practice and a system of care. It originated originated in Finland in the 1980s where long-term observational studies have reported high rates of recovery and low levels of hospitalisation and long-term service use.
It brings together the person in crisis, their family, friends, and professionals in a shared conversation where every voice is heard and lived experience is valued. Clinical staff work as equal partners in the dialogue, focusing on listening, building connection and helping the network to find meaning and their own personal path to recovery.
An NIHR-funded multi-centre randomised controlled trial
The ODDESSI Trial (Open Dialogue: Development and Evaluation of a Social Network Intervention for Severe Mental Illness) - the largest and most rigorous study of Open Dialogue ever conducted - has been delivered across multiple NHS Trusts.Led by University College London (UCL), a team of researchers, clinicians, and people with lived experience, ODDESSI evaluated how an adaptation of Open Dialogue, known as ODDESSI Peer-supported Open Dialogue (OPOD), can be implemented safely and effectively within NHS community mental health and crisis teams. View the NIHR Funding Awards Page.
The headline findings of the ODDESSI Study are:
- There was no statistically significant difference in the time it took to relapse in the Open Dialogue arm of the trial compared with standard care. This was the primary outcome of the trial.
- The odds of being admitted to hospital for severe mental illness was three times less for those who had Open Dialogue compared to standard care, reducing the use of hospital by 54%.
- The chance of being referred to a crisis service was halved for those who had Open Dialogue compared to standard care.
- Patient-defined recovery (people's rating of their own relationships, work, study and other self-rated markers of recovery) improved for those who had Open Dialogue compared to standard care.
- Overall quality of life was improved for those who had Open Dialogue compared to standard care.
- Patient experience and rating of the care they received was higher for those who had Open Dialogue compared to standard care.
To find out more and learn about the results, read the paper and commentary in The Lancet Psychiatry.
Open Dialogue Implementation Programme
The NCCMH, together with the Centre for Open Dialogue Education (CODE) - who brought Open Dialogue to the UK and delivered all of the training for staff and teams in the ODDESSI trial - and in partnership with Neurodiverse Connection and Black Thrive Global and other key stakeholders, are developing a programme to implement Peer-supported Open Dialogue at scale across whole community pathways with overall programme oversight and performance management by Healthy Brains Global Initiative (HBGI).
Together we will provide training, Quality Improvement, leadership and organisational change coaching over four years to support the cultural and clinical changes required to shift to a more relational way of working. Additional clinical capacity for Open Dialogue practitioners will also be provided to support this transformation. Implementation plans will be worked out individually with each participating Trust and Health Board.
The implementation programme is itself an opportunity to test whether the ODDESSI findings can be reproduced at scale. We will evaluate implementation, outcomes, costs and unintended consequences transparently as the programme is delivered.
Using innovative funding mechanisms, there would be no upfront costs to Trusts or Health Boards to take part in the programme.
Interested in bringing Open Dialogue to your Mental Health Trust or Health Board?
If you are a Mental Health Trust in England or a Health Board in Wales or Scotland, who would like to learn more about the programme and explore the opportunity to participate in bringing Peer-Supported Open Dialogue to your local area, the NCCMH would love to talk to you. Contact us to start a conversation with our team.
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