Open Dialogue trial reports fewer psychiatric admissions

When Rachel Banister’s daughter was in crisis, she said, the family watched her move between professionals and repeat her story. Open Dialogue changed the setting: patients, clinicians and relatives or friends meet regularly, with two practitioners staying involved after the crisis. Banister said that, in six months, one daughter went from social isolation and inability to work to completing her A-levels and securing a university place 120 miles (190 kilometers) from home.

The model has now faced its first randomized controlled trial. The ODDESSI study, led by a University College London researcher with North East London NHS Foundation Trust and King's College London, included 494 participants in England who received either Open Dialogue or usual treatment after presenting to a mental-health service in crisis. Researchers followed them for two years.

The primary result was negative: Open Dialogue did not change the time to first relapse after initial recovery. But its secondary outcomes pointed in a different direction. Participants offered the approach had more than three times the odds of never being admitted to psychiatric inpatient care, alongside lower odds of being referred back to crisis care. They also reported better self-rated recovery, health-related quality of life and satisfaction with services.

The limits are part of the result. The trial did not include family interventions routinely used in Finland, and relatives or friends joined fewer network meetings than intended. The researchers say the benefits may therefore have come partly from improved mental-health team functioning, not only from the full Open Dialogue method; more work is needed to understand and refine it for the UK.

So what changes in practice? For people in crisis, continuity could mean fewer handoffs, fewer repeated accounts and more decisions made with their support network. For services under pressure, the potential gain is lower use of inpatient beds and crisis care—but the trial does not yet establish a reduction in relapse, and researchers are continuing to track whether the model works best as access expands across the UK.