It has been known and evidenced for several decades now that three things bring about improved recovery and reduced long term burden on services in the area of mental health:

  1.     Stronger therapeutic relationships between clinicians and patients
  2.     Continuity of care; ensuring these relationships are maintained throughout care
  3.     Working systemically, not just with patients, but with all other significant people; their family and wider networks too.

Our current mental health services are not generally designed in accordance with these key drivers. Indeed, with fragmented care, limited emphasis on therapeutic relationships and very little therapeutic engagement with families and networks, in many ways, current service design works against each of these factors.

Imagine a transformative model of care for mental health services that addresses each of these issues. That’s Open Dialogue. It doesn’t replace any tools clinicians use to deliver care currently, rather it is the culture and operating framework within which care is delivered. You could say it's the carpet on which everything else sits. It originated in Finland in the 1980s and is now operating in over 30 countries.

How does it work?

All patients are seen by staff who are rigorously trained in systemic ways of working and in deep listening skills in order to maximise therapeutic relationships. Together with the patient and their loved ones, they form ‘network meetings’ which act as the central organising spine of treatment which is also a way of bringing all services and agencies together, including Third Sector providers. All decisions are made in a collaborative, person-centred, less hierarchical way through network meetings, and this remains a consistent, central organising and therapeutic forum for all care that is delivered.Ìý

The initial Finnish research showed substantial drops in in-patient usage, almost immediately on utilisation of Open Dialogue, as well as an overall reduction in service usage, improved recovery, and an overall reduction in service costs as a result.

The ODDESSI trial in the UK

As the Clinical Lead of the NIHR funded ODDESSI trial, alongside Professor Steve Pilling as the Chief Investigator, I am part of the team working to bring it to the UK. The trial was a large multi-centre Cluster Randomised Controlled trial that ran from 2017 to 2025 studying the implementation of Open Dialogue in six pilot sites across five NHS Trusts.ÌýOutcomes measured were very much aligned with major national NHS priorities:

  1.     Moving care from hospital to community
  2.     Improving long-term outcomes
  3.     Improving preventative care

Results are shortly to be published and, if the Finnish results, particularly the improved patient recovery and reduction of service burden and cost, are replicated by ODDESSI, then it will be a landmark finding, and could potentially lead to an implementation programme that accelerates the transformation of mental healthcare towards a model that is more relational, achieves better recovery, better patient experience and is far more cost effective.

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