Community Mental Health Care Cuts Hospital Admissions

Evaluating the ODDESSI Trial of Open Dialogue in England

The ODDESSI trial evaluated 494 participants who presented in crisis to mental health services in England, assigning them to either Open Dialogue or treatment as usual. Led by Professor Steve Pilling at UCL Psychology and Language Sciences, the multisite study involved collaboration with the North East London NHS Foundation Trust (NELFT), King’s College London, and international co-authors, with funding from the National Institute for Health and Care Research.

While the primary outcome of the trial showed no impact on the time to first relapse following initial recovery, secondary outcomes revealed distinct advantages. Patients treated with Open Dialogue faced more than three times higher odds of never being admitted to psychiatric inpatient care compared to those receiving standard treatment. They also experienced lower odds of re-referral to crisis care over a two-year follow-up period, suggesting potential reductions in National Health Service (NHS) costs.

How Open Dialogue Transforms Crisis Care Delivery

Traditional mental health crisis care often forces patients to recount their stories to multiple distinct teams, which Professor Pilling notes can feel frustrating and disjointed. Open Dialogue addresses this by keeping the same practitioners involved in ongoing care after the initial crisis. The model emphasizes personal agency, supportive relationships, and collaborative care planning.

Despite these structural benefits, the study noted certain implementation challenges in the English setting. Researchers observed less involvement from family and friends in network meetings than originally intended, and the trial did not incorporate family interventions routinely used in Finland. Professor Russell Razzaque, a consultant psychiatrist at NELFT and professor of relational psychiatry at SOAS, stated that mental health services are under enormous pressure with revolving doors of crisis care, but building care around relationships and shared decision-making leads to better recovery and quality of life.

Real-World Impact on Families and Recovery

For families navigating severe mental health distress, structured relational models offer an alternative to traditional exclusion from care. Rachel Banister, co-founder of Mental Health – Time for Action, experienced the model firsthand after struggling to access support for her teenage daughters. According to Banister, earlier care felt isolating and decisions were made without family input, but Open Dialogue placed everyone in the room together to listen and be heard.

Banister noted that within six months of utilizing the approach, one of her daughters transitioned from being socially isolated and unable to work to completing her A-levels and securing a university place 120 miles from home. Researchers are currently working to expand access to Open Dialogue across the UK while continuing to track its clinical efficacy and impact on inpatient bed usage.

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