Open Dialogue trial finds fewer psychiatric admissions, but no faster recovery from relapse

Open Dialogue is a person-centred approach to mental health care. It aims to keep care more continuous during and after a crisis, rather than moving a person between different teams. It uses network meetings that can include the person receiving care, people in their social network, and usually two practitioners who remain involved over time.

Researchers tested this approach in a completed cluster-randomised trial in England. In this kind of trial, groups rather than individual people are randomly assigned to different types of care. Here, general practices were grouped into clusters and assigned either to Open Dialogue or to usual care.

The study took place across five NHS mental health trusts in London and southern England. It enrolled 494 adults aged 18 or older who presented to mental health services in crisis between June 2019 and December 2021. Of those participants, 271 were in the Open Dialogue group and 223 received treatment as usual. Usual care was the functional team model used across English mental health services.

The main question was whether Open Dialogue changed the time to a first relapse after a person had initially recovered from the crisis that brought them into care. Researchers assessed this over two years.

It did not. Among participants who recovered and had enough information for the analysis, there was no statistically significant difference in time to relapse between the two groups. The study reported a hazard ratio of 0.95, with a 95% confidence interval from 0.67 to 1.32. In everyday terms, the results did not provide clear evidence that Open Dialogue delayed relapse compared with usual care.

Several secondary results were more positive. Open Dialogue was linked with significantly lower chances of psychiatric inpatient admission and of being referred again to crisis care or other secondary mental health services. The journal abstract describes reduced acute inpatient bed use, while the news coverage says people offered Open Dialogue had more than three times the odds of never being admitted to psychiatric inpatient care.

Participants receiving Open Dialogue also reported better scores for their own sense of recovery, health-related quality of life and satisfaction with services. However, the researchers found no significant differences in the size or quality of participants’ social networks.

Safety results did not raise a clear concern about the intervention. There were 386 serious adverse events recorded in total: 281 in the usual-care group and 105 in the Open Dialogue group. Researchers judged 376 of these events, or 97%, unrelated to the intervention. The abstract does not provide further detail about the events.

The findings matter because hospital admissions and repeated crisis referrals can be disruptive experiences. A care model that reduces inpatient bed use while improving people’s experience of services could be useful. Still, the trial’s primary outcome was negative, so the results do not establish that Open Dialogue is more clinically effective overall or that it prevents relapse.

The researchers said further investigation is needed to understand whether Open Dialogue can improve both the effectiveness and acceptability of crisis and continuing community mental health care. More research would also need to clarify which parts of the model are most helpful and how well it works in other services and populations.