When a person in England experiences a severe mental health crisis, their family and friends are rarely brought into the treatment room. This programme tests a Finnish model called Open Dialogue, which replaces brief, isolated clinical contacts with regular network meetings that include the patient’s relatives, friends, and any other professionals involved. The problem is that current crisis services—Crisis Resolution and Home Treatment Teams—often fail to reduce hospital admissions, partly because they offer short-term contact with no continuity of care. Research also shows that poor social networks drive mental illness and relapse, yet no existing crisis intervention explicitly targets the network itself. Open Dialogue fills that gap by making the social network the central tool for shared decision-making and long-term mutual support. If the trial succeeds, the NHS could adopt a sustainable in-service training programme and an implementation toolkit, shifting crisis care from episodic bed management to continuous, network-based recovery. This would directly affect how thousands of people each year experience psychiatric crisis—not as isolated patients, but as members of a supported community.
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Aims and Objectives This programme has four aims: to develop a protocol acceptable to clinicians and service users for the delivery of Open Dialogue (OD) for the management of mental health crisis, to assess the clinical and cost-effectiveness of OD, to understand the experience of service users, carers and staff of OD and finally, to develop a model of OD that can be implemented in routine NHS care. Background and Rationale In England there is excessive pressure on psychiatric beds which has been attributed to increased demand for beds, often in the context of reduced community resources, limitations in crisis response (including Emergency Departments and Crisis Response and Home Treatment Teams (CRHTTs)) and the decreasing availability of long-term community support. Research suggests CRHTTs may not be associated with a reduction in hospital admissions which could be due to atrophy of their key functions. Epidemiological research implicates poor social networks in the development and maintenance of mental Disorder. Interventions which target the social network may have a role in ameliorating mental health crises and reducing the likelihood of relapses. Given the brief nature of CRHTT contacts and lack of continuity of care such interventions are not currently provided. A systematic review identified few studies of social network interventions , of which few were crisis care or explicitly focused on bringing about change through the network. Open Dialogue (OD) is a new therapeutic practice and service delivery model developed in Finland that explicitly targets social networks as a focus for the intervention (Seikkula 2006; 2011). In contrast to current care models, in which families are rarely directly involved, OD uses network meetings attended by family members, friends and other professionals involved as the central means of intervention delivery. Service users and their network engage in shared decision making with professionals to deploy appropriate pharmaceutical, psychological or social interventions with the aim of developing longer term mutual support. PSWs work with the service user to develop a more coherent and sustainable network. Continuity of care is a key principle. Research Plan The research plan has five related Workpackages. The first is a programme of work to develop the Open Dialogue intervention so that it is adapted for use in the NHS. In WP1 we will also undertake development work of the role of service users as key members of the OD team; Peer Support Workers (PSW). After completion, we will move to the feasibility trial in WP2 to assess whether it is possible to assess OD in a large multicentre cluster RCT; if the feasibility study is positive we will progress to WP3. This is a large (506 participant) multicentre trial of OD compared to Treatment as Usual for people presenting to NHS services in crisis. WP4 is a process evaluation of the RCT which also contains further development work on implementation of OD and development of an in-service training programme to support the sustainability of OD in routine care. Projected outputs and dissemination plans In addition to the preparation of peer reviewed publications and presentation at national and international conferences, we will develop a dissemination plan in collaboration with organisational and service user stakeholders which will include the following on a specifically designed ODESSI website; a protocol for the delivery of OD accessible summaries of programme progress an implementation toolkit a suite of outcome and process measure including fidelity and adherence a sustainable in-service training programme We will establish with key participants a national training programme and develop links with Health Education England, NHS England, AHSNs, local commissioners, relevant Royal Colleges and other professional bodies to promote the implementation of OD. We will collaborate with key service user groups to support the role of peer sup
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