New approach to mental health care reduces hospital admissions

A new mental health care approach called Open Dialogue, which emphasizes continuity and community involvement, has been shown to reduce hospital admissions and improve patient satisfaction, according to a study led by University College London researcher Professor Steve Pilling. Published in The Lancet Psychiatry, the open-label randomized controlled trial is the first of its kind for Open Dialogue, a treatment method and organization model for mental health services developed in Finland in the 1980s.

The ODDESSI trial involved 494 participants who received either Open Dialogue or standard treatment after seeking crisis care in England. While the primary outcome of time to first relapse after initial recovery did not differ between groups, Open Dialogue was associated with several promising secondary outcomes. Patients treated with Open Dialogue had a greater than threefold increased likelihood of never requiring psychiatric inpatient care compared to those receiving usual care.

They also experienced lower odds of re-referral to crisis care over a two-year follow-up period. Additionally, Open Dialogue was linked to improvements in self-rated recovery, health-related quality of life, and satisfaction with care services.

Open Dialogue's success relies on regular network meetings where patients, their social network (family, caregivers, or friends), and two Open Dialogue practitioners collaborate to plan and review care during and after a mental health crisis. This person-centered network model aims to develop shared understanding of mental health issues, increase personal agency, and foster supportive relationships.

The trial's findings suggest Open Dialogue may help lower NHS costs by decreasing hospital bed usage and improving patient experiences with mental health services. However, the study did not find any difference in time to relapse, which is a crucial measure of mental health treatment efficacy.

Professor Pilling noted that Open Dialogue could potentially help reduce hospital admissions and improve patient satisfaction, but further research is needed to establish its clinical effectiveness, refine its methods, and understand the mechanisms behind its success. The researchers also mentioned that the trial did not include family interventions or other psychological interventions commonly used in Open Dialogue in Finland, and there was less family involvement than intended.

These limitations may have contributed to the observed benefits, which could be attributed to improved mental health team functioning.