Editor’s Note: This article originally appeared on our affiliate site, Mad in Ireland. Mad in America will be publishing further blogs about the ODDESSI results in the coming days.

A non-medical approach to mental health treatment—Open Dialogue—can reduce hospital admissions and improve satisfaction with care, new research has found.

The ODDESSI trial, published in The Lancet Psychiatry, involved 494 people presenting in crisis to mental health services in England. It compared Open Dialogue with treatment as usual and found that people’s reported recovery, quality of life and satisfaction with services improved with OD.

The findings are from the first randomised controlled trial of Open Dialogue, a model of mental health care developed in Finland which places relationships, continuity and shared decision-making at the centre of care.

Researchers found that people receiving Open Dialogue had more than three times higher odds of avoiding psychiatric inpatient admission altogether during a two-year follow-up period.

They were also less likely to be referred back to crisis care or secondary mental health services and reported better recovery, health-related quality of life and satisfaction with services.

Open Dialogue differs substantially from conventional mental health service provision as it takes an approach involving the person, members of their social network such as family or friends, and OD practitioners who remain involved throughout their care. Meetings aim to develop a shared understanding of what the person is experiencing, while supporting personal agency and maintaining important relationships.

The study’s findings are particularly significant given concerns about the potentially traumatic and coercive nature of psychiatric hospital care.

In a press release, Professor Russell Razzaque, Consultant Psychiatrist at North East London NHS Foundation Trust and a co-author of the study, said currently mental health services are increasingly characterised by a “revolving door” of crisis care and hospital admissions.

He said that when care is structured around relationships and shared decision-making, people report better recovery and quality of life while making “far less use of inpatient or crisis services.”

The study does, however, contain some caveats. OD did not perform better than treatment as usual when comparing time to relapse following initial recovery. Relapse was determined to mean the return of significant symptoms and deterioration of social functioning

Dr. Tomi Bergström is a prominent Finnish clinical psychologist, researcher, and a leading expert on the Open Dialogue (OD) approach to psychiatry. He recently published an invited commentary in The Lancet Psychiatry regarding the ODDESSI trial.

He contends that “although no statistically significant difference was observed in the prespecified primary outcome of time to relapse, in the 2-year follow-up, Open Dialogue was associated with lower probabilities of psychiatric inpatient admission and re-referral to secondary mental health services, as well as better self-rated recovery, health-related quality of life, service satisfaction, and fewer adverse events.”

He further wrote that while the trial used time to relapse, which is a well-established outcome in psychiatric research and was important for the trial’s credibility within so-called mainstream psychiatry, “its construct validity as the primary endpoint for evaluating Open Dialogue deserves further consideration.”

It’s also important to note that the UK version of Open Dialogue tested in the trial differed from the model developed in Finland. For example, it did not include family interventions or some psychological interventions that are incorporated into Open Dialogue practice elsewhere. Family and friends were also involved in network meetings less frequently than researchers had intended.

Also quoted in the press release, Rachel Banister, who sought OD support after years of trying to obtain appropriate help for her daughters, described conventional services as leaving her family excluded from decisions while her daughter repeatedly had to retell her experiences to different professionals.

“Open Dialogue has completely changed that. For the first time, we were all in the room together, being listened to and heard. It allowed us to be honest, to be upset, and to start understanding each other in a way we never had before,” she said.

Researchers are now working to expand access to Open Dialogue in the UK while continuing to examine its effectiveness, particularly its potential to reduce reliance on psychiatric inpatient beds.

The post Open Dialogue Approach Cuts Psychiatric Hospital Use in Major Trial appeared first on Mad In America.

 

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