Community-based mental health approach shows promise in reducing hospital admissions

A different way of organising support after a mental health crisis has produced encouraging results in a major trial led by a University College London researcher.

Open Dialogue brings the person receiving care, clinicians and members of their support network together to plan and review treatment. The model puts particular weight on continuity, shared decision-making and keeping supportive relationships involved rather than repeatedly moving people between disconnected teams.

The ODDESSI trial involved 494 people who had presented to mental health services in crisis. Participants were offered either Open Dialogue or treatment as usual and were followed for two years.

The study did not find a difference in its primary measure, the time to first relapse after recovery. That is an important limitation. However, people receiving Open Dialogue had more than three times the odds of never requiring a psychiatric inpatient admission, were less likely to be referred back to crisis care, and reported better recovery, quality of life and satisfaction with services.

Researchers say more work is needed to establish exactly how the approach works best in the UK and to test its clinical effectiveness further. The findings nevertheless add useful evidence to the idea that continuity and collaboration can improve people’s experience of mental health care while potentially reducing pressure on inpatient and crisis services.