Open Dialogue: The radical new treatment having life-changing effects on people’s mental health

Open Dialogue is currently being piloted in four NHS trusts. It could revolutionise mental-health care in the UK, according to its champions. The North East London Foundation Trust, where he works, has just given the go-ahead for an Open Dialogue-based service for patients referred from anywhere in the country, starting next May.

Open Dialogue is primarily for people who are suffering a mental-health crisis such as suicide or psychosis – 1.8 million of them in the UK last year. They badly need help: a damning report from the Care Quality Commission in June found that the current system is struggling to cope with mental-health crises, with 42 per cent of patients not getting the help they need. A campaign launched last month calls for an increase in funding for mental-health services and parity with physical health.

The Open Dialogue approach was first developed in Finland in the 1980s, which at the time had one of the worst incidences of schizophrenia in Europe. There are now well-established services in Berlin and New York, where state investment in four respite centres that practise Open Dialogue has been doubled to $100m (£66m). Services are also springing up in Italy, Poland and Scandinavia.

What’s most impressive about Open Dialogue is its success with even the most intractable mental illnesses, where current systems of care too often fail, or offer only short-term respite. Results over the past 30 years from Finland sound impressive: 74 per cent of patients experiencing psychosis are back at work within two years, compared with just 9 per cent in the UK. Crucially, relapse rates are far lower than here: after an average of two years’ treatment, most patients don’t need to come back – ever. Here, a mental-health diagnosis can feel like a life sentence.

Open Dialogue’s key principles are: people are seen within 24 hours of becoming unwell; and all meetings with the psychiatric team are held at home, or wherever the patient finds most helpful. Significant others in the patient’s life – family members, or trained peer-support workers – are engaged in meetings from the word go.