Today a truly historical event in mental health care has taken place. The results of an NHS clinical trial into ‘Open Dialogue’ have been published in the Lancet journal. This is big news for mental health patients and professionals alike who have been trying to change and improve practice for decades. Seeing these changes a reality is Platfform’s mission. We have been campaigning hard for these changes both in the way we deliver services and our policy and influencing work.

The study found several important beneficial outcomes. It found that those receiving help through the open dialogue approach were:

• 3 x less likely to have a hospital admission
• If they we’re admitted they spent 54% less time in hospital
• And were half as likely to be referred to crisis teams.

Reduced inpatient admissions and lower use of crisis services, means this approach may offer significant cost savings as well as improve outcomes for patients. A cost benefits analysis will be published separately.

There are also signs of improved staff wellbeing. Anecdotally Dr Russell Razzaque, Professor of Relational Psychiatry, SOAS, observed that in and Open Dialogue team there was a 20% staff turnover compared service as usual teams where some had a 100% turn over the same period. An analysis of the benefits to staff will also be published separately.

What is really promising is that the results fit with the Welsh Government’s 10-year mental health strategy aspiration which are currently being implemented across Welsh Health Boards. Open dialogue would greatly support the open access and same day service transformation.

What is the ODDESSI Trial?

The clinical trial was called the ODDESSI programme which stands for Development and Evaluation of a Social Network Intervention for Severe Mental Illness. It was led by researchers at University College London and delivered across multiple NHS England Trusts.

It was designed to explore whether Open Dialogue could be effectively implemented within NHS services and whether it improved outcomes for people experiencing severe mental health difficulties. The trial contributes to a growing evidence base that connection itself can be a powerful component of mental health support.

What is Open Dialogue?

Open Dialogue is both a therapeutic approach and a way of organising mental health care. When someone experiences a mental health crisis, practitioners bring together the person, family members, friends, supporters, and relevant professionals together. This kind of approach is more routinely found in children’s mental health services and services for people with a learning disability but not for adult mental health services.

In the approach decisions are made collaboratively rather than being imposed on people by professionals. The emphasis is on listening, hearing different perspectives, and creating meaning together. This aligns with what the evidence base is telling us is important in effective care.

Why these findings matter

The ODDESSI trial is widely regarded as the first large randomised controlled trial of Open Dialogue, addressing longstanding criticism that previous evidence came mainly from observational studies.

The results suggest the following are potential benefits:

• Reducing costs associated with inpatient admissions
• Avoiding coercive or hospital-based care when possible.
• Improving people’s experience of services.
• Keeping people connected to their communities.
• Supporting recovery through relationships and continuity of care

Implications for Wales

From a Welsh policy and relational practice perspective, the findings are highly relevant because Open Dialogue aligns closely with the Welsh Government’s Mental Health and Wellbeing Strategy 2025-2035, which emphasises prevention, connection, early intervention, person-centred support, and action on the social determinants of mental health.

Across Wales, there is growing recognition that mental health is not simply an issue of diagnosis, symptoms, or treatment. Our mental health is shaped by our relationships and experiences of trauma, poverty, inequality and sense of belonging.

An Opportunity to Deliver much needed Change

For Wales, this matters. A nation committed to prevention, compassion, community, and wellbeing needs approaches that strengthen relationships rather than individualising distress.

As Wales implements its Mental Health and Wellbeing Strategy over the coming decade, Open Dialogue provides a compelling example of how policy aspirations can become everyday practice.

The approach was shown to foster improved team functioning, including an emphasis on reflective practice, shared decision making, risk management, and continuity of care.

By valuing relationships, lived experience, and shared decision-making, it offers a vision of mental health support that is consistent with both the strategy’s ambitions and a broader commitment to social justice as well.

Ready to go: Welsh NHS Mental Health Services

This approach isn’t new to Wales. A lot of great work has already happened in NHS Wales mental health services that already shows the benefit of this approach including the promotion of peer support.

Dr Benna Waite has been working with colleagues in Aneurin Bevan Health Board exploring how to implement this across our adult mental health services here in Wales with lots of success and Dr Andrew Vidgen at Cardiff and the Vale Health Board have been applying the approach to older adult mental health services.

In Wales there are several hub and sanctuary models already in existence. These are partnerships between NHS services and the Third Sector. At Platfform we deliver a number of these services for both adults and children and young people. We have found similar successes in applying a relational approach to organising our support and service designs. In our Hangout services we have seen a reduction in number of GP and A&E referrals alongside improved satisfaction and outcomes.

What we need now is for the Welsh Government to fund a network of early support hubs for adults that links to housing and benefit support, and for young people those that link to education and youth services across Wales.