Open Dialogue is a form of therapy that was developed in Western Lapland in the 1980s for the treatment of psychosis, although it can be used more widely. It has its roots in systemic therapy (therapy which also involves an individual’s family or support network). What is different about Open Dialogue’s approach to psychosis is that it views psychosis not as something which is ‘within’ the individual (for example, a series of symptoms or experiences), but rather as something which exists ‘in between’ people. By seeing psychosis as a form of breakdown between people, it looks to promote healing and recovery through better connection and communication. It is carried out through a series of ‘network’ or ‘system meetings’ – meetings that always include the person who is experiencing the mental health crisis together with their friends and family.
In Open Dialogue, people are seen within 24 hours of becoming unwell, all meetings take place in the individual’s home (or wherever they find most helpful), and significant others in the person’s life are involved in the process from the word go. Meetings always include the same clinicians, and all discussions about the individual in distress (including making decisions about treatment) take place in front of them.
The aim of Open Dialogue is not necessarily to change the person’s experiences, beliefs or behaviour, but to bring their family and support networks together to talk about what’s happening as equals. The idea is that if they can explore the problems in their lives and relationships together – sitting with difficult emotions and uncertainty – it will be possible to arrive at a shared understanding of the crisis, why it might have occurred, and how best to respond to it.
Services informed by the Open Dialogue approach are currently available on the NHS in a selection of Mental Health Trusts. Dialogue First at North East London NHS Foundation Trust (NELFT) can be accessed by people from across the UK if they are not in crisis or under the care of a secondary mental health team. Open Dialogue services are also available in Kent and Medway NHS and Social Care Partnership and a limited number of other trusts including Barnet, Enfield and Haringey Mental Health NHS Trust. Access is limited as a number of these trusts are taking part in a Randomised Controlled Trial to determine its effectiveness within the NHS.
Find out more
The Mental Elf (2019). ‘Open Dialogue: What’s the evidence?‘
Celia Dodd (2015). Open Dialogue: The radical new treatment that is having life-changing effects on people’s mental health. The Independent.
Tom Stockmann (2015). Open Dialogue: A new approach to mental health care. Psychology Today.
Tom Stockmann (2015). The UK National Health Service Peer Supported Open Dialogue Project. Mad in America.
The Developing Open Dialogue website.
The Open Dialogue UK website.
The Academy of Peer Supported Open Dialogue website.
Russell Razzaque (2018). Breaking Down is Waking Up. Mad in America.
KMPT NHS (2018). Open Dialogue: Key Principles. Youtube.