Open Dialogue did not delay relapse after a crisis but was associated with fewer admissions

Design

Multicentre cluster-randomised superiority trial, 2-year follow-up

Population

494 adults presenting in crisis, 30 clusters in 5 English NHS trusts

Primary outcome

Time to first relapse after recovery from the index crisis

Effect

HR 0.95 (95% CI 0.67 to 1.32)

ODDESSI randomised 30 clusters of general practices in five English NHS trusts to Open Dialogue — network meetings with the person, their family or friends and two practitioners throughout care — or standard functional-team care. It enrolled 494 adults presenting in crisis and followed them for two years.

The primary outcome, time to first relapse after recovery, did not differ (hazard ratio 0.95, 95% CI 0.67 to 1.32). Secondary outcomes favoured Open Dialogue: lower probability of psychiatric admission and of re-referral to crisis or secondary services, and better self-rated recovery, quality of life and satisfaction. Social networks did not change. Serious adverse events were fewer in the Open Dialogue arm (105 vs 281), almost all judged unrelated.

The trial answers its main question in the negative, and secondary outcomes cannot overturn that. But the consistent signal on admissions and experience keeps the model worth studying, especially where bed pressure is high.

• Involving family and social network early in crisis care is safe and was valued by patients
• Open Dialogue did not prevent relapse, so it is not a relapse-prevention strategy
• The fewer admissions are a secondary result and need confirmation before services are redesigned around them
• Where Open Dialogue exists locally, it is a reasonable choice for people who want their network involved

Why it matters

It is the first large randomised test of a model many services have adopted on enthusiasm.

Don't overread it

The admission and satisfaction benefits are secondary outcomes in a trial whose primary outcome was null, and it was retrospectively registered.

The statistics, in plain English

A hazard ratio of 0.95 with an interval from 0.67 to 1.32 means the trial cannot tell Open Dialogue apart from usual care on relapse. Secondary outcomes carry more risk of chance findings because several were tested.

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