The ODDESSI study: Exploring the results of the largest Open Dialogue study so far
Last week I had the pleasure of attending the launch of the long-awaited ODDESSI study into Open Dialogue within the NHS in England at Rethink’s HQ. This study, costing millions of pounds and taking place over five sites compared Open Dialogue with standard NHS mental health care. The particular variant of Open Dialogue explored by this study – Peer Supported Open Dialogue – combines Open Dialogue with mindfulness practice for practitioners and the integration of at least some Peer Support Workers within Open Dialogue teams. Whilst I trained in a different Open Dialogue variant, I had the pleasure of working within a Peer Supported Open Dialogue Team in Canterbury prior to the ODDESSI trial. It was work that filled by heart and I’m still grateful to my colleagues and the families/social networks we worked alongside. In this blog post I will share some of the headline outcomes and what they mean to me – a both a practitioner and someone with Lived Experience of significant mental distress.
Read the full research article in the Lancet.
Time to relapse – a red herring of an outcome?
When looking at the paper, the first outcome that stands out is that ‘time to relapse’ is no different between the two groups – Open Dialogue or standard NHS mental health care. This sounds pretty disappointing. The results from Western Lapland demonstrated frankly stunning results from a clinical perspective, with many participants reporting that they were free of the experiences (voices, visions, distressing beliefs) that may have led to the diagnosis of schizophrenia (which was reduced within the original studies). Some of us hoped the English implementation would show similar results.
For my part, I was ambivalent about this as a primary outcome. I know from my own experiences and those within the Hearing Voices Network that clinical recovery (or lack of voices and visions, for example) does not equate to recovery in real terms. I hear voices and I live a full and vibrant life. I am not ‘recovered’ and have had many experiences that would count as ‘relapses’ within this trial, and yet each one has helped me learn more about myself and move towards a deeper sense of wellbeing. Each ‘relapse’ can be seen as breadcrumbs, leaving a trail I can follow to gain greater awareness of the things that I find difficult in this world and the things that have contributed to my overwhelm. They are part of my healing and – whilst distressing – are not something I shy away from. The key is what support I am lucky enough to have during these challenging times and the attitude of those around me towards them.
The research shows that there was no significant difference between the time to relapse in both groups. Some may stop reading at that point, I know. Yet, for me as both a practitioner and a patient, this is where it starts to get interesting – and a lot more hopeful.
Less hospitalisation in the Open Dialogue group
The results show that those who received Open Dialogue were three times less likely to be admitted to hospital than those in standard NHS mental health care. The proportion of people who spent any time in hospital at all reduced by 52% during the 2 years of the study. The odds of being re-referred to crisis or secondary care services were halved for those who received Open Dialogue.
Whilst NHS bosses may be particularly excited about this aspect of the study, my own excitement goes far beyond potential cost savings (NHS inpatient care is expensive, after all, and anything that reduces it is worth looking at in a cash strapped system). Yes, inpatient stays can cost a lot more than money – they can mean you’re uprooted from your home, your loved ones and kept somewhere that is often chaotic and unfamiliar. Your life is disrupted, put on hold. Sure, sometimes an inpatient stay is the least worst option in a crisis. But if it can be avoided or minimised – in a way that people and their families find helpful – then surely that is something to be celebrated. We need to make inpatient stays more therapeutic when they are needed, ofcourse, and to challenge practices that can be abusive. I want inpatient units to be a sanctuary, a place of respite and recovery. Still, avoiding them where possible fills me with hope. It seems like there is something in Open Dialogue services that enables more people to go through challenging times and feel supported in their own community. Let’s build on that.
Self-defined recovery and Open Dialogue
This study showed that people’s own definitions of recovery, the things that mattered to them, were improved in the Open Dialogue group. That means people were feeling improvements in their relationships, their work/study lives and their sense of agency and purpose. In the paper, this outcome wasn’t focused on so much. Yet, for me, it is extremely important. Irrespective of whether we continue to have times we feel low, hear voices, get anxious or struggle with life – can we begin to live our lives in the way that we choose and the way that feels important to us? Surely that is something to be strived for in all mental health services. It seems that Open Dialogue, as well as people being more satisfied with the support they receive, leads to better recovery outcomes when looking through this lens.
What next?
What happens next is something I’m both excited to find out and a bit apprehensive about. As with all research, there is a call for more research – and the study certainly raises questions as well as providing some useful answers. There’s the question of peer support – how can the wisdom of Lived Experience practitioners and those family members who have been through crises be integrated with Open Dialogue – something many people across the world are exploring in different implementations. There’s the question of clinical outcomes and recovery – why was this study different to those in Western Lapland in this regard? Is there something about this implementation that missed some of the parts of Open Dialogue that may have been present in its founding team (length of training, for example, and time bedding in a new approach in teams)? If research is about learning more than providing evidence for something you already believe in, I hope that more research will lead to a greater understanding of this approach in different contexts.
Beyond the call to research is the call for greater implementation. This is something I, too, hope for. I hope that Open Dialogue will not be a postcode lottery, with only the few and fortunate having access to it. I hope more NHS trusts will think, alongside Service Users, families and clinicians, about how they can make their services more dialogical and responsive. My fear is that greater implementation will lead to cutting corners, reducing the 1 year training that practitioners need as a minimum for this approach and developing work books and cookie cutter implementation guides. In an approach that is so centred on relationships and responsivity, the ability to grow this approach in situ seems vital for its success. I hope we can build on ODDESSI’s results and that this will be a part of developing mental health services that are essentially human and good for all who work in or encounter them.
Want to find out more about Open Dialogue?
We are running a 2 day experiential online workshop that introduces Open Dialogue on 7 & 8 September. Find out more and book your place here: Introducing Open Dialogue.
