Back in February, Rachel Bannister despaired for her 20-year-old daughter’s future. After years of only fitful school attendance as she battled chronic anxiety, she was socially isolated, unable to work and claiming welfare benefits.
“I was almost resigned to the fact that this was what her life was going to be like,” Bannister recalled. But by September her daughter, who did not wish to be named, had studied online to complete her A-level syllabus and won a place at a university 120 miles from home.
While she still needed plenty of maternal and professional support, she was thriving, said Bannister, who has co-founded a mental health charity.
The young woman’s rapid turnaround came after a form of treatment called Open Dialogue, which focuses on the power of human connection, with true recovery only possible by involving the wider circle of the person living with mental illness.
It is currently the subject of a randomised controlled trial in England’s NHS — the biggest test of a new mental healthcare model anywhere in the world, according to its co-leader, consultant psychiatrist Russell Razzaque.
An Open Dialogue therapy session © MediaPhotos/Alamy
First developed in Finland more than 40 years ago, and now deployed in about 30 countries — including Japan, where it is mandated in all prisons — Open Dialogue has two main tenets.
Discussions about patients must always be conducted in front of them. Patients are expected to attend regular “network meetings” with friends and family, mediated by two mental health professionals — a psychiatrist and a “peer support worker” who has experienced mental illness, for example — but where the patient sets the agenda. Everyone is on an equal footing.
The NHS trial encompassed 500 patients with conditions ranging from schizophrenia to anxiety who were followed over a two-year period. As they await the results in 2026, proponents of Open Dialogue are convinced it can play a part in meeting the accelerating demand for mental healthcare.
In network meetings with patients, relatives are treated not as a focal point for blame, as can sometimes happen in conventional mental healthcare, but as allies in the quest to discover the root causes of a loved one’s mental illness.
At some point, said Razzaque, one person would generally ask the others, “Shall we talk about it?”
Almost every family has an “it”, he said, and treatment breakthroughs can come when the long-taboo subject begins to be aired openly.
Consultant psychiatrist Russell Razzaque
Initially a sceptic, Gareth Jarvis, medical director for the adult mental health services of central and north west London, embraced Open Dialogue after witnessing the impact on his patients.
“You start to see the network take responsibility and start solving the issues without the professionals having to give all the answers and solutions. And they’re often much better solutions than the ones we could come up with.”
Most patients have the same team caring for them throughout their treatment, and unlike many mental health interventions that offer a finite number of sessions, the treatment is open-ended.
Although Razzaque’s study is the first to bring the full rigour of a randomised controlled trial to Open Dialogue, observational studies in Finland have provided strong evidence of its effectiveness.
One found that, 19 years after first experiencing psychotic crises, more than 80 per cent of people who had received conventional treatment, primarily medication and hospitalisation, were still taking antipsychotic drugs and 60 per cent had permanently left the labour market. The Open Dialogue group fared substantially better: 70 per cent had remained in the workforce, while just 36 per cent were still on medication and 46 per cent had never started it.
Open Dialogue was also cheaper, according to a study of Finnish adolescents, which found the cost per case was about half of conventional treatment — a likely attraction for England’s NHS. The most recent official data shows the number of people in contact with NHS mental health services in England rose by more than 1mn between 2018-19 and 2023-24.
Razzaque said Open Dialogue could readily be adapted to meet the needs of those who require more intensive treatment. However, not immediately resorting to a pharmacological solution, and allowing time for the network meetings to have an impact, meant drugs could often be avoided altogether, he said.
A bigger question is whether it has the potential to become the framework for mental health treatment across the NHS. So far, about 1,000 practitioners have been trained by Razzaque, some of whom were initially reluctant to abandon traditional ways of working, he acknowledges. But most quickly became converts when they saw how valuable the treatment was to their patients.
A concern, he said, was that health services might seek to deliver the treatment on the cheap, for example, by shortening the training period.
Some psychiatrists are reserving judgment until the trial results are released. Jon Van Niekerk, group medical director at Cygnet Health Care, which provides mental health services to the NHS, said the approach was “very person-centred . . . and it involves the family from the start, all of the stuff that clinicians love and that we know that patients and carers are looking for”.
However, he suggested that what worked in Finland might need to be adapted to fit the UK where, particularly in urban areas, the population is often transient, making it harder to reap the benefits of continuity that are integral to Open Dialogue.
Among many who have found it transformative is Allan Penstone.
After years of anxiety and self-harm, his sessions have helped the 55-year-old financial services worker to understand the huge impact the death of his brother had on him as a 16-year-old. His experience demonstrates that the network approach can deliver important insights even for those who have no family members to invite to the meetings or prefer to undertake them alone.
He has opted not to involve his partner or daughter, but said he could still bring in different perspectives by reflecting on what others, such as his parents, may have felt.
Penstone wanted to send a simple message to Razzaque whom he lauds for bringing Open Dialogue to the UK: “You saved my life.”