Treatment involving patient's family cuts mental health hospital admissions, study finds

Involving a patient’s family and friends in mental health treatment makes them three times less likely to be admitted to a psychiatric hospital, according to a landmark study published in The Lancet Psychiatry.

The trial, led by University College London, evaluated a therapeutic approach known as Open Dialogue across five National Health Service trust areas. Researchers followed 500 patients who had approached mental health services in crisis, splitting them into two groups: one receiving Open Dialogue and the other receiving standard care.

While the study found no significant difference in relapse rates between the two groups, patients undergoing Open Dialogue reported higher quality of life and better overall recovery. Additionally, because fewer participants required hospitalisation, the total time spent as inpatients among the Open Dialogue group was cut in half compared to those in traditional care.

First developed in Finland in the 1980s and currently used in more than 20 countries, Open Dialogue focuses on patient-led priorities, continuity of clinicians, and regular network meetings. These sessions bring together the patient, two trained practitioners, and members of the individual's personal circle—such as family, friends, or colleagues—to discuss treatment and recovery in an open dialogue.

Dr Bill Travers, a consultant psychiatrist at North East London NHS Foundation Trust who has used the model since 2019, noted that while network meetings are longer than standard appointments, patients generally require fewer of them. He said the approach enables clinicians to reach a firmer and deeper understanding of underlying problems and seek solutions that come directly from the person and their family.

Among those treated through the program is Dr Nihad Fathi, who experienced severe depression, anxiety, and suicidal thoughts during the pandemic. He and his wife, Farah, participated in home-based sessions with Dr Travers and community psychiatric nurse David Adebayo. Farah noted that the process allowed clinicians to truly understand how her husband felt and helped him see a better path forward.

Trial clinical lead Dr Russell Razzaque, a consultant psychiatrist, highlighted the potential economic benefits for public healthcare. He stated that reducing hospital admissions offers substantial cost savings for the NHS by diverting spending away from expensive inpatient beds and toward community-based care.

However, some medical experts emphasized the need for further research before broad implementation. Consultant psychiatrist Dr Sameer Jauhar raised concerns that the observed benefits might be explained by the extra resources allocated to the trial rather than the treatment model itself. He noted that the question of whether the distinctive elements of Open Dialogue provide added value beyond well-resourced standard community care remains unresolved.