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

Involving a patient's family and friends as part of a new approach to mental health treatment makes it three times less likely they will be admitted to psychiatric hospital, research has found.

Patients rated their recovery and quality of life more highly than those who were treated in the traditional way, it also found.

It is the first major study of Open Dialogue, a way of providing treatment and organising mental health services that involves focusing on the patient's priorities, seeing the same clinicians, and involving people close to them.

But, the trial, in five NHS trust areas, found it did not stop patients suffering relapses, and some critics say there needs to be further research into its effectiveness.

Dr Nihad Fathi has benefited from the approach after he felt his life started to spiral out of control as the Covid pandemic took hold in 2020.

By the next summer, problems in his work had left him feeling anxious, depressed and worthless. He felt like he was letting his clients down.

"It was so much pressure, stress," he said.

He contemplated ending his life.

"I caught myself like a lost child and I didn't know what's going on in my mind," he said.

It was a terrifying time for his wife Farah. "At that stage, I didn't know what to do," she said.

For one of his sessions Nihad and Farah sit in a circle in their east London home with two clinicians – consultant psychiatrist Dr Bill Travers and community psychiatric nurse David Adebayo.

They have been working with Nihad for five years and the NHS trust they work for, North East London NHS Foundation Trust, has been using Open Dialogue with some of its community patients since 2019.

Open Dialogue was first devised in the 1980s in Finland. It is now used in more than 20 countries around the world, although the research into its effectiveness has been limited.

The idea is for a patient to regularly take part in "network meetings". As well as two Open Dialogue practitioners, these meetings also involve the friends, families, neighbours or colleagues of the patient. They then remain involved in the patient's recovery.

The sessions allow a free-flowing conversation about how the patient feels, what help they would like and how that may be achieved. It also allows the "network" to talk about what they have observed about the patient and their own feelings.

Dr Travers said although the network meetings were longer than a normal appointment, the patients need fewer of them.

"It enables you to reach a much firmer and deeper understanding of the underlying reasons for the problems and indeed to seek solutions that come very much from the person and their family," he said.

The study, led by University College London, involved 500 patients that had approached mental health services in crisis. They were split into two groups - one was entered into Open Dialogue, the other received treatment as usual.

Researchers found there was no significant difference in whether a patient had a relapse of their illness. But, as well as the reduction in need for psychiatric hospital, if patients in the Open Dialogue group did need to be admitted, the length of time they spent there was on average half that of the other group.

There were also improvements in how the patients felt about their wellbeing and recovery.

Dr Russell Razzaque, a consultant psychiatrist and the clinical lead on the trial, said this could have significant implications for how the NHS runs psychiatric care.

"There's a substantial reduction in cost because you're not spending all the money on inpatient beds, which are the most expensive part of the system," he said.

"So yes, you might be spending a bit more time in the community, but that is what the NHS wants."

However, consultant psychiatrist Dr Sameer Jauhar feels the benefits seen in the trial might be explained by the extra resources put into it, and that more research is needed.

"The important question is whether the distinctive, resource-intensive elements of Open Dialogue itself add benefit beyond good, adequately staffed community care. On the evidence of this trial, that question remains unresolved," he said.

But for Farah, Open Dialogue was the right intervention for Nihad.

"It needs somebody to hear him, somebody to understand him, how he feels, what he's trying to even to achieve. They are helping him and then he sees a better picture," she said.

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