ABOUT OPEN DIALOGUE
What is Open Dialogue?
Open Dialogue is a way of working that brings families together in moments of distress, so that healing can happen with everyone at the table, not behind closed doors.
How it Started
A Quiet Revolution in Western Lapland
In the early 1980s, a mental health system in Western Lapland, Finland, was stuck. People kept cycling back through hospitals. Medications kept increasing. Families kept breaking apart. Hope kept fading.
At Keropudas Hospital, a group of clinicians – Jaakko Seikkula, Birgitta Alakare, and Jukka Aaltonen among them – decided something had to change. They looked at what wasn’t working and asked a radical question: What if we stopped treating the person alone and brought everyone who cares about them into the room?
They stopped making decisions behind closed doors. Instead of rushing to diagnose, they listened.
Instead of working with individuals in isolation, they invited families, friends, and entire networks to sit together in the moment of crisis.
They called these Network Meetings. And something shifted.
Over the next 20 years, Western Lapland transformed. People returned to work. To study. To living. Hospital admissions dropped. Medication dependency fell. The idea that you needed lifelong hospital care and endless pills began to crumble.
What they discovered wasn’t just a new therapy. It was a completely different way of thinking about human distress, one that honoured families as the real experts in their own lives.
A Quiet Revolution in Western Lapland
In the early 1980s, the mental health system in Western Lapland, Finland, was facing a crisis common to many institutions: high rates of “revolving door” admissions, heavy reliance on medication, and poor long-term outcomes for those diagnosed with schizophrenia.
At Keropudas Hospital, a team of clinicians—including Jaakko Seikkula, Birgitta Alakare, and Jukka Aaltonen—decided to radically restructure their system. Drawing on Yrjö Alanen’s Need-Adapted Treatment, they made a decision that would change the course of modern psychiatry:
They stopped making decisions behind closed doors.
Instead of treating the individual in isolation, they invited the family, friends, and the entire social network into the room from the very first point of crisis. They stopped rushing to diagnose and started listening.
They called these Network Meetings.
Over the next 20 years, this approach, now known as Open Dialogue, transformed Western Lapland from a region with some of Europe’s poorest mental health outcomes into one with the best.
What Makes Open Dialogue Different
Open Dialogue is built on seven core principles. The first five shape how care is organised. The last two describe the spirit in which it all happens.
Structural Principles: How Care is Organised
Therapeutic Principles: How We Show Up
What the Research Shows
Open Dialogue has been studied in Western Lapland for several decades. The best known of these studies followed 42 people through their first episode of psychosis for five years (Seikkula et al., 2006). At five years, 82% had no remaining psychotic symptoms, 86% had returned to work or study, and 29% had used antipsychotic medication at some point in their treatment. People treated with Open Dialogue spent significantly fewer days in hospital than a comparison group treated before the approach was introduced.
These are striking numbers, and they need to be read carefully. This was a small study without randomisation, comparing a group treated with Open Dialogue against people treated in the same region before it began. Outside of the hospital day figures, the differences between the two groups were not statistically significant. That is part of why the ODDESSI trial was commissioned, to test the approach at scale under randomised conditions in the NHS.
The ODDESSI trial, the largest randomised controlled trial ever conducted on Open Dialogue, was published in The Lancet Psychiatry in August 2026. It found no difference in time to relapse, alongside substantially fewer hospital admissions, fewer crisis re-referrals, and higher ratings from people of their own recovery and their care.
