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Implementing Open Dialogue in an Australian Context

Overview

This implementation brief from The ALIVE National Centre for Mental Health Research Translation examines Open Dialogue as a recovery-oriented, rights-based approach to supporting people experiencing psychological distress and their social networks. It outlines the principles and fidelity elements of the Open Dialogue model, summarises international and Australian evidence on its effectiveness, and explores the growing role of lived experience practitioners through Peer-supported Open Dialogue (POD). The brief addresses the significant scaling challenges facing implementation in Australia and provides practical guidelines across systems, community, service, and individual practitioner levels.

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Developed by The ALIVE National Centre for Mental Health Research Translation

Key insights

This implementation brief introduces Open Dialogue as a recovery-oriented, human-rights-aligned approach to mental health support that centres dialogue, network inclusion, and lived experience. Originally developed in Finland and now implemented across more than 24 countries, Open Dialogue offers a fundamentally different way of organising mental health support — one that prioritises rapid access, equal voices, and needs-adapted care. While the evidence base is growing, significant scaling challenges remain in Australia, and the brief calls for coordinated action across policy, service, community, and practitioner levels to increase the availability and sustainability of Open Dialogue in Australian contexts.

<p>Open Dialogue is not simply a therapy technique but a fundamentally different way of organising mental health support, centred on rapid network meetings where all voices — including family, friends, and supporters — are considered equal. The model's seven key principles include immediate help, a social network perspective, flexibility and mobility, responsibility, psychological continuity, tolerance of uncertainty, and dialogism. Twelve fidelity elements guide practice, emphasising open-ended questions, multiple viewpoints, transparency, and tolerance of uncertainty. Crucially, the dialogical nature of the approach has meant there has been no standardisation or manualisation of practice or training, which presents both a strength and a challenge for implementation.</p>

<p>There is a growing focus internationally on the inclusion of people with lived experience as peer practitioners in Open Dialogue, including through the Peer-supported Open Dialogue (POD) model. POD was developed in the Netherlands from the mid-2010s and is being implemented elsewhere, including in the ODESSI trial in the UK. In POD, peer workers play a core role in facilitating network meetings, supporting fragmented networks, and fostering agency within those networks. Empirical evidence for POD's effectiveness is currently being developed through the ODESSI trial, and growing advocacy in Australia reflects the alignment of lived experience roles with the values of the Open Dialogue approach.</p>

<p>Early Finnish research reported positive outcomes for people with first-episode psychosis, but a broader review of 23 more recently conducted studies found promising but low-quality evidence overall. The challenges of conducting research on Open Dialogue include variations in implementation approach and outcome measures, and the individualised nature of the practice makes conventional randomised controlled trials difficult to undertake. Some researchers argue that irrespective of measurable outcomes, Open Dialogue is warranted because it offers respectful, ethical, needs-adapted, client-centred, and family-inclusive practice aligned with human rights. A large program of research accompanying implementation in the UK National Health Service through the ODESSI trial is expected to report results in coming years.</p>

<p>Despite growing enthusiasm among individual practitioners and policy endorsement from the Victorian Royal Commission into Mental Health, achieving implementation of Open Dialogue at substantial scale in Australia has been met with significant difficulties. Shifting the status quo of current mental health services is identified as a core implementation challenge, requiring a multidimensional focus that accounts for policy change (scaling up), culture change across the mental health system (scaling deep), and spreading the approach more broadly (scaling out). The Open Dialogue Centre in Australia is now offering one-year foundation training and shorter training options, increasing the practitioner base, but systemic conditions including funding models, staffing structures, and service culture remain significant barriers.</p>

<p>Practical, level-specific guidelines are provided to increase the traction of dialogical practices and the availability of Open Dialogue across Australia. At the systems level, embedded research, continued trial support, funding for training, and adapted practice models allowing two practitioners in network meetings are recommended. At the community level, awareness-building, culturally adapted explanations, and rapid engagement strategies for families are identified as priorities. At the service level, organisational leadership, shifts in routine practices, staff reflective practice opportunities, staged implementation approaches, and telehealth provision are recommended. At the individual practitioner level, awareness of the transformative and potentially disruptive nature of training, and support for those pioneering implementation in the face of resistance, are highlighted.</p>

Did this resource draw on transformative evidence?

<p>Yes — The brief includes a dedicated section on lived experience involvement in Open Dialogue, a first-person quote from a family member sourced from the Open Dialogue Centre website, and a practice example from Alfred Health's Youth Early Psychosis Program. The Peer-supported Open Dialogue model, which centres peer workers as core practitioners, is also discussed in depth.</p>
<p>Yes — The implementation guidelines draw on practitioner and organisational experience from Australian and international Open Dialogue implementation. The Alfred Health Youth Early Psychosis Program case example reflects accumulated service-level learning, and references include practice-focused publications on organisational change and training experiences.</p>
<p>Yes — The brief draws on 21 referenced sources including systematic reviews, clinical trial protocols, qualitative studies, and WHO guidance. Key sources include Freeman et al. (2019), Seikkula et al. (2006, 2011), the ODESSI trial protocol (Pilling et al., 2022), and Buus et al. (2023).</p>

How can this resource help me as a...?

Toggle audience types below to explore.

The brief directly calls on policy makers and government structures to fund embedded research, support trials, and develop adapted funding and practice models to enable Open Dialogue implementation in mainstream services.

Organisational leaders are identified as essential to creating the conditions for staff and teams to initiate and sustain the significant practice changes that Open Dialogue requires, including shifts in crisis response, staffing models, and clinical culture.

Open Dialogue practitioners and those considering training are a core audience, with specific guidance on the nature and intensity of training, the transformative and potentially disruptive outcomes of practice development, and the importance of reflective practice.

The brief identifies significant gaps in the Australian and international evidence base and references ongoing large-scale trials, making it highly relevant to researchers in mental health, implementation science, and dialogical practice.

People experiencing psychological distress are the central focus of the Open Dialogue approach, and the brief's discussion of rights-based, person-centred, and network-inclusive practice makes it relevant to consumer advocates and those interested in alternatives to conventional mental health support.

Family members, friends, and supporters are explicitly positioned as essential participants in Open Dialogue network meetings. A lived experience quote from a family member is included, and community-level guidelines address the need to build family and network awareness of the approach.

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Categories

Resource type

Evidence Summary

Practice Guideline

Target audiences

Consumers

Carers

Practitioners

Researchers

Policymakers

Service Leaders

Translational research priority theme

Community-based models of care

Alternatives to compulsory treatment, seclusion and restraint

Workforce capability

Working with diverse consumers, families and communities

Embedding responsible, safe and ethical practice

Understanding and responding to trauma

Understanding and responding to mental health crisis and suicide

Working effectively with families, carers and supporters

Delivering holistic and collaborative assessment and care planning

Delivering compassionate care, support and treatment

Promoting prevention, early intervention and help-seeking

Supporting system navigation, partnerships and collaborative care

Enabling reflective and supportive ways of working

Embedding evidence-informed continuous improvement

Working effectively with digital technologies

Population cohort

Adults

Collaborative Centre core function

Lived Experience Participation

Service delivery

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