Skip to main content

An introduction to peer-supported open dialogue in mental healthcare

  • Russell Razzaque and Tom Stockmann

Peer-supported open dialogue is a variant of the ‘open dialogue’ approach that is currently practised in Finland and is being trialled in several countries around the world. The core principle of the approach is the provision of care at the social network level, by staff who have been trained in family, systems and related approaches. These staff include peer workers, who will help to enhance the democratic nature of the meetings around which care is centred, as well as enabling such meetings to occur where networks are fragmented or lacking. Certain organisational and practice features and underlying themes are key to the approach. Crucially, open dialogue is also a system of service provision. Staff trained in peer-supported open dialogue from six National Health Service (NHS) trusts will launch pilot teams in 2016, as part of an intended national multicentre randomised controlled trial.

Corresponding author
Dr Russell Razzaque, NELFT NHS Foundation Trust, Goodmayes Hospital, Barley Lane, Ilford, IG3 8XJ, UK. Email:
Hide All


• Be able to describe the organisational principles of peer-supported open dialogue

• Be able to summarise the practice principles of peer-supported open dialogue

• Gain an increased understanding of the evolving role of peer-supported open dialogue in the NHS



Hide All
Aaltonen, J, Seikkula, J, Sutela, M et al (1997) Western Lapland project: a comprehensive family- and network centered community psychiatric project. In ISPS: Abstracts and Lectures 12–16 October 1997 (ed ISPS): 124. International Society for Psychological and Social Approaches to Psychosis.
Alanen, Y, Lehtinen, K, Aaltonen, J et al (1991) Need-adapted treatment of new schizophrenic patients: experiences and results of the Turku Project. Acta Psychiatrica Scandinavica, 83: 363–72.
Alanen, Y (1997) Schizophrenia: Its Origins and Need-Adapted Treatment. Karnac.
Andersen, T (1990) The reflective team. In The Reflecting Team: Dialogues and Dialogues about the Dialogues (ed Andersen, T) 18-107. Bormann.
Andersen, T (1995) Reflecting processes. Acts of informing and forming. In The Reflecting Team in Action: Collaborative Practice in Family Therapy (ed Friedman, S) Guilford Press.
Anderson, H (1997) Conversation, Language, and Possibilities. Basic Books.
Anderson, H, Goolishian, H (1992) The client is the expert: a not-knowing approach to therapy. In Therapy as Social Construction (eds McNamee, S, Gergen, KJ). Sage.
Bracken, P, Thomas, P, Timimi, S et al (2012) Psychiatry beyond the current paradigm. British Journal of Psychiatry, 201: 430–34.
Coe, S (2013) Parachute NYC: a new approach for individuals experiencing psychiatric crises. Mental Health News, 15 (2): 16 (available at
Department of Health (2008) A Common Purpose: Recovery in Future Mental Health Services. TSO (The Stationery Office).
Dodd, C (2015) Open Dialogue: the radical new treatment having life-changing effects on people's mental health. Independent ( Accessed 15 July 2016.
Giacco, D, McCabe, R, Kallert, T et al (2012) Friends and symptom dimensions in patients with psychosis: a pooled analysis. PLoS ONE, 7: e50119.
Gillard, S, Holley, J (2014) Peer workers in mental health services: literature overview. Advances in Psychiatric Treatment, 20: 286–92.
Haarakangas, K (1997) [The voices in treatment meeting. A dialogical analysis of the treatment meeting conversations in family-centred psychiatric treatment process in regard to the team activity. English summary]. Jyväskylä Studies in Education, Psychology and Social Research, 130: 119–26.
Holquist, M (ed) (1981) The Dialogic Imagination: Four Essays by M.M. Bakhtin (trans C Emerson, M Holquist). University of Texas Press.
Hopfenbeck, M (2015) Peer-supported Open Dialogue. Context, 138: 29-31.
Hoult, J, Rosen, J, Reynolds, I (1984) Community orientated treatment compared to psychiatric hospital orientated treatment. Social Science & Medicine, 18: 1005–10.
Hoult, J (1986) Community care of the acutely mentally ill. British Journal of Psychiatry, 149: 137–44.
ImROC (Implementing Recovery through Organisational Change) (2013) Peer support workers in mental health recovery – benefits and costs. ImROC ( Accessed 12 July 2016.
Jablensky, A, Sartorius, N (2008) What did the WHO studies really find? Schizophrenia Bulletin, 34: 253–5.
Keränen J (1992) [The choice between outpatient and inpatient treatment in a family centred psychiatric treatment system. English summary]. Jyväskylä Studies in Education, Psychology and Social Research, 93: 124–9.
Lambert, MJ, Simon, W (2008) The therapeutic relationship: central and essential in psychotherapy outcome. In Mindfulness and the Therapeutic Relationship (eds Hick, SF, Bien, T) 19-33. Guilford Press.
Mahlke, CI, Krämer, UM, Becker, T et al (2014) Peer support in mental health services. Current Opinion in Psychiatry, 27: 276–81.
Olson, M, Seikkula, J, Ziedonis, D (2014) The Key Elements of Dialogic Practice in Open Dialogue: Fidelity Criteria. The University of Massachusetts Medical School (
Pharoah, F, Mari, JJ, Rathbone, J et al (2010) Family intervention for schizophrenia. Cochrane Database of Systematic Reviews, 12: CD000088.
Priebe, S, Burns, T, Craig, TKJ (2013) The future of academic psychiatry may be social. British Journal of Psychiatry, 202: 319–20
Razzaque, R, Okoro, E, Wood, L (2015) Mindfulness in clinician therapeutic relationships. Mindfulness, 6: 170–4.
Repper, J, Carter, T (2011) A review of the literature on peer support in mental health services. Journal of Mental Health, 20: 392-411.
Seikkula, J (1994) When the boundary opens: family and hospital in coevolution. Journal of Family Therapy, 16: 401–14.
Seikkula, J, Aaltonen, J, Rasinkangas, A et al (2003) Open dialogue approach: treatment principles and preliminary results of a two-year follow-up on first episode schizophrenia. Ethical Human Sciences and Services, 5: 163–82.
Seikkula, J, Trimble, D (2005) Healing elements of therapeutic conversation: dialogue as an embodiment of love. Family Process, 44: 461–75.
Seikkula, J, Aaltonen, J, Alakare, B et al (2006) Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: treatment principles, follow-up outcomes, and two case studies. Psychotherapy Research, 16: 214–28.
Seikkula, J, Alakare, B, Aaltonen, J (2011a) The Comprehensive Open-Dialogue Approach in Western Lapland: II. Long-term stability of acute psychosis outcomes in advanced community care. Psychosis: Psychological, Social and Integrative Approaches, 3: 192-204.
Seikkula, J (2011b) Becoming dialogical: psychotherapy or a way of life? Australian and New Zealand Journal of Family Therapy, 32: 179–93.
Seikkula, J (2015) Open dialogues with clients and their families. Context, 138: 2-6.
World Health Organization (1979) Schizophrenia: An International Follow-up Study. John Wiley & Sons.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 2056-4678
  • EISSN: 2056-4686
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 50 *
Loading metrics...

Abstract views

Total abstract views: 121 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 21st March 2018. This data will be updated every 24 hours.

An introduction to peer-supported open dialogue in mental healthcare

  • Russell Razzaque and Tom Stockmann
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *