From Evidence to Practice: Closing Mental Health's Implementation Gap
Despite unprecedented investment in mental health and growing public awareness about the issues, we’re not seeing the outcomes we need. Crisis presentations continue their upward trajectory. Emergency department presentations for mental health rose 16% between 2019-20 and 2021-22 (AIHW). People wait months for care. Families and friends—often the most consistent source of support—remain systematically excluded.
The problem isn’t a lack of services and programs; it’s that our system remains fragmented, difficult to navigate, and structurally opposed to prevention. We keep adding capacity without addressing the fundamental question: are we funding the right models for care and support?
Our current mental health system is built around individual treatment delivered by specialist services, often activated only when crisis hits. It separates people from their natural support networks, relies heavily on clinical interventions, and measures success by symptom reduction rather than social connection and recovery.
Open Dialogue offers a different approach
The Open Dialogue Approach ensures people are connected to a network of support in their community. It shifts the focus from crisis-driven care by enabling people to shape their recovery journey with support from chosen family, friends, and local services.
The implementation gap
We know what works—involving chosen families and friends, responding quickly, and creating space for dialogue produces better outcomes. Yet our systems still operate as if the individual in isolation is the primary focus of care. There is a gap in how we implement what works. The gap isn’t in the evidence; it’s in translating that evidence into everyday practice. We lack the infrastructure, training pathways, and system-level commitment to make relationship-based approaches like Open Dialogue the norm rather than the exception. But it is possible to address the gap.
In recent years, Open Dialogue has moved from a promising alternative to an evidence-based approach seeing active implementation across multiple continents.
What we’re exploring now isn’t whether Open Dialogue works—it’s how quickly we can reorganise our systems around what we’re learning to be effective, and how we can create the right conditions for community-based approaches with a clear pathway for implementing approaches like Open Dialogue.
England’s NHS is poised to commit at scale. The ODDESSI trial is testing an Open Dialogue-informed approach across six NHS sites. Early feasibility demonstrated Open Dialogue’s acceptability to both staff and service users, with participants reporting they feel able to rely on services and have genuine choice in their care.
Full trial results are expected soon.
Two forces driving change
The economic case is compelling Mental health conditions that escalate into crisis require far more expensive interventions. In Australia, the cost of mental ill-health and suicide is estimated at $220 billion annually (Productivity Commission, 2020). Peer-supported Open Dialogue teams in Kent demonstrated lower hospital bed usage than traditional crisis services. When combined with reduced medication costs, fewer emergency presentations, and higher rates of return to work, the economic case becomes increasingly persuasive.
Practitioners are seeking better models The workforce crisis in mental health isn’t only about numbers—it’s about meaning and sustainability. Practitioners who complete Open Dialogue training often describe it as transformational, not because it taught entirely new techniques, but because it created permission to practice dialogically and collaboratively, with time and space for what matters most
We can close the implementation gap The evidence is clear. The economic case is strong. The workforce is ready. What’s needed now is the courage to shift our funding from models that fragment care to models that connect people—from crisis response to community support, from treating individuals in isolation to enabling networks of recovery.
The question isn’t whether we can afford to implement Open Dialogue. It’s whether we can afford to keep funding systems that aren’t working.
Keith Bryant, CEO