Examining the feasibility of an Open Dialogue pathway within routine NHS community-based services

<title>Abstract</title> <p>Open Dialogue (OD) is a relational, network-based approach to mental health care that emphasises shared decision making and the inclusion of service users’ social networks. While emerging evidence has demonstrated promising outcomes for OD, less is known about its feasibility when integrated into routine NHS community mental health services. This mixed-methods study examined the feasibility of implementing and sustaining an OD pathway within the Southwark Directorate of the South London and Maudsley NHS Foundation Trust, integrating service user and network perspectives alongside indicators of OD facilitator adherence. Quantitative data included 47 Consultation and Relational Empathy (CARE) measures completed by service users and their social/professional networks, and 30 adherence rating scales completed by facilitators of network meetings. Qualitative data comprised 4 semi-structured interviews with service users and carers, alongside written feedback from the CARE measures, analysed using reflexive thematic analysis. Findings indicated consistently high levels of perceived relational empathy across participants, with network meetings described as emotionally supportive, non-hierarchal spaces that facilitated shared dialogue. However, participants also highlighted challenges relating to service-level constraints, variability in the delivery of dialogical practice and the distinction between the relational value of Open Dialogue and the practical realities of care in the NHS. Adherence ratings further revealed difficulties in implementing certain OD principles within NHS structures, with some components consistently being achieved while others were more difficult to sustain. Overall, OD was experienced as relationally meaningful, though its implementation into current existing care pathways highlighted the need for targeted adaptation and integration to support sustainable delivery.</p>