The Moral Blind Spots of Evidence-Based Psychiatry: Learning from Britain’s Trial of “Peer-Supported Open Dialogue”

Abstract

Open Dialogue is a rights-based approach to psychiatric crisis response with growing global uptake. Over the last five years, it has been subject to a large-scale randomized controlled trial (RCT) within the UK’s National Health Service. While the trial researchers have emphasized the need for more evidence to inform policy, many practitioners involved in the trial have been lobbying for Open Dialogue’s immediate rollout across the country. Drawing on 24 months of clinical ethnography, we suggest this tension reveals moral dimensions of mental health care that are not adequately accounted for in evidence-based psychiatry.