Open Dialogue

The film records the Western Lapland service at Keropudas Hospital in Tornio, where a person in first-episode psychosis is seen with their family and wider network within a day of first contact. Mackler filmed on location over two weeks, speaking with the psychiatrists, psychologists and nurses who run it. The camera stays close to how the meetings work: everyone present, decisions taken in the room, antipsychotic medication held back or used sparingly early on while the team waits to see what the crisis needs.

Since its free release the film has circulated widely among clinicians and service-user networks and is cited by those arguing for network-based alternatives to standard acute care. Seikkula and colleagues have published follow-up data reporting high rates of return to work and low continued neuroleptic use; commentators writing in Mad in America note that these outcomes rest on small, non-randomised Finnish samples and remain contested.

For the practising clinician it sets out a working model of staying with uncertainty inside a group rather than resolving it quickly, of tolerating disturbed states without moving to suppress them, and of treating dialogue itself as the therapeutic act.