Open DialogueOpen Dialogue
All In The Mind
When people reach a crisis point with their mental health, the last thing they need is to feel they are being judged and their reality denied. More than 25 years ago in a small town in Western Lapland, a group of clinicians decided to do things differently.
28:50•21 Feb 2016
Open Dialogue: When Every Voice Matters in Mental Health Crisis
Episode Overview
- Mental health crises are approached as relational events involving the whole network, not just an isolated individual.
- Open Dialogue prioritises early, frequent meetings with families and the person in distress before deciding on long-term medication.
- All voices in the room are heard and respected, including disagreement and ambivalence, without rushing toward solutions.
- Psychotic experiences are framed as responses to difficult life situations and as possible metaphors for trauma that lacks language.
- Including families, friends and peer workers can reduce anxiety, increase understanding and support better long-term social outcomes.
“"He decides when and he decides who."”
Curious about how others navigate their sobriety journey and wider mental health struggles? This episode of All In The Mind looks at what happens when a whole network is brought into the room during a mental health crisis, instead of focusing only on the "chemicals in the head". You’ll hear how the Open Dialogue approach treats psychosis as something that affects families and relationships, not just an individual.
Mental health researcher Flick Gray explains that traditional responses often centre on hospitalisation and long-term medication, while Open Dialogue asks everyone involved to sit together, talk openly and allow meaning to emerge over time. As she puts it, "the problem is the problem" — not the person, not the drug use, and not one family member. Anna Arabski, now coordinator of Soteria House in the UK, shares the emotional story of supporting her son through years of psychosis.
Her account of being constantly hypervigilant, sleep-deprived and torn between rescuing her son and looking after herself will strike a chord with anyone who’s lived alongside crisis.
A pivotal moment comes when psychiatrist Jako Sukula responds to her son’s refusal to talk about his experiences with simple respect: "He decides when and he decides who." That shift in pressure lets Anna finally see that her son is trying to build a life where his experiences are only a small part of the picture.
You’ll also hear about impressive long-term outcomes from Western Lapland, where Open Dialogue became the main psychiatric service model, with reduced hospitalisation and high rates of people returning to work and life. The episode gently questions how Australian and UK services might change if families, friends and peer workers were routinely involved from day one.
If you or someone you love has felt unheard in crisis care, this conversation may leave you asking: what would it be like if every voice in the room truly counted?
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