Soteria

Soteria is a milieu-therapeutic recovery method, characterized by its founder as "the 24 hour a day application of interpersonal phenomenologic interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment."Mosher, L. R. (1999). "Soteria and Other Alternatives to Acute Psychiatric Hospitalization: A Personal and Professional Review." Journal of Nervous and Mental Disease, 187, 142-149. PMID 10086470 ] More recent adaptions of this model sometimes employ professional staff. [Luc Ciompi, MD (1997) The Soteria-concept. Theoretical bases and practical 13-year experience with a milieu-therapeutic approach of acute schizophrenia PMID 9396381] It has traditionally been applied to the treatment of those given a diagnosis of schizophrenia. The houses Soteria patients are admitted to are called Soteria houses.

Soteria houses are often seen as gentler alternatives to a psychiatric hospital system perceived as authoritarian, hostile/violent and based on a routine use of psychiatric (particularly antipsychotic) drugs. They are sometimes viewed as early intervention or crisis resolution services based on a supportive recovery model.

History

The original Soteria Research Project was founded near San Francisco between 1969 and 1971 by psychiatrist Loren Mosher, who was influenced by the philosophy of moral treatment, previous experimental therapeutic communities (such as the Fairweather Lodges), the work [Sullivan HS (1962) Schizophrenia as a human process. New York: Norton.] of Harry Stack Sullivan, and Freudian psychoanalysis. The name "Soteria" comes from the Greek "Σωτηρία" for "salvation" or "deliverance" (see Soter).

Mosher's first Soteria house specifically selected unmarried subjects between the ages of 18 and 30 who had recently been diagnosed as meeting the DSM-II criteria for schizophrenia. Staff members at the house were encouraged to treat residents as peers and to share household chores. The program was designed to create a quiet, calming environment that respected and tolerated individual differences and autonomy. There was also an ethos of shared responsibility for the running of the house and playing a part in a mutually-supportive community, with the distinction between experts and non-experts downplayed (similar to therapeutic communities). Psychotropic medication, including anti-psychotics, were not completely rejected and were used in some circumstances. The Soteria staff, compared to staff in other psychiatric services, were found to possess significantly more intuition, introversion, flexibility, and tolerance of altered states of consciousness. [Hirschfeld RM, Matthews SM, Mosher LR, Menn AZ. (1977) "Being with madness: personality characteristics of three treatment staffs." Hosp Community Psychiatry. Apr;28(4):267-73. PMID 844816]

The Soteria project was admired by many professionals around the world who aspired to create mental health services based on a social, as opposed to a medical, model of mental health. It was also heavily criticised as irresponsible or ineffective. The US Soteria Project closed as a clinical program in 1983 due to lack of financial support, although it became the subject of research evaluation with competing claims and analyses. Second generation US successors to the original Soteria house (called Crossing Place and McAuliffe House) also closed around that time.

A first European near-replication of the original Soteria approach was implemented in 1984 in Berne, Switzerland, on a somewhat different conceptual basis. Three Soteria-like environments focused on longer term rehabilitation were created in Sweden (Perris, 1989).

Current Soteria work

Soteria or Soteria-based houses are currently run in Sweden, [Perris, C.M. Cognitive Therapy with Schizophrenic Patients. Guilford, New York, NY, 1989.] Finland,Fact|date=May 2007 Germany, [ [http://www.zfp-web.de/K3/html/artikel.php3?path=0:3:32:138&a_id=83 Allgemeine Psychiatrie I / Soteria ] ] [ [http://www.toll-haus.de/index.html Toll - Haus ] ] [ [http://www.lunaticpride.de/SOTERIA.HTM Soteria ] ] Switzerland, [ [http://www.soteria.ch Soteria Bern ] ] Hungary [ [http://www.soteria.hu/ Soteria Alapítvány ] ] and some other countries.

Research at Soteria Berne found that most acute schizophrenia patients can be as successfully treated as by standard hospital proceedings, but with significantly lower doses of antipsychotics and without higher daily costs. In addition, the Soteria approach appeared to offer certain advantages mainly located at the subjective-emotional, familial and social level. [Ciompi, L & Hoffmann, H (2004)] [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1414694 Soteria Berne: an innovative milieu therapeutic approach to acute schizophrenia based on the concept of affect-logic.] "World Psychiatry" 3(3): 140–146.]

In the context of increasing interest in the Soteria approach in the United Kingdom, several European countries, North America, and Australasia, a review of controlled trials suggested the Soteria paradigm yields equal, and in certain specific areas better, results in the treatment of people diagnosed with first- or second-episode schizophrenia spectrum disorders (and with considerably lower use of medication) when compared with conventional, medication-based approaches. A reevaluation of the approach was called for. [Calton T, Ferriter M, Huband N, Spandler H. (2008) [http://schizophreniabulletin.oxfordjournals.org/cgi/content/full/34/1/181 A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia] Schizophrenia Bullutin. Jan;34(1):181-92.]

References

Links

* [http://www.yoism.org/?q=node/120#ChemicalImbalance Video] of Robert Whitaker and Loren Mosher discussing the evidence for the Soteria model.
* [http://www.moshersoteria.com/soteri.htm Website on Soteria] started by Loren Mosher.
* [http://www.soteria.hu/?lang=en Soteria Foundation] A Hungarian Soteria organization that provides multiple services to people with mental health problems and their families and communities.
* [http://www.soterianetwork.org/ UK Soteria Network] planning Soteria houses in the UK.
* [http://soteria-alaska.com/ Alaskan Soteria Network] in the process of establishing a Soteria house.