From Wish to Reality: Soteria in Regular Care-Proof of Effectiveness of the Implementation of Soteria Elements in Acute Psychiatry

The Soteria project recounted by Mosher and its clinical resonances today

BACKGROUND

The American psychiatrist Loren R. Mosher has passed to posterity as an eager proponent of a psychosocial approach to psychosis. The best example of this is the Soteria project that he founded in San Jose, California, in the 1970s. The contribution of Alma Zito Menn, ACSW, also merits attention as project director of Soteria and for her links to the Mental Research Institute, Palo Alto. She was later replaced as program director by Voyce Hendrix, LCSW, when she turned to other preoccupations linked to the grant continuation of Soteria. Equally, the nonprofessional staff of the facility should receive appreciation.

AIM/OBJECTIVE

Bearing this in mind, the main aim of this paper is to reflect upon the Soteria project, giving voice to Mosher himself, while simultaneously connecting his ideas with other empirical works that have been published on this topic in recent decades.

METHODS

Using a selection from the extant literature assessing the implementation and outcomes of adapting Soteria-elements to different settings, I present here provisional results obtained from current research. First, I expound what Mosher hoped to achieve in creating Soteria and why it worked. In this respect, I go beyond what is commonly reported in scholarly works, where the Soteria project is considered without paying too great attention to its main architect, as if the project could be separated from the man who created it.

RESULTS AND CONCLUSIONS

As I have corroborated here, there is today growing and promising scientific evidence validating the principles of the Soteria project. Undoubtedly, this would not have been possible without the pioneering work of Mosher, who, imbued with the tenets of interpersonal phenomenology, shook the psychiatric establishment, leading others to follow the path that he had begun.

Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2017-2022

Since the 1960s, empirical research has focused on a better understanding of the characteristics of assaultive psychiatric patients. International research from 1960 to 2017 indicated that male and female patients with schizophrenia and substance use disorder presented the greatest risk for assault with nursing personnel being at higher risk. This present review of studies sought to assess the latest research findings on assaultive patients for the most recent five-year period, 2017-2022. It was hypothesized that patients with schizophrenia and substance use disorders would present the greatest assault risk for nursing personnel. The studies in this review supported this hypothesis. Assaults by patients with schizophrenia and substance abuse has been a consistent finding worldwide for 62 years of published research. Explanations for these findings, the possible role of posttraumatic stress disorder (PTSD) in assaultive patients, and an updated methodological review are presented.

Treatment with Soteria-elements in acute psychiatry-Effectiveness for acutely ill and voluntarily treated patients

Objective

This article aims at evaluating the treatment outcomes of acute psychiatric patients before and after the implementation of Soteria-elements in an acute psychiatric ward. The implementation process resulted in an interconnected small locked and much larger open area, enabling continuous milieu therapeutic treatment by the same staff in both areas. This approach enabled the comparison of structural and conceptual reconstruction regarding treatment outcomes of all voluntarily treated acutely ill patients before (2016) and after (2019). A subgroup analysis focused on patients suffering from schizophrenia.

Methods

Using a pre-post design, the following parameters were examined: total treatment time, time in locked ward, time in open ward, antipsychotic discharge medication, re-admissions, discharge circumstances, and treatment continuation in day care clinic.

Results

Compared to 2016, there was no significant difference in the total time of stay in the hospital. However, data show a significant decrease of days spent in locked ward, a significant increase of days in open ward, a significant increase of treatment discontinuation but without an increase of re-admissions, and a significant interaction of diagnosis and year regarding the medication dosage, resulting altogether in a reduction of antipsychotic medication for patients suffering from schizophrenia spectrum disorder.

Conclusion

The implementation of Soteria-elements in an acute ward facilitates less potentially harmful treatments of psychotic patients, likewise enabling lower dosages of medication.

Facilitating and hindering factors of personal recovery in the context of Soteria-A qualitative study among people with (early episode) psychosis

OBJECTIVE

The objective of this study was to gain insight into patients' experiences of how personal recovery (PR) is facilitated or hindered in the context of an early episode psychosis setting (Soteria). We thereby aimed to contribute to the understanding of how care settings may promote or hinder the process of PR in people with (acute) psychosis.

METHOD

This study used a qualitative method, consisting of semi-structured in-depth interviews with people who had been admitted to a Soteria house in the Netherlands. Interview transcripts were analyzed following the Grounded Theory approach.

RESULTS

Five themes emerged from the data illustrating how Soteria facilitated or impeded PR. The experience of togetherness in contact with staff and peers, feeling at home, and being active facilitated PR, while the emphasis put on medication by staff was experienced as hindering, and attention to spirituality was missed.

CONCLUSION

In addition to the literature that identified factors associated with PR in psychosis, the current study gives a sense of how this can be put into practice. By offering treatment within a normalizing, holding environment, with emphasis on equality, close contact, optimism, active structured days, open-mindedness toward spirituality, and the role of medication, PR can be facilitated without detracting from guideline-based treatment aimed at symptomatic recovery. Similarities with existing concepts are discussed.