American Alternative to Psychiatric Hospitalization Revived in Israel

Traditional approaches to treating psychosis and other serious mental health conditions frequently involve hospitalization and the prescription of powerful medications. Critics argue they are often ineffective and involve the risk of serious adverse effects.

The Soteria model was meant to be an effective alternative to psychiatric hospitalization, preserving patients’ personal power, social networks, and communal responsibilities. The original project was founded by psychiatrist Loren Mosher in San Jose, California, in 1971.

A second Soteria facility opened in 1974 near San Francisco. Mosher was influenced by the philosophy of moral treatment, previous experimental therapeutic communities, and Freudian psychoanalysis. The name Soteria is derived from the Greek word for “salvation” or “deliverance.” Soteria or Soteria-based houses are currently run in the United States, Sweden, Germany, Switzerland, and other countries.

The Soteria concept recently received an upgrade in Israel. In an article for Psychology Today, John Read reported on the successes and challenges of three new Soteria-style houses in Jerusalem and Tel Aviv.

Read was delighted to be invited himself to the opening of the first of the three Soteria-Israel houses in 2016 in Jerusalem. “The warm, relaxed atmosphere in the house was such that it took some time before I could tell who were residents and who were staff,” he remembered. “Not being a religious person I had mixed feelings about the presence of a rabbi until it was explained to me that the person in question was not a rabbi but a resident who sometimes liked to be a rabbi, which seemed to bother nobody.”

Friedlander, Tzur-Bitan, and Lichtenberg evaluated the Israeli Soteria homes. While “crucial components of the original model were preserved … others had to be altered,” they reported in “The Soteria model: implementing an alternative to acute psychiatric hospitalization in Israel.”

The researchers presented eight basic principles for the functioning of Soteria: “care is given in a home, not an institution; groups are small, eight or less; communication is open; activities are client-centered; treatment is consensual; medication is de-emphasized; staff learns to ‘be with’ the resident empathically and non-judgmentally, and the group is the central therapeutic instrument.”

“The heart of the staff remained the ‘companions’, usually students or individuals with personal experience of acute emotional crises,” Friedlander, Tzur-Bitan, and Lichtenberg explained. “These companions were instructed, as in the original Soteria, to cultivate a therapeutic community, with a warm and non-hierarchical atmosphere, blurring the differences between staff and residents.“

Participation and empowerment of patients are key ingredients of the model. “Medication was not considered the first line of treatment, and when used, was understood to be mainly symptomatic treatment—drug-centered and not disease-centered. Its use was not forbidden (contrary to the original Soteria during the first six weeks of the stay), nor was it mandatory, except in exceptional cases where there was a concern for the safety of the residents or their environment. As with all treatment decisions, considerations pro and con were discussed candidly with the resident.”

As Read pointed out in Psychology Today, “the Soteria model is by no means the only alternative to the traditional ‘medical model’ approach of label (diagnose), medicate and, when that fails, hospitalize.”

A similar treatment alternative to psychiatric hospitalization is available at Colorado Recovery. Our Warner Model emphasizes empowerment, integration, and self-actualization. The late Dr. Richard Warner was internationally known for his groundbreaking approach to mental health treatment and for the new model of treatment he created, based on a warmer and more familial setting, comprehensive levels of care that result in a path of self-reliance, and community engagement for connection and a feeling of contribution.

The Treehouse at Colorado Recovery is a social-vocational center run by and for our clients. The program helps prepare them for success in relationships, volunteer work, education and training, internships, and job placements.

At Colorado Recovery it is our mission to help adults with serious mental health issues stabilize their illness, minimize symptoms, improve functioning and enhance each person’s social inclusion, quality of life, and sense of meaning in life.

If you have questions about our recovery model or our services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Power of Groups

Last year, Colorado Recovery expanded services outside the signature continuum of care, and started admitting directly into our intensive outpatient program (IOP) clients who may be ready to begin their recovery at the IOP level of care, or for those in the process of stepping down from another program. 

Community integration and social engagement continue to be at the heart of our approach, setting the course for a life of engagement, purpose, and connection. This non-institutional approach created by the late Colorado Recovery founder Richard Warner is key to outcomes associated with independence and self-respect. 

Dr. Warner considered schizophrenia and similar conditions bio-psycho-social disorders significantly affected by the environment surrounding the client on multiple levels. The Warner method harnesses the benefits of client empowerment to increase skills and work preparedness and assist them with social integration. 

Our groups are an integral part of that treatment approach. “We have all sorts of different groups: a hiking group, a musical group, art therapy, a movement group, motivational therapy, the ACT therapy group (acceptance and commitment) therapy group—all different kinds of groups, all different kinds of approaches for clients to progress in their recovery,” says admissions coordinator Julie Owen, MA.

Every IOP patient is assigned a therapist who participates in the weekly treatment planning meeting with the team’s psychiatrists and other treatment staff. Groups include dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), co-existing disorders group for psychiatric illness and substance misuse issues, the breakfast group, an art therapy group, the movement therapy group, the creative writing group, and a garden group as well as various activity groups.

One of the groups available at the IOP level is movement therapy. Dance/movement therapy (DMT) is defined by the American Dance Therapy Association  as “the psychotherapeutic use of movement to promote emotional, social, cognitive, and physical integration of the individual, for the purpose of improving health and well-being.”

“The basic tenet is that emotions live in the body,” says Colorado Recovery’s movement therapist Elise Alvarez. “It’s about creating awareness around clients, and then movement to process those emotions. In case of anger management issues, we could ask ‘Is there a specific part of your body that you feel anger in?’ Anxiety might manifest as feeling a weight in the chest.” 

By expanding the awareness of such feelings, people are better able to recognize what’s happening in each present moment and then make more informed decisions about their feelings instead of simply reacting to them impulsively.

Meaningful employment is an important aspect of the treatment model originated by Dr. Warner. Clinical research shows that employment can improve outcomes of mental health treatment. “Several studies have shown that patients discharged from psychiatric hospital who have a job are much less likely to be readmitted to hospital than those who are unemployed, regardless of the patient’s level of pathology,” Dr. Warner wrote in The Environment of Schizophrenia

“Finding suitable employment for clients as part of their treatment plan is the task of the employment group,” explains vocational rehabilitation counselor Dalma Farkas. “Clients learn and practice social skills which are essential for job searches and placements. Participants receive continued support, assistance, and encouragement—from each other as well—to successfully get back into the labor market.”

Employment support includes helping clients find a job, go back to school, or find volunteer work in the community. The group covers a lot of territory: how to write a stellar resume, how to prepare for a job interview, and how to keep a job.

Farkas usually gets things rolling with a thorough career assessment. “I ask them what they would like to do, what’s their dream job? I inquire about their job record and also find out what didn’t work for them to avoid bad experiences in the future.”

Another offering available at the IOP level is our Treehouse group. It’s “a safe space to take a break and just hang out,” says Treehouse community organizer Elise Alvarez. “At the same time, it’s a great opportunity to build more comfortable relationships.” The Treehouse group highlights the value of social integration, “many people have found roommates and best friends here,” says Alvarez. “Treehouse gives a population that doesn’t have too much opportunity to socialize the chance to do just that.”

It’s important to give clients some measure of control, to let them work out the budget and create the space the way they want it to be. “We typically start with me making announcements, and then open the floor to things they want to talk about,” explains Alvarez. “We’ve had discussions about terminology: should it be mental illness or biopsychosocial disease? Other times, we plan out dinners or days at the beach.”

Our groups help prepare our clients for success in relationships, volunteer work, education and training, internships, and job placements.

For more information about direct admission to our intensive outpatient program or our other services, connect with a specialist who can answer your questions at (720) 218-4068.