•ABSTRACT: The author reviews the clinical and special
social environmental data from
the Soteria Project and its direct successors. Two random assignment studies of the Soteria model and its modification for
long-term system clients reveal
that roughly 85% to 90% of acute and long-term clients deemed in need of acute hospitalization can be returned to the
community without use of conventional
hospital treatment. Soteria, designed as a drug free treatment environment, was as successful as antipsychotic drug
treatment in reducing psychotic
symptoms in 6 weeks. In its modified form, in facilities called Crossing Place and McAuliffe House where so-called long term
"frequent flyers" were treated,
alternative-treated subjects were found to be as clinically improved as hospital-treated patients, at considerably lower cost.
Taken as a body of scientific
evidence, it is clear that alternatives to acute psychiatric hospitalization are as, or more, effective than traditional hospital
care in short-term reduction of psychopathology
and longer- social adjustment. Data from the original drug-free, home-like, nonprofessionally staffed Soteria Project and
its Bern, Switzerland, replication
indicate that persons without extensive hospitalizations (<30 days) are especially responsive to the positive therapeutic
effects of the well-defined, replicable
Soteria-type special social environments. Reviews of other studies of diversion of persons deemed in need of hospitalization
to "alternative" programs have
consistently shown equivalent or better program clinical results, at lower cost, from alternatives. Despite these clinical and cost
data, alternatives to psychiatric
hospitalization have not been widely implemented, indicative of a remarkable gap between available evidence and clinical
practice.
•THE JOURNAL OF
NERVOUS AND MENTAL DISEASE 187:142-149, 1999