An alternative to psych hospitals

An Alternative to Psychiatric Hospitals | Psychology Today United Kingdom

" * Traditional, ‘medical model’ approaches to treating psychosis are often ineffective and involve the risk of serious adverse effects.

  • An effective alternative to psychiatric hopitalisation, initiated in California in the 1970s, has been resurrected in Israel.
  • A recent article reports on the successes and challenges of three new Soteria-style houses in Jerusalem and Tel Aviv.

The scientific journal I edit, Psychosis, is proud to have just published a rather remarkable article, entitled ‘The Soteria Model: implementing an alternative to acute psychiatric hospitalization in Israel’.

The first two Soteria Houses were run in California in the 1970s. They were initiated by the eminent radical psychiatrist Loren Mosher, who was head of ‘schizophrenia’ research at the National Institute for Mental Health in the USA. Loren had come to believe that when we lose touch with reality, compassion and supportive environments are more helpful, than diagnostic labels, ‘anti-psychotic’ drugs, electric shocks and psychiatric hospitals.

His Soteria Houses, staffed by non-professionals with the essential capacity to calmly ‘be with’ extreme emotional states, were found to have similar outcomes to ‘treatment as usual’ in terms of symptoms even though most Soteria residents took no psychiatric drugs. Furthermore, the Soteria group performed better than the hospitalised, medicated control group on Quality of Life measures, such as returning to work.

After the closure of the California project, due to withdrawal of funding, a few, isolated, replications followed, including in the Netherlands, Sweden, Germany, Japan, France, Hungary and the USA. The longest lasting project is in Berne, Switzerland under the guidance of psychiatrist Dr Luc Ciompi.

I was delighted to be invited, with my family, to the opening of the first of 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. 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.

The three houses, one all male, one all female and one mixed gender, are the brain child of remarkable Israeli psychiatrist Dr Pesach Lichtenberg, supported by the equally remarkable team of caring human beings he has gathered together on this mission. They are a mixture of professional staff and ‘companions’.

In the Psychosis article, Dr Lichtenberg, sumarises the guiding principles as:

Care is given in a home not an institution;

Groups are small, eight or less;

Communication is open;

Activities are client-centred;

Treatment is consensual;

Medication is de-emphasized;

*Staff learn to ‘be with’ the resident empathically and non-judgmentally; and

The group is the central therapeutic instrument.

The article presents data on the first 486 residents. It is an honest appraisal of the successes and failings, the challenges and compromises, inevitably involved in such an innovative project. Over time, however, the number of residents needing hospitalization (primarily because of suicidality or violence) reduced steadily from 37% in 2016 to 8% in 2020. Put another way, this means that between 63% and 92% of people who would otherwise probably have been hospitalised, were not. Furthermore, only 19% returned to their Soteria House after an initial stay, a rate far lower than re-admission rates to many psychiatric hospitals.

One clear indication of success has been the official recognition of the model by Israel’s Ministry of Health, leading to the recent establishment of 10 more homes ‘providing a community-based residential care alternative to acute psychiatric hospitalization’.

The Soteria model is by no means the only alternative to the traditional ‘medical model’ approach of label (diagnose), medicate and, when that fails, hospitalise. Two other approaches that have grown in leaps and bounds, internationally, in the past two decades are the Open Dialogue approach, which brings together the social network of a person to seek shared solutions, and the Hearing Voices network, which provides peer support groups without pathologizing or labelling.

All effective alternatives are extremely welcome given that while some people find their anti-psychotic medication very helpful, at least in the short-term, many discard their pills because of their adverse effects, which can include extreme drowsiness, diabetes, obesity, sexual dysfunction, reduced brain volume and shortened life span. The three alternatives mentioned in this article are certainly in keeping with recent calls by the World Health Organisation and the United Nations for a move away from the traditional but largely ineffective medical model, towards evidence-based, humane approaches that address the social causes of human distress such as poverty, child abuse, discrimination, violence, war trauma, etc.

Having worked in several psychiatric inpatient units over the years, initially as a nursing aide and later as a clinical psychologist, I have often questioned why we still insist on rounding up the 50 or 100 (it used to be several hundred) most distressed and/or distressing people in a community, put them all in the same building, and then wonder why they don’t get better."


You could say the same about prisoners! Very little rehabilitation goes on in hospital or prison

Interesting article.

Was this the thing either @crimby or @77nick77 stayed in California? Sorry if I got that wrong but I remember one of you talking about something like this in the past


Prisons a great alternative.

Prisoners have a lot more rights.

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Prisons are good to lose weight and become muscular.


I believe @77nick77 spent time in a Soteria styled setting and was underwhelmed with it.


Also great for curing constipation and catching Hep C.


Our member @77nick77 has practical experience with this from back in it’s heyday. He has some insight to how it didn’t or did work.


It wasn’t me. I haven’t been in Australia for almost fifty years.

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Sorry, I mean California.

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Don’t ever think that prison is a resort. From what I’ve heard it is a pretty nasty place.


Well, Soteria houses sound wonderful, but funds are needed to start them and there are probably long waiting lists to stay there, like any group homes.

Plus medication shouldnt be discouraged because it is helpful in many cases


An alternative for me would be a sandy beach and a rum punch.

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It’s true. Locking mentally ill people up together is dangerous. People absorb others delusions, and some people are abusive/harassing towards others.

I’ve been harassed, had racist abuse and been sexually harassed on wards by men and women.

Screw hospitals

Hospital pdocs are so f*cking dumb. They wonder why some people are ill for so long
…it’s because of the other patients.

Some patients are barbaric animals and I wish bad things on them. :rage:


Yea my roommate was a prisoner and he stole my stuff. I had to report him to security as I didn’t want to fight with him, he was big muscular with tattoos and intimidating. Another patient who was completely nude came to my room at night in the dark, I had to yell at him to make him go away.


I was abused multiple times in the psych hospital 5 years ago.
It was a total hell hole.

The staff with an exception of a few were a bunch of sociopaths.

On the positive side the food they served was excellent


Yeah, I was in Soteria House :house_with_garden: n San Jose, Ca 1980-81. It was an experience.
I was fresh out of the hospital when I moved in and newly psychotic. It was a big two story house in the middle of a residential neighborhood. There were usually 7 or 8 clients there at any given time and there were about six staff who rotated in and out and at least one of them would spend the night there.

The staff were mostly nice, young and friendly. There was one staff member who nobody liked. It was my first experience with a mental health worker who made me think he should never be in that profession. I’ve run into a few like him over the years. People who were just unlikable and treated the mentally ill (and everybody else) badly.

Anyways, I remember the night I moved in, I walk in the door and there were a few young people and a guy my age (19) walked up and stuck out his hand and shook my hand and welcomed me. I remember feeling that it seemed like summer camp. Reality soon set in. Also unreality. I became extremely psychotic and stayed that way for the next year and a half that I was there.

It’s true that for the majority of the time, no one was on medication. But they kept bottles of medication inside a locked cupboard upstairs and they used it twice that I know of when people got extremely agitated and excited. Personally, I was never given medication the whole time I was there. Day to day life consisted mostly of people hanging out in the kitchen with staff talking. There were several clients who couldn’t handle just doing that though. For the first three months I was there one guy stayed in his room all day. He came out very occasionally to eat by himself. The guy looked like Jesus Christ and I never heard him talk. Surprisingly, he was one of the few who made improvements. A couple guys sat in the corner of the living room all day.

One guy sat their talking to himself, another guy was a gangsters son and acted like his hand was a gun and made weird shooting noises at everybody. When I first moved in me and two other people, a guy and a girl used to have little parties in my room with beer and pot. At first the staff looked the other way but they soon shut down our parties. Later, I lost my virginity to that girl and became friends with the guy. He had a car and we drove up to the mountains once and partied with a bunch of strangers. We did some other things too.

But none of us had any responsibilities. None of us were working and we just hung out all day or walked places. The house was near the downtown area and I used to walk downtown all the time. This was before they cleaned up San Jose and made it family friendly in the nineties. But when I was there in the eighties the streets were lined with sex shops and you would see hookers sometimes and there were really bad bars and adult movie theaters. It was pretty wild on a Saturday night:

I was extremely psychotic like I said and it was the worst year and half of my life. I felt I was just going to crazy at any second and not know what I was doing and go off the deep end and never come back. And being in the house didn’t help me at all. In fact, I regret my stay there. I wish I had been on medication and in the hospital or a different group home. I guess it helped some people but it didn’t help me at all. In fact, three weeks after I got kicked out I ended up in the long term hospital. The hospital was no picnic for 8 months but at least I got put on medication which is when I really started to recover.

Soteria House was interesting, it was part of my life and I met some cool people there.


I lived in a group house for about a year I think.

It was only open weekdays I think and you had your own room.

There were perhaps six clients in the house with staff 24/7.

We shared living room, bathroom, kitchen but got our own bed room.

We were medicated and a psychiatrist came to visit us.

Had to clean once a week.Fridays.

I didn’t make friends there.

I was homeless at the time so spent weekends at Anders family place.

I didn’t want to eat with the others so tried eating in my room alone.

The staff and patients cooked together.

I kept to myself.

I sewed a little and crewchetted.


After my first and only stay in a hospital, I had gone to a partial hospitalization program. There’s group therapy all day and you meet with a social worker and a psychiatrist each day. You get to go home at night. It’s something like 9am-3pm. This, to me, is a good alternative to a psych hospital.


…and learning the tricks of the trade.

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I did a lot of outpatient but I was in the military so I was the only psychotic patient. Every one else had PTSD and sexual trauma. Didn’t get much out of it.

I went to a day treatment program for more than a month but there wasn’t much therapy. We mostly watched movies.