Soteria-California and Its American Successors: Therapeutic Ingredients

Soteria was a small, home-like, residential alternative to psychiatric hospitalization that used minimal or no neuroleptic medications to treat young, unmarried, first or second episode psychotic persons. This article describes the background and characteristics of Soteria, and two later adaptations of its treatment approach. The adaptations, Crossing Place and McAuliffe House, treated unselected, long-term, public sector clients in similar settings. Nearly all of the clients in these two settings received one or more psychotropic drugs. Specially selected nonprofessionals, trained to "be with" psychotic persons, staffed all three facilities. Results of two experimentally designed studies, one of Soteria and the other of McAuliffe House, comparing alternative residential to usual hospital treatment are reviewed. Six-week, postadmission data from the Soteria study indicate comparable and significant symptom reduction in control and experimental groups despite minimal use of neuroleptics with experimental participants and their nearly universal use with hospital-treated controls. Forty-three percent of Soteria participants received no neuroleptic drug treatment between 6 weeks and the 2-year follow-up. At the 2-year follow-up, completing Soteria participants had significantly better overall outcomes (+ 0.47 SD, p = .03), and participants rediagnosed with DSM-IV schizophrenia and treated at Soteria had much better outcomes than similar controls (+ 0.81 SD, p = .02). The McAuliffe House study demonstrated symptom reduction that was comparable to the hospital, yet resulted in a 44% reduction in acute care costs, saving nearly $10,000 per year per client for this sample of long-term system users. Factors likely to be responsible for the effectiveness of this psychosocial treatment model for both newly identified and long-term clients are detailed.