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

Abstract

Objective: This article examines the influence of the implementation of Soteria elements on coercive measures in an acute psychiatric ward after reconstruction in 2017, thereby comparing the year 2016 to the year 2019. The special feature is that this is the only acute psychiatric ward in Hennigsdorf Hospital, connected now both spatially and therapeutically to an open ward and focusing on the treatment of patients suffering from schizophrenia and schizophrenia spectrum disorders.Methods: The following parameters were examined: aggressive assaults, use of coercion (mechanical restraints), duration of treatment in open or locked ward, type of discharge, coercive medication, and dosage of applied antipsychotics. For this purpose, the data of all legally accommodated patients in the year 2016 (before the reconstruction) and 2019 (after the reconstruction) were statistically analyzed in a pre–post mirror quasi-experimental design.Results: In 2019, the criteria of the Soteria Fidelity Scale for a ward with Soteria elements were reached. In comparison to 2016 with a comparable care situation and a comparable patient clientele, there was now a significant decrease in aggressive behavior toward staff and fellow patients, a significantly reduced number of fixations, a significantly reduced overall duration of inpatient stay, and a significant increase in treatment time in the open area of our acute ward.Conclusion: The establishment of Soteria elements in the acute psychiatric ward leads to a verifiable less violent environment of care for severely ill patients and to a drastic reduction in coercive measures.

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

“…In 2019, an increase in the number of patients with schizophrenia spectrum disorder and acute psychotic disorder was notable. When added to the legally accommodated patients [treatment outcomes are presented in a previous article ( 10 )], this group forms the majority of patients treated on the acute ward. This is in keeping with the requirements of the Soteria Fidelity Scale ( 12 ) for a ward with Soteria-elements.…”

“…A transfer to other wards in case of reduced controllability is thus not possible. Previously published data ( 10 ) demonstrated a significant benefit for legally accommodated patients treated with Soteria-elements in acute care in the Oberhavel Klinik Hennigsdorf. The present article however, focusses on the effect of Soteria-elements in acute care on all patients in the same acute ward, who were treated voluntarily and who constitute the vast majority.…”

It is time for more holistic practices in mental health

“…An important aspect of the report is the emphasis placed on the importance of lived experience and the presentation of successful stories of medicalization reduction, which include many successful practices documented across several countries from the 1970s onwards, in the wake of the Psychiatric Reform. Consolidated examples of crisis care in Mental Health include the 'Open Dialogue' approach [4], the 'Soteria Houses' [5], and peer-run nursing homes such as 'Peer Respite' [6], which have contributed to the reduction of chronicity, disabilities, and other harmful effects of the conventional ways of treating acute crises and psychic emergencies. Particularly interesting are the practices based on peer support, i.e., on mutual support between people who go through similar health distress and have the objective of enhancing the overcoming of the difficulties brought about by the experience of mental suffering through a relationship of equality, trust, and mutual respect between the participants of the group, i.e., the peers.…”

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

“…In the years after, the model evolved toward a holistic framework, in which much attention is paid to psychological and social interventions, next to guideline-based low-dose medications ( 3 , 4 ). To date, several Soteria houses and wards with Soteria elements are operating around the world ( 5 , 6 ). Previous research into Soteria focused on clinical and functional outcomes.…”