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 drugfree treatment
environment, was as successful as anti-psychotic 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 "alternati-ve" 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. J Nerv Ment Dis 187:142-149, 1999