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The Residential Care Alternative for the Acutely Psychotic Patient

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Abstract

Community homes for the treatment of the acutely psychiatrically ill have been established in several places in the world as alternatives to inpatient hospitalizations. We reviewed sources from the psychiatric and psychological literature which examine these models. Several features are common to this treatment setting: fewer residents in comparison with hospital wards; a supportive and caring milieu including intense and regular therapeutic contact with staff; a de-emphasis of medication; and a destigmatization of the therapeutic treatment of psychosis. The models differ with respect to use of psychotropic medication, emphasis upon first admissions, and composition of staff. The varying models are comparable to inpatient treatment in terms of clinical and psychosocial outcome, and generally cost less. For most patients requiring psychiatric hospitalization, residential treatment can be a viable alternative to inpatient hospitalization. Issues of cost, therapeutic effectiveness, and long-term outcomes still need to be studied.

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References

  1. Johnson S, Gilburt H, Lloyd-Evans B, Osborn DP, et al.: In-patient and residential alternatives to standard acute psychiatric wards in England. British Journal of Psychiatry 194:456–463, 2009

    Article  PubMed  Google Scholar 

  2. Lloyd-Evans B, Slade M, Jagielska D, Johnson S: Residential alternatives to acute psychiatric hospital admission: Systematic review. British Journal of Psychiatry 195:109–117, 2009

    Article  PubMed  Google Scholar 

  3. Stein LI, Test MA: Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry 37:392–397, 1980

    CAS  Google Scholar 

  4. Tuke S: Description of the Retreat, an Institution Near York, for Insane Persons of the Society of Friends: Containing an Account of its Origin and Progress, the Modes of Treatment, and a Statement of Cases. Philadelphia, Isaac Pierce, 1813

    Google Scholar 

  5. Pinel P: A Treatise on Insanity (D. D. Davis, trans.). New York, Hafner Pub. Co., 1962

    Google Scholar 

  6. Borthwick A, Holman C, Kennard D, et al.: The relevance of moral treatment to contemporary mental health care. Journal of Mental Health (Routledge) 10:427–439, 2001

    Article  Google Scholar 

  7. Foucault M: Madness and Civilization: A History of Insanity in the Age of Reason. New York, Vintage Books, 1965

    Google Scholar 

  8. Scull A: Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective. Berkeley, University of California Press, 1989

    Google Scholar 

  9. Laing RD, Esterson A: Sanity, Madness and the Family. London, Tavistock Press, 1964

    Google Scholar 

  10. Barnes M, Berke J: Two Accounts of a Journey Through Madness. London, MacGibbon and Kee, 1971

    Google Scholar 

  11. Mullan B: Mad to be Normal: Conversations with R. D. Laing. London, Free Association Books, 1995

    Google Scholar 

  12. Mosher LR: Soteria and other alternatives to acute psychiatric hospitalization. Journal of Nervous and Mental Disease 187:142–149, 1999

    Article  PubMed  CAS  Google Scholar 

  13. Bola JR, Mosher LR: Treatment of acute psychosis without neuroleptics: Two-year outcomes from the Soteria project. Journal of Nervous and Mental Disease 191:219–229, 2003

    Article  PubMed  Google Scholar 

  14. Matthews SM, Roper MT, Mosher LR et al.: A non-neuroleptic treatment for schizophrenia: Analysis of the two-year post-discharge risk of relapse. Schizophrenia Bulletin 5:322–333, 1979

    PubMed  CAS  Google Scholar 

  15. Mosher LR, Menn AZ: Community residential treatment for schizophrenia: Two-year follow-up. Hospital and Community Psychiatry 29:715–723, 1978

    PubMed  CAS  Google Scholar 

  16. Bola JR, Mosher LR: At issue: Predicting drug-free treatment response in acute psychosis from the Soteria project. Schizophrenia Bulletin 28:559–575, 2002

    PubMed  Google Scholar 

  17. Mosher LR: Soteria and other alternatives to acute psychiatric hospitalization: A personal and professional review. The Journal of Nervous and Mental Disease 187:142–149, 1999

    Article  PubMed  CAS  Google Scholar 

  18. Kresky-Wolff M, Matthews S, Kalibat F et al.: Crossing place: A residential model for crisis intervention. Hospital and Community Psychiatry 35:72–74, 1984

    PubMed  CAS  Google Scholar 

  19. Fenton W, Mosher L, Herrell J, et al.: A randomized trial of general hospital versus residential alternative care for patients with severe and persistent mental illness. American Journal of Psychiatry 155:516–522, 1998

    PubMed  CAS  Google Scholar 

  20. Kay SR, Opler VA, Fiszbein A: Positive and Negative Syndrome Scale (PANSS) Rating Manual (Appendix 5). San Rafael, CA, Social and Behavioral Sciences Documents, 1987

    Google Scholar 

  21. Leff J, Kuipers L, Berkowitz R, et al.: A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry 141:121–134, 1982

    Article  PubMed  CAS  Google Scholar 

  22. Neuchterlein KH, Dawson ME: A heuristic vulnerability/stress model of schizophrenia episodes. Schizophrenia Bulletin 10:300–312, 1984

    Google Scholar 

  23. Zubin J, Spring B: Vulnerability: A new view of schizophrenia. Journal of Abnormal Psychology 86:103–123, 1977

    Article  PubMed  CAS  Google Scholar 

  24. Ciompi L.: The concept of affect logic. An integrative psychosociobiological approach to understanding and treatment of schizophrenia. Psychiatry 60:158–170, 1997

    CAS  Google Scholar 

  25. Ciompi L, Dauwalder HP, Maier C, et al.: The pilot project “Soteria Berne”: Clinical experiences and results. British Journal of Psychiatry 191(suppl. 18):145–115, 1992

    Google Scholar 

  26. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. Washington DC, APA, 1987

  27. Ciompi L, Hoffmann H: Soteria Berne: An innovative milieu therapeutic approach to acute schizophrenia based on the concept of affect-logic. World Psychiatry 3:140–145, 2004

    PubMed  Google Scholar 

  28. Warner R, Wollesen C: Alternative Acute Treatment Settings. In: Vaccaro JV, Clark GH (Eds) Practicing Psychiatry in the Community: A Manual. Washington, DC, American Psychiatric Press, pp. 89–115, 1996

    Google Scholar 

  29. Hawthorne WB, Green EE, Gilmer T et al.: A randomized trial of short-term acute residential treatment for veterans. Psychiatric Services 56:1379–1386, 2005

    Article  PubMed  Google Scholar 

  30. Hawthorne WB, Green EE, Lohr JB, et al.: Comparison of outcomes of acute care in short-term residential treatment and psychiatric hospital settings. Psychiatric Services 50:401–406, 1999

    PubMed  CAS  Google Scholar 

  31. Lindgren I, Hogstedt MF, Cullberg, J: Outpatient vs. Comprehensive first-episode psychosis services, a 5-year follow-up of Soteria Nacka. Nordic Journal of Psychiatry 60:406–409, 2006

    Article  Google Scholar 

  32. Gilburt H, Slade M, Rose D, Lloyd-Evans B, Johnson S, Osborn DPJ: Service users’ experiences of residential alternatives to standard acute wards: Qualitative study of similarities and differences. British Journal of Psychiatry 197:s26–s31, 2010

    Article  Google Scholar 

  33. Osborn DPJ, Lloyd-Evans B, Johnson S, Gilburt H, Byford S, Leese M, Slade M: Residential alternatives to acute in-patient care in England: Satisfaction, ward atmosphere and service user experiences. British Journal of Psychiatry 197:s41–s45, 2010

    Article  Google Scholar 

  34. Radcliffe J, Smith R: Acute in-patient psychiatry: How patients spend their time on acute psychiatric wards. Psychiatric Bulletin 31:167–170, 2007.

    Article  Google Scholar 

  35. Lloyd-Evans B, Johnson S, Morant N, et al.: Alternatives to standard acute in-patient care in England: Differences in content of care and staff–patient contact. British Journal of Psychiatry 197:s46–s51, 2010

    Article  Google Scholar 

  36. Carpenter WT, Buchanan RW: Commentary on the Soteria project: Misguided therapeutics. Schizophrenia Bulletin 28:577–581, 2002

    PubMed  Google Scholar 

  37. Francey SM, Nelson B, Thompson A, et al.: Who needs antipsychotic medication in the earliest stages of psychosis? A reconsideration of benefits, risks, neurobiology and ethics in the era of early intervention. Schizophrenia Research 119:1–10, 2010

    Article  PubMed  CAS  Google Scholar 

  38. Streiner DL: Regression toward the mean: Its etiology, diagnosis, and treatment. Canadian Journal of Psychiatry 46:72–76, 2001

    CAS  Google Scholar 

  39. Gutheil TG: The therapeutic milieu: Changing themes and theories. Hospital and Community Psychiatry 36:1279–1285, 1985

    PubMed  CAS  Google Scholar 

  40. Whiteley S: The evolution of the therapeutic community. Psychiatric Quarterly 75:233–248, 2004

    Article  PubMed  Google Scholar 

  41. Calton T, Ferriter M, Huband N, et al.: A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia. Schizophrenia Bulletin 34:181–192, 2008

    Article  PubMed  Google Scholar 

  42. Stroul BA: Residential crisis services: A review. Hospital and Community Psychiatry 39:1095–1099, 1988

    PubMed  CAS  Google Scholar 

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Correspondence to Pesach Lichtenberg.

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Lichtenberg, P. The Residential Care Alternative for the Acutely Psychotic Patient. Psychiatr Q 82, 329–341 (2011). https://doi.org/10.1007/s11126-011-9176-0

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