The Soteria care model is an alternative to restrictive inpatient psychiatric care for people experiencing psychosis in which patients and service users stay in residential housing largely staffed by lived experience experts and laypeople. This model emphasizes communal living, personal autonomy, non-hierarchical relationships with staff, and minimal, consensual psychiatric drug use. A new study published in Psychiatry Research finds that the Soteria care model is linked to reduced likelihood and frequency of readmission, as well as longer time to readmission compared to traditional inpatient treatment. This research, led by Avraham Friedlander from the Hebrew University of Jerusalem, also reports that these associations were strongest among younger adults (≤ 30 years). The authors write:
“This study identified an association between treatment in a Soteria home and lower long-term psychiatric readmission rates compared with traditional inpatient care, with effects most evident among patients aged 30 and below. Individuals treated in Soteria showed lower odds of readmission, fewer readmission events, and longer time to first readmission.”
Benefits Linked to the Soteria Model
Early research into the Soteria model found that it was linked to improved work performance, social competence, and independent living in people diagnosed with schizophrenia. These improvements persisted at a two-year follow-up, suggesting that this model is linked to long-term improvements. A similar 2003 study found that patients and service users treated through the Soteria model had better social functioning compared to those receiving inpatient psychiatric treatment.
This treatment paradigm is linked to improved recovery from first episode psychosis, preserves autonomy and upholds human rights, and reduces costs associated with mental healthcare due to reduced reliance on hospitalization and less need for lifelong clinical management. Past research has also found that the Soteria care model results in clinical improvement similar to inpatient psychiatric treatment, but without the overly medicalized environment and with substantially reduced psychiatric drug exposure.
Study Details
The goal of this study was to investigate how treatment in a Soteria home compared to inpatient psychiatric admission in terms of likelihood of readmission, time to readmission, frequency of readmission, and duration of readmission. The authors also wanted to examine whether these factors were affected by age, gender, and prior admission history.
Using data from Israel’s Ministry of Health, the researchers identified patients admitted in 2018 to either an Israeli Soteria home or the acute psychiatric ward at the Jerusalem Mental Health Center. The authors used data from 82 Soteria patients with 395 admission events and 630 control patients with 6,956 admission events. The main analysis was conducted on matched pairs of 82 Soteria patients and 82 patients treated in an acute psychiatric ward. The authors followed each patient through May 31, 2021, allowing more than two years of follow-up. They compared the Soteria patients to acute ward patients in terms of readmission rates, number of readmissions, time to first readmission, and the length of stay during readmissions.
To be included in the current research, patients had to be voluntarily admitted to a Soteria home in Jerusalem or the acute psychiatric ward at the Jerusalem Mental Health Center for at least five days in 2018. Included patients also had to be at least 18 years old and had to have electronic administrative records that were retrievable through Israel’s national psychiatric hospitalization registry.
The authors note that Soteria houses in Israel differ from the original model in that they accept a broader range of diagnoses including mood disorders, anxiety disorders, substance use disorders, and personality disorders in addition to people experiencing psychosis. The length of stay is also relatively shorter at just four to eight weeks compared to two to six months in the original model.
Overall likelihood of readmission was significantly lower for people treated at a Soteria house compared to the acute inpatient ward. Thirty-eight (46.3%) Soteria patients were readmitted during the duration of the study compared to 52 (63.4%) acute ward patients. Likelihood of readmission was lower for Soteria patients at six months (22% vs 39%), one year (34.1% vs 51.2%), two years (41.5% vs 61%), and two-and-a-half years (45.1% vs 63.4%). Patients ≤ 30 years old had a significantly lower likelihood of readmission, with 77% reduced odds. While the authors report 17% reduced odds of readmission for Soteria patients over 30, this association was not statistically significant.
Soteria patients had reduced frequency of readmission, with 41% fewer readmissions compared to acute ward patients. People treated at Soteria houses also had shorter stays during their readmissions (22% fewer days), but this association did not reach statistical significance.
Soteria care was linked to significantly longer time to readmission. When including only people that were eventually readmitted, Soteria patients averaged 660 days from discharge to readmission compared to 506.9 days for acute ward patients. When accounting for people that were never readmitted, Soteria patients averaged 781.2 days from discharge to readmission compared to 581.6 days for acute ward patients. At any given point in time after discharge, patients treated in the acute ward were 66% more likely to be readmitted compared to Soteria patients.
The results of this study suggest that non-coercive, community-based care models that emphasize non-hierarchical relationships with staff and minimize psychiatric drug use can significantly reduce and delay readmission.
This research had several limitations. The study’s design means that the findings can speak to associations between lower readmission rates and the Soteria model, but cannot definitively say that treatment with the Soteria model caused these lower readmission rates. There may have been unmeasured differences between patients that chose to go to a Soteria house and those that chose the acute psychiatric ward. There were relatively few Soteria patients that met inclusion criteria. This research looked at patients treated in Jerusalem, limiting generalizability to other populations. Lower readmission rates could reflect other factors besides clinical recovery such as different thresholds for hospitalization, differences in service use, and access to alternative community services.
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Friedlander, A., Oren, S., Sinai, D., Bitan, D. T., Yoffe, R., Eitan, R., & Lichtenberg, P. (2026). Psychiatric Readmissions following soteria versus traditional inpatient care: A propensity score-matched cohort study. Psychiatry Research, 364, 117263. (Link)
