Soteria—A Human Response to a Human Problem

In recent years, I have been part of Soteria Israel, initially as the director of Hasharon Soteria House, and later in other management and development roles. For many years, my professional path was in the realm of psychoanalysis, and included years of work in a regular psychiatric ward. The combination of in-depth study of psychoanalysis, encountering the limitations of the system, and exposure to new ideas in psychiatry and psychology around the world eventually led me to Soteria. In my remarks here, I will try to describe some of this process.

This is also an opportunity for us to tell the English-speaking public about our work at Soteria Israel and to expand our network of connections and collaborations. Soteria Israel operates two Soteria houses, based on the Soteria model, which offers a community-based, non-coercive alternative to traditional psychiatric hospitalization for individuals experiencing severe mental health crises, including psychosis.

Starting with the first house in Jerusalem in 2016, the Soteria model has gained recognition in Israel, with another house active since 2019 and by now some 35 other similar houses operated by other NGOs and companies. The Ministry of Health has published guidelines for these types of residential treatment centers, they are called “stabilizing houses” and most of them are publicly funded.

Here’s a few principles of our activity:

• Humane and Holistic Approach: Our philosophy views mental health crises as a natural human experience rather than as a disease. The approach emphasizes creating a warm, accepting, and non-hierarchical therapeutic community.
• De-emphasis on Medication: While not rejecting medication, the Soteria model in Israel prioritizes empathetic relationships, open communication (“being with”), and understanding the individual’s unique story over heavy reliance on psychiatric drugs. Medication use is typically less frequent than in traditional hospital settings.
• Focus on Therapeutic Community: The houses foster a sense of community where residents and staff (both professional and non-professional “companions”) interact openly. Activities are client-centered, and meals are often prepared and shared together to encourage spontaneous social interaction.
• Aim to Prevent Hospitalization: The primary goal is to provide a supportive environment that helps individuals navigate their mental health crisis and return to community life without the need for or prolonged stay in a psychiatric hospital.
• Adaptations to the Original Model: While adhering to the core principles of Soteria, the Israeli implementation has made some adaptations to fit local regulations, insurance requirements, and cultural considerations. This includes having a full professional staff, developing individual treatment plans, and in some cases, establishing single-gender homes.

Our emphasis at the Hasharon Soteria House in Kfar Yona, which has been active since 2019, is on fostering a trust-based organization. We empower all staff members to have a significant impact on every aspect of the house’s activities. Our current understanding is that cultivating a strong sense of community among the staff is paramount. By focusing on and developing the relationships between staff members, we believe we contribute to better treatment for our residents. Furthermore, we’ve found that by allowing the house to be an ongoing environment for personal development for the staff, we can create a space for existential growth for the residents, rather than just a temporary place for recovery. In what follows, I will describe why enabling individuals to find significance and meaning in their crises, beyond treating them solely as medical conditions, is important both theoretically and clinically.

The crisis of the dominant biological paradigm in psychiatry is known and felt by most practitioners in the field. The problem, as Brunner presents it, is that it is not clear which paradigm will replace it. Will progress come through advances in brain science, that is, precisely from within the paradigm, or will an alternative paradigm become dominant in its place?

Here come various approaches for dealing with mental crisis situations that share the recognition of the vital importance of addressing the social and human aspects of a mental crisis. Just as we would not approach understanding characters in a book through a physical or biological analysis of them, it is unlikely to understand mental crises without understanding the important components of the story and of human relationships within the crisis. The story does not stand alone, and it is interwoven with the body; the imprint of the story and the relationships in which we grew up is embedded in our body, and therefore physical treatments and psychoactive substances also have an important place in coping with mental crises, but this is within a context that understands that these are not independent biological diseases.

Treating psychosis and other severe mental crises as phenomena of a break between the individual and society, between the individual and the world, has therapeutic implications. Within a mental crisis, a person is in their most sensitive state, often with an experience of intrusiveness and with great difficulty in communicating with people. Think about yourself in a state of crisis and difficulty and imagine the environment in which you would want to be. I think few would think of choosing a hospital for such a situation. As part of bringing mental states into medicine and giving doctors the mandate to be responsible for treatment, the medical model was also applied to these situations. Sometimes people take it for granted that a person in the depths of depression or in a state of terrible anxiety bordering on psychotic terror will arrive at a ward built like a regular hospital – with doctors, nurses, a nurses’ station, and a treatment room, but along with many today, I do not find much logic in this.

Since the 1960s, there have been various attempts to create alternatives to the accepted psychiatric model (including alternatives to psychoanalytic approaches that were dominant in psychiatry in the mid-twentieth century), partly from anti-psychiatric approaches. This is what Laing did in England, and this is what Loren Mosher did with the establishment of the first Soteria House in the USA. The approaches were not identical, but both were based on the importance of community in accompanying people in severe mental crises, with avoidance or dramatic reduction in the use of antipsychotic drugs. They emphasized the importance of human connection at the expense of the conception that professionals are required to treat people in such crises. The first two Soteria Houses in the USA operated for about ten years and closed due to funding problems, but similar houses in this spirit have been opened and are operating in various places around the world to this day.

The first Soteria House in Israel was established under the leadership of Professor Pesach Lichtenberg and the management of Avremi Friedlander. Shortly after the establishment of the house, the Mental Health Division of the Ministry of Health supported its operation, and within a short time, binding standards were written for its operation, which allowed the establishment of additional houses in a similar format. The name given to these houses was “Balance House for the Prevention of Hospitalization,” and their purpose was to be an alternative to hospitalization for severe crisis situations that can nevertheless be treated without coercion.

The principles that guide us at Soteria House are consistent with the understanding that the social rupture is central to mental crises and therefore healing and coping with these situations require a community support system and a pleasant and inclusive environment as much as possible. Thus, the houses accommodate up to 10 residents, with a team of companions who are with them throughout the day. The houses are run somewhat like a commune, where responsibility lies with the staff, but with an effort that residents gradually take part and contribute to the place themselves as much as possible. Activities include cooking and eating together, cleaning, group activities, physical activity, and with this also professional staff support by social workers, psychiatrists, psychologists, art therapists, and more.

Treatment at Soteria House is based on several principles – we relate to the difficult situations people arrive with as a crisis and not as an illness, even if it is a prolonged and deep crisis. We assume that a person can recover and emerge from the crisis. We make a great effort to reduce judgment and allow each person to express themselves as freely as possible, within the limitations of belonging to the community and the need to maintain it. We do not use psychiatric diagnoses, except out of the need to communicate with external parties and refer to various services that require it. The stay at Soteria is only by choice, and the responsibility for the process a person undergoes lies first and foremost with themselves. We hold weekly meetings in the spirit of the Open Dialogue approach, and thus we make an effort to involve families, friends, and therapists throughout the entire process at Soteria.

Beyond all the therapeutic principles and the various roles of the staff, Soteria is a community that hosts people in crisis for the purpose of recovery and healing. An organic community to which a person belongs is the most natural and correct place to go through mental crises, but unfortunately not everyone has a sufficiently supportive community, and sometimes a community whose specialization is this is required. It is our ongoing effort to create a community that works together, with a reduction of hierarchies and an attempt to give every community member the opportunity to influence how it looks and how it functions. Deep friendships have formed within the staff, and we make great efforts to allow expression of the soul and spirit of the staff members. There is no standardization in our treatment, and we seek the way forward with each resident anew. The fact that many of the situations in which people come to us are situations of social withdrawal, sometimes social withdrawal that has lasted for many years, makes the invitation to integrate into a kind of commune a very great challenge for all parties and is not suitable for everyone. Nevertheless, we see that the discovery that social connections can be beneficial and safer has great value for healing, and can sometimes allow, for the first time, to give meaning and context to the crisis the person has reached. Similarly, this is an environment that allows the processing of traumatic events in life, where support is not based specifically on a professional who accompanies the person once or twice a week, but on a community that accompanies the person together, communicates continuously within itself, and helps them cope with the anxiety and overwhelming memories that accompany the processing. Here too, one can see the value of an approach that treats the mental crisis as a human problem and not as an illness and sees supportive and gentle human accompaniment as a central therapeutic tool.

In conclusion, the journey to the community-based approach of Soteria House represents a significant shift in understanding and responding to severe mental distress. By recognizing the fundamentally human nature of these experiences, rooted in our complex social and linguistic worlds, and by prioritizing connection and community over purely biological or diagnostic frameworks, models like Soteria offer a promising alternative to traditional psychiatric care. While challenges remain in implementing and sustaining such approaches, their emphasis on empathy, social integration, and the inherent capacity for recovery underscores the vital importance of a human response to what are ultimately human problems.