Inpatient Departments in the Spirit of Soteria

"Soteria", a Greek word meaning "redemption", is a therapeutic approach for people in severe psychiatric distress, designed to prevent stigma and further trauma during treatment. The first Soteria home was established in California in the 1970s, and from there the model spread to Europe. A decade ago, it also arrived in Israel, with the establishment of the first balancing homes in the community. In the past two years, the approach has also found its way into hospitals as closed units, with the aim of allowing people in particularly great distress to experience this unique treatment.

Soteria: Humane and inviting care, without judgment

The Soteria approach treats the person holistically. We do not treat just any symptom, but rather address the entirety of the person's struggles. In addition, the person does not exist alone, but as part of a social network that surrounds him. In Soteria settings, in the community and in hospitalization, a therapeutic community operates, whose members include everyone who has come to receive help, as well as those who give it. The barriers between the staff and the patients are lowered. Everyone participates in activities together, has lively conversations, and even dines together.

The language used in the Soteria unit is human and inviting rather than professional and alienating. Within the community, the main tools for advancing the patient are empathetic listening, a sympathetic gaze, a caring word, and encouragement. The central principle of the place is "being with", that is, through deep empathy, first building a connection with the person in distress, without judgment or labels.

The treatment also includes the use of medication, usually in small doses, and the decision of this is made only after a joint discussion, and with a willingness to take into account as much as possible the patient's wishes and consent.

The treating team

As in all the various inpatient departments, each unit has a professional team consisting of professionals from the following fields: Nursing, social work, expressive and creative therapy, psychology and psychiatry. In addition, the uniqueness of these units lies in the presence of a team consisting of companions who are chosen for the position not on the basis of what they have studied and the certificate they hold, but on the basis of who they are: Benevolent and inclusive people who do not shy away from connecting with people in extreme mental states. The accompaniment team includes many students, as well as people who have themselves undergone psychiatric treatment, including hospitalizations.

Daily routine in the ward

Many activities take place in the units using the Soteria approach, including morning and evening meetings, psychodrama, yoga and more. Inside each unit there is a kitchen that allows for the preparation of meals on site – an important, humane, unifying and tasty activity.

Since the units accept people in extreme conditions, those who cannot stay at home or even in a balancing home, they operate as closed units. However, as soon as possible, they allow people to walk outside, accompanied or alone, depending on the situation.

Studies conducted on the existing units indicate that there is less violence in them and the overall experience in them is better.

Length of stay in the ward

The length of stay in the unit is determined by the patient's condition. The average is over a month, slightly longer than in regular wards. Apparently, the reason for this is related to the desire of many patients to stay there longer, in order to arrive better prepared to return to their lives.

These units accommodate up to 10 patients who, without the unit, would otherwise be admitted to a closed ward. They are usually admitted through the medical center's emergency room, like anyone else who is admitted, and the medical center takes care of approvals directly with the HMO. Sometimes the patient is transferred to a Soteria unit from another department where they were hospitalized.

The Soteria units that currently exist in Israel prove that psychiatry can be humane and beneficial, without trauma and stigma, with treatment in smaller units, even when it comes to mentally challenged men and women in the most difficult situations. The Ministry of Health continues to promote a plan to establish additional Soteria-approach units nationwide. As the number of balancing homes has increased in Israel, we believe that such units will also become the norm in the future.