New concept

Treating first-time sufferers of mental breakdowns.

Soteria (photo credit: YOEL KASSEL)
(photo credit: YOEL KASSEL)
For parents experiencing their son or daughter thrust into psychosis or other forms of psychiatric trauma for the first time, there is almost nothing scarier. I have met dozens of parents who have had no experience in the field of mental illness and suddenly find themselves in the midst of a crisis with their child experiencing some form of psychosis.
Whether induced by drug use or by some traumatic event, parents are reluctant to approach psychiatrists and hospital emergency rooms, fearing the stigma that can affect their son or daughter in the future. Also of concern is the over-medicating often being the first recommendation of professionals in the field of psychiatry; whether private, through health fund medical services or hospitals.
The average parent has had little to no experience of the mental health system and simply doesn’t know where to turn.
The desire to believe that this will pass and to underestimate the severity of the situation is natural. No parent wants to admit that their child is suffering from a mental breakdown and/or disorder.
Feelings of fear, confusion, guilt and shame all come to the surface.
Parents have no idea whether the episode is the first indication of schizophrenia, which is usually indicated by at least two psychotic symptoms for at least a month and consisting of delusions, hallucinations or disorganized speech. Another kind of episode is brief psychotic disorder, one that lasts for less than a month and has only one of the above mentioned symptoms. BLIPS (brief and limited psychotic symptoms) is a disorder determined by symptoms lasting less than one week, compared to BIPS (brief intermittent psychotic symptoms), whose symptoms may last up to three months.
Parents fear that these episodes are an indication of a longtime mental illness.
They would want to believe that the above disorders do not indicate that the condition would reappear. However, according to Paolo Fusar-Poli, one of the authors of a new study and a clinical senior lecturer in psychosis studies at King’s College London, after analyzing 93 earlier studies of more than 11,000 patients who’d experienced brief psychotic episodes, the indications are less than definitive.
“Whether a person was diagnosed with brief psychotic disorder, acute and transient psychotic disorder, BLIPS, or BIPS, he or she had about a 50-50 chance of experiencing another psychotic event in the future,” Fusar-Poli concludes. “In comparison, almost all patients with first-episode schizophrenia experienced future psychosis.
“The study points to the need to treat psychotic episodes aggressively,” he said. “If even a one-day break with reality brings with it a 50 percent chance of further problems, patients need help to prevent a worst-case scenario.”
With this in mind, parents cannot ignore these first-time episodes and must seek treatment. For the first time in Israel, an alternative to the conventional hospital and medication treatment is available.
Spending years in the world of psychiatric hospitals heading up these departments, Prof. Pesach Lichtenberg felt there was something wrong with the way patients were treated, especially those new to the world of traumatic breakdowns. Lichtenberg found himself exploring the Soteria model established in the US in 1971 by Loren Mosher.
Soteria, named after the Greek goddess of safety from harm, was established to provide a comfortable, homelike atmosphere whose staff are chosen not only for their professional backgrounds, but their ability to work lovingly and empathetically with the residents.
Even language is important, where those treated are referred to as residents and not patients. They are encouraged to maintain their social networks, to have frequent contact with their family and friends and to maintain their communal responsibilities when possible.
Medication is optional and no restraining methods are used.
Mosher believed, as did Lichtenberg, that personal connection and empathy is the best way to reach those who are struggling with psychiatric breakdowns.
Danny Lewis, the psychotherapist of Jerusalem’s Soteria house, spoke about the importance of this facility for parents who first realize their son or daughter is in need of psychiatric care.
Jerusalem’s Soteria realizes the importance of connection with the staff to help the resident unfold his or her experience and engage in their language.
The connection with the staff helps to defuse the fear and anxiety. If medication is an option, it is jointly decided upon by the resident and staff and not imposed by hospital staff, as is done in other facilities.
If the use of medication is decided upon, the family and resident are kept in the loop tracking the success of the decision. The philosophy of Soteria is that psychosis is not a disease, but rather a response to living. The concept is not to speak about the person in terms of symptoms, but rather how their psychosis is related to stress or trauma and how the staff can help them to resolve the psychotic reaction to their life’s traumatic situation through empathy and connection.
Creative therapies are used to help residents open up. Together with the staff they help maintain the facility by participating in the household chores, including cooking and cleaning.
Residents are not segregated from the community as in hospitals. As with the original Soteria model, connections with the personal environment are maintained and residents maintain their self-determination. No stigmas or labels are applied.
Soteria is especially designed for firsttime psychosis, whether brought on by drugs or traumatic situations, though it has also gained experience helping people with longer histories of emotional suffering. A social worker works with the residents and staff to plan follow-up strategies. However, those suffering from addiction are not appropriate for the facility.
Lichtenberg hopes the non-profit Soteria method can change the way the establishment views treatment. He believes that within a few months Soteria will be accepted as a part of the official mental health system and would therefore be funded by the state.
As of now the cost is high, but a sliding scale is available. “It is expensive to operate such a facility,” he notes. “No one pays the actual costs required to fund the operation of Soteria. Many do pay the fee requested, but those who truly can’t afford to pay the requested fee are given a reduced cost to cover.”
The Soteria model brings up the importance of communication and connection with our sons and daughters.
We often find ourselves trying to show them the right direction to go and criticize their choices out of fear that these choices will bring disastrous results.
In the end, we cannot control our children’s choices; but as they have discovered with the Soteria model, the “tell me more” approach is apparently the best way to go when it comes to assisting our kids. It’s a relief to know that, if we are faced with a crisis, we have a kinder, safer place to take them.
For more information contact Danny Lewis at (02) 999-8947, see the Soteria Facebook page or email
The writer is a teen and young adult counselor specializing in addictions and working with youth and their parents for over 26 years.;