We are writing to recommend the creation of a Soteria-Vermont as part of the effort to create community services that can replace or reduce the need for Vermont icon

We are writing to recommend the creation of a Soteria-Vermont as part of the effort to create community services that can replace or reduce the need for Vermont


August 19th, 2011


To Christine Oliver:


We are writing to recommend the creation of a Soteria–Vermont as part of the effort to create community services that can replace or reduce the need for Vermont State Hospital. While this brief letter will give an overview of the concept of Soteria, attached is a much more thorough report prepared for stakeholders in Alaska before opening a Soteria-Alaska in 2009. It contains vital information that Vermont could adapt and use towards creating its own version.


The original Soteria project was created by the late psychiatrist Dr. Loren Mosher in the early 1970s and funded by a National Institute of Mental Health grant. It involved an unlocked residence in a California community where up to eight individuals having an initial psychotic break received voluntary support. What made Soteria different from traditional hospitalization was its focus on “being with” instead of “doing to” individuals, its tolerance and flexibility to adapt to one’s psychotic process, its cautious use of neuroleptic medications, its creative and nonprofessionalized environment, and most importantly, its belief that psychosis could be a temporary experience that one could work through as opposed to a mental illness that needed to be managed.


The Soteria project lasted for eleven years and was rigorously studied. Compared with controls at a traditional hospital, residents of Soteria fared as well or better on every measure. These results were striking because – contrary to standards of care at hospitals – the vast majority of Soteria residents were never exposed to neuroleptic medications. Instead, Soteria proved that interpersonal and psychosocial approaches alone could facilitate recovery for persons on course to schizophrenia.


The original Soteria closed in 1983, mostly due to political reasons. Said Mosher:


Its message was difficult for the field to acknowledge, assimilate, and use. It did not fit into the emerging scientific, descriptive, biomedical character of American psychiatry, and, in fact, called nearly every one of its tenets into question. In particular, it demedicalized, dehospitalized, deprofessionalized, and deneurolepticized what Szasz has called “psychiatry’s sacred cow”– [schizophrenia]


However, the message of Soteria never died. Several adapted versions of Soteria later emerged in Europe, and today we have a Soteria house in Alaska.


Indeed, the climate for creating a new Soteria has changed. There is now growing recognition and a solid evidence base that neuroleptic medications can cause considerable harm and impede an individual’s recovery. In light of this, alternative approaches for people experiencing psychosis are springing up internationally, and much attention has been drawn to the Open Dialogue Approach in Finland and to the Soteria models.


A Soteria-Vermont would specifically reduce the need for Vermont State Hospital by providing support to five individuals at a time who would otherwise be using VSH services. It would ideally work with people having a first or second psychotic break who have not had substantial prior exposure to neuroleptic medication. Within the focus of interpersonal relationship-building, Soteria-Vermont will offer residents:


  • A safe, non-coercive, flexible, self-determining, and homelike environment

  • Techniques for stress reduction – such as bodywork, yoga, and meditation

  • Trauma-informed peer supports

  • Access to creative tools, such as art supplies and musical instruments

  • Voluntary medication in selective instances

  • Healthy food

  • Naturopathic consultation

  • Access to farm animals

  • The ability to continue social roles (such as working, family, leisure) when appropriate

  • Linkages to the community

  • Aftercare, including the opportunity to volunteer

  • Skill development, including basic life skills such as cooking, budgeting, gardening, and cleaning



Staffing will include a Program Director, House Manager, part-time psychiatrist as Medical Director, Residential Assistants, Administrative Assistant, Consultants and Volunteers.


Based on conversations with Soteria-Alaska, we expect that residents will stay on average three to four months. Thus, at full capacity Soteria-Vermont will serve roughly fifteen to twenty individuals per year, and at significant economic savings to the state of Vermont. Currently, Soteria-Alaska costs about $330 per bed per day ($600,000 annual operating budget). On a similar budget, Soteria-Vermont would cost four times less than the Vermont State Hospital’s $1400 per bed per day, and three times less than Second Spring or Meadowview’s roughly $900 per bed per day. Annually, this amounts to two million dollars in savings.


The development of a Soteria-Vermont would involve creating a new non-profit organization. To begin this process, a host organization would likely need to provide financial and technical assistance. Another Way, Alyssum, Pathways to Housing, and Vermont Psychiatric Survivors have all tentatively expressed interest. Additionally, from years of conversations and meetings about a potential Soteria-Vermont, there appears to be strong support from a range of stakeholders, which indicates that a competent and committed Board of Directors would emerge quickly. A Soteria-Vermont could reasonably be operating within a year thereafter.


Thank you for your consideration of this proposal, and we look forward to future dialogue.


Sincerely,


Steven Morgan

Executive Director

Another Way Inc.


Gloria van den Berg

Executive Director

Alyssum Inc.


Linda J. Corey

Executive Director

VT Psychiatric Survivors


Hilary Melton

Executive Director

Pathways to Housing VT


Floyd Nease, MA

Executive Director

VT Assoc for Mental Health


Ed Paquin

Executive Director

Disability Rights Vermont Inc.


Lauren Spiro

Executive Director

National Coalition for Mental Health Recovery


Sandra Steingard, MD

Psychiatrist

Burlington, VT


Steve Sobel, MD

Psychiatrist

St Albans, VT


Alice Silverman, MD

Psychiatrist

St Albans, VT


Joe Lasek, MD

Psychiatrist

Burlington, VT


Ronald B. Miller, PhD

Professor of Psychology

Director, Graduate Program in Clinical Psychology


Dr. Sam Tsemberis

CEO and Founder

Pathways to Housing Inc.


James B. Gottstein, ESQ

President & CEO

Law Project for Psychiatric Rights


Shery Mead, MSW

Intentional Peer Support


Seth Collins

Montpelier, VT


Laura Ziegler

Plainfield, VT


Laurie Curtis, MA, CPRP

Middlesex, VT


Michael Sabourin

Marshfield, VT


Michael Pearson, PhD

Norwich, VT


Xenia Williams, MS, LCMHC

Barre Town, VT


Deborah Shell, MA, LCMHC

St Albans, VT




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