Transcript The Interface Between Soteria And Windhorse

Royal College of Psychiatrists
'General Adult Psychiatry in Uncertain Times'
11-12 October 2012
“Rarely considered therapies”
Soteria paradigm
Jen Kilyon
Antipsychotics: is it time to introduce
patient choice?
Anthony P. Morrison, Paul Hutton, David Shiers and Douglas Turkington
The British Journal of Psychiatry (2012) 201, 83–84.
Summary
Evidence regarding overestimation of the efficacy
of antipsychotics and underestimation of their
toxicity, as well as emerging data regarding
alternative treatment options, suggests it may
be time to introduce patient choice and
reconsider whether everyone who meets the
criteria for a schizophrenia spectrum diagnosis
requires antipsychotics in order to recover.
Five-year experience of first-episode nonaffective psychosis in opendialogue approach:treatment principles, follow-up outcomes, and two
case studies by Jaakko Seikkula, Jukka Aaltonen, Birgittu Alakare, Kauko
Haarakangas, Jyrki Kera¨Nen, & Klaus Lehtinen, Psychotherapy Research,
March 2006; 16(2): 214/228.
This study of the Open Dialogue approach in
Finland that used as little neuroleptics as
possible found that in a group of 42 patients,
82% did not have psychotic symptoms at the
end of five years, 86% had returned to their
studies or jobs, and only 14% were on disability
allowance. Only 29% had ever been exposed to
a neuroleptic medication at all during the five
years, and only 17% were on neuroleptics at the
end of five years.
Treatment of Acute Psychosis Without Neuroleptics: Two-Year Outcomes From the Soteria Project
JOHN R. BOLA, PH.D.,1 and LOREN R. MOSHER, M.D.
The Soteria project (1971–1983) compared
residential treatment in the community and
minimal use of antipsychotic medication with
“usual” hospital treatment for patients with early
episode schizophrenia spectrum psychosis.
Soteria treatment resulted in better 2-year
outcomes for patients with newly diagnosed
schizophrenia spectrum psychoses ... In
addition, only 58% of Soteria subjects received
antipsychotic medications during the follow-up
period, and only 19% were continuously
maintained on antipsychotic medications.
—Journal of Nervous and Mental Disease 191:219–229, 2003
Soteria Critical Elements
Luc Ciompi, Loren Mosher
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Facility
Social Environment
Social Structure
Staff
Relationships (These are central to the project’s work)
Therapy
Medications
Length of stay
After care
FACILITY
• Small, community based
• Open, voluntary home-like
• Sleeping no more than 10 persons
including two staff ( 1 man & 1 woman) on
duty
• Preferably 24 – 48 hour shifts to allow
prolonged intensive 1:1 contact as needed
SOCIAL ENVIRONMENT
• Respectful, consistent, clear and
predictable with the ability to provide
asylum, safety, protection, containment,
control of stimulation, support and
socialization as determined by individual
needs
• Over time it will come to be experienced
as a surrogate family
SOCIAL STRUCTURE
• Preservation of personal power to maintain
autonomy, diminish the hierarchy, prevent the
development of unnecessary dependency and
encourage reciprocal relationships
• Minimal role differentiation ( between staff and
clients) to encourage flexibility of roles,
relationships and responses
• Daily running of house shared to the extent
possible; “usual” activities carried out to maintain
attachments to ordinary life – e.g. cooking,
cleaning, shopping, art, excursions etc.
STAFF
• May be mental health trained
professionals, specifically trained and
selected nonprofessionals, former clients,
especially those who were treated in the
program or a combination of the three
types
• On the job training via supervision of work
with clients, including family interventions,
should be available to all staff as needed
RELATIONSHIPS these are central
to the program’s work
• Facilitated by staff being ideologically
uncommitted (i.e. to approach psychosis
with an open mind)
• Convey positive expectations of recovery
• Validate the psychotic person’s subjective
experience of psychosis as real by
developing an understanding of it by
“being with” and “doing with” the clients
• No psychiatric jargon is used in
interactions with these clients
THERAPY
• All activities viewed as potentially
“therapeutic” but without formal therapy
sessions with the exception of work with
families of those in residence
• In-house problems dealt with immediately
by convening those involved in problem
solving sessions
MEDICATIONS
• No or low dose neuroleptic drug use to
avoid their acute “dumbing down” effects
and their suppression of affective
expression, also avoids risk of long term
toxicities
• Benzodiazapines may be used short term
to restore the sleep/wake cycles
LENGTH OF STAY
• Sufficient time spent in program for
relationships to develop that allow
precipitating events to be acknowledged,
usually disavowed painful emotions to be
experienced and expressed and put into
perspective by fitting them into the
continuity of a person’s life
AFTER CARE
• Post discharge relationships encouraged
(with staff and peers) to allow easy return
(if necessary) and foster development of
peer based problem solving community
based social networks
• The availability of these networks is critical
to long term outcome as they promote
community integration of former clients
and the program itself
AFTER CARE
• Post discharge relationships encouraged
(with staff and peers) to allow easy return
(if necessary) and foster development of
peer based problem solving community
based social networks
• The availability of these networks is critical
to long term outcome as they promote
community integration of former clients
and the program itself
Soteria Bradford
Adapting Soteria Approach
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Using aspects of Soteria and Windhorse
Project
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Initially starting small supporting one person to
recover
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Two housemates and basic attendance team
with a coordinator
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Renting a house with a garden near
countryside
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Soteria team to provide fundraising and
support for the people living and working in
the
house
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The Windhorse Project
“Recovering Sanity”
by Edward Podvoll
The Windhorse approach is characterized
by five principles of recovery:
1. Psychosis is a disruption in the balance of
body-mind-environment. Effective
treatment must always work with the
whole person. All aspects of the imbalance
must be addressed - the biological,
psychological, social, and spiritual.
2. Sanity is always present even within psychosis.
Moments of insight, common sense, or
compassion continually interrupt mental turbulence. These experiences, however brief, are
like awakening from a dream. They are “islands
of clarity” that must be recognized as the seeds
of recovery. It is essential to train staff to notice
and value these moments and to respect the
person, even when his extreme mental state
may frighten or inconvenience them.
3. Significant recovery is a real possibility.
Recovery is a natural process that can occur
gently in a sane, healthy environment and can
be fostered through authentic relationships.
Grouping severely disturbed people in one
place of treatment, such as a mental
institution, risks the health of both clients
and staff and may actually prevent recovery.
Recovery is facilitated only when a genuine
sense of friendship is fostered among caring
people, both staff and clients.
4. Recovery requires community. A healing community is one that promotes the wellbeing of
each of its members. The community begins
with the client’s own home, and includes
housemates, family, and friends. A therapeutic
treatment team extends this community to the
world at large.
5. Compassionate care can be taught. Windhorse
has developed training techniques that cultivate
empathy as a skill. Contemplative practices from
many healing traditions can foster this skill.
These are skills that deepen the quality of
relationships, and these authentic therapeutic
relationships are the foundation of the work
together. Using these techniques and practices
in clinical work creates the buoyancy and
patience required to attend to someone on the
arduous journey of recovery.
Developing and Sustaining the
Bradford Soteria Group
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Make up of group
Regular meetings and workshops
Team building
Bringing in new people
Timing of opening the house
Future plans
Conference in Bradford 10th December
References
A list of references and further reading will
be put on my website where you can also
follow future progress of the Bradford
Soteria Group:
www.jenkilyon.net