Development of the Therapeutic Alliance in Alternative Settings to Psychiatric Hospitalization: An Open Comparative Study.

Patient-therapist alliance in two alternative treatment settings developed similarly to that in traditional psychiatric hospitalization.

Technologically assisted intensive home treatment: feasibility study.

Introduction: In recent year, many attempts have been made to provide patients with alternatives to psychiatric hospitalization during acute distress. Although several hospitalization alternatives have been offered, most of them still require patients to be distanced from their families, friends, and the social environment. Methods: In this report we describe the implementation of a novel approach to psychiatric care termed "Technologically assisted Intensive Home Treatment", where patients arriving to emergency settings are directed to home care with technological aids that enable close monitoring and ongoing contact with their therapists. Results: We describe the rationale and treatment principles of the treatment, and provide an elaborative description of the implementation process during the first year of implementation. Discussion: Additional attention is given to factors associated with early dropout from the program, in order to inform readers of predictors to optimal care. Limitations and directions for future research and practice are discussed.Clinical Trial Registration: The study was registered in the database of clinical trials (registration number SHEBA-19-6555-MW-CTIL) and in the Ministry of Health (registration number MOH_2022-08-22_011992).

The Effect of Short-Term Acute Residential Treatment on Psychiatric Rehospitalization.

ABSTRACT: Short-Term Acute Residential Treatment (START) homes, located in the community and operating in noninstitutional atmospheres, seek to reduce rehospitalization. This report investigates whether these homes reduced rates and duration of subsequent inpatient stays in psychiatric hospitals. For 107 patients treated in START homes after psychiatric hospitalization, we compared the number and duration of psychiatric hospitalizations before and after their START stay. We found that, compared with the year before the START stay, in the year after the START stay, patients had fewer episodes of rehospitalization (1.60 [SD = 1.23] vs. 0.63 [SD = 1.05], t[106] = 7.097, p < 0.001) and a briefer accumulative duration of inpatient stays (41.60 days [SD = 49.4] vs. 26.60 days [SD = 53.25], t[106] = -2.32, p < 0.03). This suggests that START homes can reduce rehospitalization rates and should be considered a valid alternative to psychiatric hospitalization.

[SOTERIA HOUSE, A NEW SERVICE FOR PREVENTING PSYCHIATRIC HOSPITALIZATION: THREE VIGNETTES AND A DISCUSSION].

INTRODUCTION: Inspired by a model developed in the early 1970s in the USA for the treatment of people in the throes of a mental crisis, often psychotic, the first "Soteria House" was established in Jerusalem in September 2016. The purpose of the house is to prevent psychiatric hospitalization, to offer a supportive therapeutic community and to help the person return to life in the community in the best possible manner. Treatment at the house is characterized by the absence of coercion of any kind, including the use of drugs, a high staff: patient ratio, and the absence of the stigma which too often accompanies psychiatric care. This model was recognized by the Israeli Ministry of Health in September 2017 under the name "Stabilizing House", and since its establishment until today (May 2018) four more houses of its kind have been established. We present three brief case studies of individuals who received care in Soteria.