A Systematic Review of the Soteria Paradigm for the Treatment of People Diagnosed With Schizophrenia

Background: The “Soteria paradigm” attempts to support people diagnosed with schizophrenia spectrum disorders using a minimal medication approach. Interest in this approach is growing in the United Kingdom, several European countries, North America, and Australasia. Aims: To summarize the findings from all controlled trials that have assessed the efficacy of the Soteria paradigm for the treatment of people diagnosed with schizophrenia spectrum disorders. Methods: A systematic search strategy was used to identify controlled studies (randomized, pseudorandomized, and nonrandomized) employing the Soteria paradigm to treat adults and adolescents meeting the criteria for schizophrenia spectrum disorders according to International Classification of Diseases and Diagnostic and Statistical Manual for Mental Disorders criteria. Results: We identified 3 controlled trials involving a total of 223 participants diagnosed with first- or second-episode schizophrenia spectrum disorders. There were few major significant differences between the experimental and control groups in any of the trials across a range of outcome measures at 2-year follow-up, though there were some benefits in specific areas. Conclusions: The studies included in this review suggest that the Soteria paradigm yields equal, and in certain specific areas, better results in the treatment of people diagnosed with first- or second-episode schizophrenia spectrum disorders (achieving this with considerably lower use of medication) when compared with conventional, medication-based approaches. Further research is urgently required to evaluate this approach more rigorously because it may offer an alternative treatment for people diagnosed with schizophrenia spectrum disorders

Psychosis and Human Rights: Conflicts in Mental Health Policy and Practice

This paper examines conflicts in polices in England and Wales pertaining to the demand for alternative, non-medical crisis support for those experiencing ‘psychosis’. We examine the limitations of current treatment, policy and legislative frameworks in supporting these demands. In particular, we focus on the limitations of prevailing conceptualisations of ‘human rights’, ‘social inclusion’ and ‘recovery’. These concepts, we argue, are embedded within a broader treatment framework which renders medication as mandatory and all other treatment modalities as inherently subsidiary, and a broader policy framework which is complicit with bio-medical orthodoxies of ‘mental illness’ and prioritises treatment compliance and compulsion. Therefore, in order to advance a ‘human rights’ approach to mental health policy, we argue that reigning orthodoxies inherent within policy and practice must be explicitly challenged to open up spaces for the availability of alternatives

Minimal-medication approaches to treating schizophrenia

UK guidelines for treating people diagnosed with schizo phrenia currently emphasise the primacy of antipsychotic medication, with or without psycho-socially based interventions as circumstances dictate. We now see increasing calls, most notably from mental health service users, for the provision of ‘whole-person-based’, minimal-medication approaches to treating people with this diagnosis. This article is intended to locate the development of such approaches within the history of modern and pre-modern psychiatry and, in doing so, summarise the available evidence base that underpins their efficacy

Opinion piece: the case for establishing a minimal medication alternative for psychosis and schizophrenia

The development of severe mental health conditions is strongly linked to our environments, particularly experiences of trauma and adversity. However treatments for severe mental health conditions are often primarily biomedical, centred around medication. In the case of schizophrenia and psychosis, this is antipsychotic medication. Although antipsychotics have been found to reduce symptoms and risk of relapse, some patients derive little benefit from these drugs, and they can lead to severe adverse effects. Subsequently a high proportion of people do not want to take antipsychotics and request an alternative. Yet in the UK and in many countries there are currently no guidelines for stopping antipsychotics or formal treatment alternatives, despite such alternatives being available in some countries. For example, in Norway and Vermont (USA), in response to pressure from service user organisations, governments have mandated the establishment of ‘minimal medication’ services. We examine whether everyone with a psychotic condition needs long-term antipsychotic treatment and evidence for alternative models of care. We recommend that healthcare providers should be encouraged to develop a psychosocial treatment package for people with psychosis or schizophrenia that provides a realistic possibility of minimising antipsychotic exposure