The Residential Care Alternative for the Acutely
Published online: 16 April 2011
Ó Springer Science+Business Media, LLC 2011
Abstract Community homes for the treatment of the acutely psychiatrically ill have been
established in several places in the world as alternatives to inpatient hospitalizations.
We reviewed sources from the psychiatric and psychological literature which examine
these models. Several features are common to this treatment setting: fewer residents in
comparison with hospital wards; a supportive and caring milieu including intense and
regular therapeutic contact with staff; a de-emphasis of medication; and a destigmatization
of the therapeutic treatment of psychosis. The models differ with respect to use of psy-
chotropic medication, emphasis upon ﬁrst admissions, and composition of staff. The
varying models are comparable to inpatient treatment in terms of clinical and psychosocial
outcome, and generally cost less. For most patients requiring psychiatric hospitalization,
residential treatment can be a viable alternative to inpatient hospitalization. Issues of cost,
therapeutic effectiveness, and long-term outcomes still need to be studied.
Keywords Residential treatment Á Alternative to hospitalization Á Soteria Á
Destigmatization Á Moral therapy
Fifty years of deinstitutionalization of psychiatric care have produced creative alternatives
to the inpatient ward as the locus of treatment [1, 2]. Options available to the acutely ill
include expanded community mental health care facilities and mobile treatment teams such
as assertive community treatment (ACT) . Nevertheless, some patients continue to
require an around-the-clock therapeutic environment, and they are likely to seek treatment
in an inpatient psychiatric ward.
The purpose of this article is to consider an alternative: psychiatric treatment for the
acutely ill in a residential, non-hospital setting.
P. Lichtenberg (&)
Department of Psychiatry, Herzog Hospital, School of Medicine of the Hebrew University
of Jerusalem, POB 3900, Jerusalem 90135, Israel
Psychiatr Q (2011) 82:329–341