Sometimes developing an innovative program for the treatment of psychiatric illnesses does not necessarily require coming up with a new idea—but rather returning to a great one. Although the Jordan House psychiatric crisis stabilization program opened its doors in April 2005, its components were carefully crafted after Crossing Place, which was started 30 years ago in Washington, D.C.
Jordan House, operated by So Others Might Eat, Inc. (SOME) in Washington, D.C., serves as a homelike, community alternative to psychiatric hospitalization for people in acute crisis. The idea for an effective treatment alternative to hospitalization goes back to the early 1970s. Loren Mosher, a psychiatrist in Northern California, decided to test his theory that a therapeutic milieu could be just as effective as the standard of care in reducing the symptoms of schizophrenia. His research led to a program called Soteria, and its offspring, Crossing Place, came about a few years later in 1977. Several research studies validated his claim, demonstrating that alternatives to hospitalization, when implemented correctly, can be more cost-effective and have equal symptom-reduction and recidivism rates compared to a hospital stay.1, 2 Such “crisis bed” facilities also allow clients more integration with the community during their stay and can offer more freedom and autonomy than a hospital allows.
Jordan House's staff has attempted to closely follow the original Crossing Place model. The following are some components that have been suggested as essential to the accomplishments of similar programs:
maintaining a small and homelike family environment with two staff members, a man and a woman, on duty for 24-hour shifts;
providing intensive one-on-one support by “being with” and “doing with” residents without being intrusive;
having a minimal hierarchy so residents are encouraged to maintain their autonomy;
offering supportive counseling and therapeutic activities such as art, outings, gardening, shopping, and cooking, but no formal therapy; and
encouraging residents to maintain relationships with the staff, program, and other alumni following discharge.
These essential ingredients helped guide the formation of Jordan House's program.
Although psychotropic medications were not used in the original Soteria model, they were routinely used in its offspring, Crossing Place, and are an important part of the Jordan House program, as well. Jordan House staff and psychiatrists emphasize the importance of receiving accurate information about each medication prescribed so that residents can make an informed choice to continue the right medications without coercion after discharge.
In its first two years, Jordan House's staff excelled in quickly stabilizing residents' psychiatric symptoms. They accomplished this by creating an environment that enabled residents to:
form positive relationships that continue after their stay is complete;
develop coping methods to prevent another crisis;
connect with desired resources in the community; and
build independent living skills.
Jordan House is a homelike family setting where counselors essentially reside with residents, whose stays are usually less than 14 days. Male and female counselors work 24-hour shifts, spending day and night with residents. The counselors have stated that some of the most therapeutic conversations take place during ordinary activities such as drinking morning coffee together, driving to an appointment, or baking a cake to celebrate a resident's birthday.
Because Jordan House is a more natural setting, the staff has been able to more easily engage resistant individuals. Jordan House has had many previously institutionalized (incarcerated, hospitalized, etc.) residents who reacted defensively upon arrival, thinking that Jordan House is another place that attempts to control behavior. The counselors have built strong therapeutic alliances by offering a nonhierarchical environment and encouraging residents' autonomy. Counselors encourage residents to develop their own goals rather than dictating what they believe is in residents' best interest.
Jordan House has an alumni group and encourages residents to maintain contact after discharge. Former residents have facilitated alumni meetings, organized an open house celebration, and supported current residents. This group, initiated by a former resident, has helped residents to feel valued, to increase their self-esteem, and to build community involvement and responsibility. Jordan House invites former residents to drop in for words of encouragement or to share news of their successes and to occasionally join in dinner as part of the extended Jordan House family.