Peer Respites for Mental Health Consumers Prevent Hospitalizations

Peer counselors Adrian Bernard and Jason Davis relax at Second Story, a short-term residential peer-operated respite house in Santa Cruz for consumers of mental health services who need support during crisis.
Credit: Lynn Graebner

As people with mental health crises overwhelm California’s hospitals, jails and homeless shelters, counties across the state are gradually embracing residential respite houses located in neighborhoods and staffed by peers — people who have been consumers of the mental health system.

For people on the verge of a crisis, staying at a peer-run respite, typically for a couple of days or up to two weeks, can help them recover with support from people who have had similar experiences.

That can prevent incarceration or forced hospitalization, which often damages family relationships and can cause the loss of housing or jobs, said Yana Jacobs, chief of outpatient adult services for Mental Health and Substance Abuse Services at the Santa Cruz County Health Services Agency.

California has three peer-run respites, two in Los Angeles County and one in Santa Cruz. San Francisco and Santa Barbara Counties are in the process of opening respites and Alameda County is considering one.

The latter three would likely be largely staffed by peers but not considered peer-run as peers probably won’t be in administrative positions. That distinction makes a big difference, say advocates.

“If respites are run by the traditional system, even peer workers can start behaving like clinicians,” said Oryx Cohen, Director of the Technical Assistance Center at the National Empowerment Center, a Massachusetts-based nonprofit peer-run mental health organization.

Without peers at the helm, hierarchical administrations can undermine shared decision making; the sense of clients and support staff being equals, each having something to offer and the dropping of clinical labels.

The peer-run model is growing throughout the country with 12 peer-run respites and two hybrid programs in 11 states. Six more are planned and funded, said Laysha Ostrow, a postdoctoral fellow at Johns Hopkins Bloomberg School of Public Health.

Growth is slow but steady. One barrier is the stigma that mental health consumers can’t handle crisis situations, Cohen said.

“Departments of mental health and behavioral health just need to be educated and need to see that this is a viable alternative,” he said.

It has been for Asha Mc Laughlin, who knows well the trauma of being hospitalized. She suffers post-traumatic stress disorder, major depression and anxiety due to being abducted, raped and threatened with murder when she was 16. Chronic back pain also plagues her mental health.

She’s spent a lot of time in psychiatric hospitals in the past, but rarely uses them now since finding the Second Story peer respite in Santa Cruz three years ago.

Peer counselors there are trained in the Intentional Peer Support method and, unlike psychiatrists, can share their own experiences, alleviating some of the isolation people feel, and creating relationships that are mutually supportive.
“It seems there’s just automatic healing in that,” Mc Laughlin said. “And when my understanding supports them, it means a lot to me.”
At Second Story guests talk conversationally with peer counselors, handle their own meds, cook meals and can join or lead group sessions ranging from art and meditation to dealing with conflict and alternatives to suicide.

“We’ve found that when we treat people like responsible adults they behave like responsible adults,” said Adrian Bernard, one of the administrators and a peer counselor.

“We have had a huge amount of success getting people out of the [mental health] system,” he said.

San Francisco is one of the latest cities experimenting with peer respites. Its Department of Public Health plans to launch a psychiatric respite next to San Francisco General Hospital and Trauma Center this fall, said Kelly Hiramoto, acting director of Transitions at the San Francisco Department of Public Health.

San Francisco desperately needs these types of alternatives to hospitalization, incarceration and homelessness. Last year the city had almost 800 jail inmates diagnosed with a psychotic, bipolar or major depressive disorder, reported San Francisco Mayor Edwin M. Lee’s office.

The San Francisco respite is one of several remedies the city is trying. It will start with four beds with room to grow to 12 or 14, and five peer counselors as well as six entry-level mental health rehabilitation workers, Hiramoto said.

The city didn’t go as far as some local mental health advocates had hoped, but they say it’s a start.

“We’re very supportive of the psychiatric respite. We think that’s a great thing that will fill a gap,” said Michael Gause, Deputy Director, Mental Health Association of San Francisco, a nonprofit advocacy organization. But they would also like to see a pure peer-run respite, he said.

Several other counties are also getting their feet wet. In the last year two peer-run respites have opened in Los Angeles County, Hacienda of Hope in Long Beach and SHARE! Recovery Retreat in Monterey Park. They’re both funded by the Los Angeles County Department of Mental Health Innovations Program as three-year pilots.

Santa Barbara County has approved a largely peer-staffed respite and is seeking a site, said Eric Baizer, with the Santa Barbara County Department of Alcohol, Drug and Mental Health Services.

And Manuel Jimenez, director of Alameda County Behavioral Health Care Services, said a stakeholder group has proposed a peer-staffed respite for his county and he’s supportive.

Statewide, California had less than half the national average of psychiatric beds per capita as of 2007, according to a 2010 report by the California Mental Health Planning Council, an advisory body to state and local government.

Respites could help fill that gap. Crisis residential programs, including peer respites, cost roughly 25 percent of hospital inpatient care and are often more effective, the report states.

Jacobs said one of the reasons these respites are successful in reaching people is they don’t focus on diagnosis. She believes only about 25 percent of people being diagnosed schizophrenic actually are.

“The rest have trauma and are being labeled,” she said. “You don’t want to tell someone they have a serious mental illness and will be disabled the rest of their lives.”

Bernard, for example, hears voices but hasn’t been hospitalized since 2003.

“Now I have a community around me and three or four times they’ve kept me from going to the brink,” he said.

Jason Davis, who first came to Second Story as a guest and is now a peer counselor, agreed that the enormous camaraderie there is what helped him overcome his paranoia.

“I support the house and the house supports me,” he said.

The nonprofit Human Services Research Institute is doing a five-year evaluation of Second Story, required by the grant it received from the federal Substance Abuse and Mental Health Services Administration. Early analysis suggests a reduction in use of high-cost hospitalizations and other emergency services by those who use the respite, said Bevin Croft, Policy Analyst for the organization.

That’s certainly true for Bernard, Mc Laughlin and Davis since joining the Second Story community.

“For the first time in my life I feel like people understand me and can support my growth,” Bernard said.

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