Examining the concept of peer respites

I have recently connected with a very engaging, compassionate and resourceful advocate in the mental health community. She’s had experience both as a clinician and a peer supporter. She’s very interested in helping others in any way possible especially when the traditional avenues of the mental health system have failed.

As I was looking more into the theories that underly her sense of the work she’s doing I came upon the concepts of peer respites.

Taken from the website:

Peer respites are voluntary, short-term, overnight programs. They provide community-based, trauma-informed, and person-centered crisis support and prevention 24 hours per day in a homelike environment. Peer respites are staffed and operated by people with lived experience of the mental health system.

I know there are more and more “crisis residential” houses popping up. These are not the same as peer respites, as much of the staff are clinicians with only maybe one peer worker, from my understanding.

Continuing from the website:

Peer respites were designed as psychiatric hospital diversion programs to support individuals experiencing or at-risk of a psychiatric crisis. The premise behind peer respites is that psychiatric emergency services can be avoided if less coercive or intrusive supports are available in the community.

That’s a good idea. I mean psych units are certainly not for everyone. Even if everyone in crisis flocked to them, which often sadly happens somewhat anyway, there are only a certain number of beds so often people don’t actually get the good care that might be available at the best of the units, and then there’s just nothing otherwise.

I do like the idea of the crisis residential house. I have a friend who has gone a few times and done well there. From my understanding, it is a very relaxed environment. People are ble to cook for themselves, have their own room, and participate in things like reading, being on the computer, talking with others there and just having a relaxed space to be.

I am intrigued as well as concerned about this concept being taken a step further in the form of these completely peer run projects.

Their belief is, taken from the website:

Peer respites engage guests in mutual, trusting relationships with peer staff. Peer support involves a process of mutual helping based on the principles of respect and shared responsibility. Peer support includes interactions in which individuals help themselves and others through fostering relationships and engaging in advocacy to empower people to participate in their communities.

This seems somewhat vague to me. What do these interactions exactly look like? If sitting down and talking with the person, in a respectful and empathetic way is what would help than I would imagine that they wouldn’t be in crisis/ need this service. What I’m saying is just sitting and listening I don’t feel is as therapeutic in being engaged by trained professionals, who are also probably just as empathetic and compassionate (the good ones), to work on their lives and find solutions that work for them. Basically saying this first statement sounds way too simplistic for what is needed for someone truly in crisis.

Peer support involves a process of mutual helping based on the principles of respect and shared responsibility

So about mutuality and shared responsibility. All great values.

However I feel that from the side of the person in crisis, this might be asking or assuming too much about their abilitys to embody these values. Mutuality involves being able to at a basic level be aware of the other person’s thoughts, feelings, and needs and be able to change their behavior/ approach to interacting to at least meet that person halfway. Someone with anything from severe depression, to psychosis (especially), is not in a position generally to be able to do this. I’m not just making this up. I live with over 200, closer to 300 people with severe mental illness who are often in crisis and hospitalized. They can’t say please, thank you, excuse me, most of the time. Though they are sighted, when walking down the hall they refuse to move out of a person’s way, at times seeming unaware at others being defiant. They have no social skills in regards to respecting other’s property personal space, or knowing how to engage in interactions and modify their behavior around compromise, conflict resolution and any of the other million ways that we are able to engage in healthy relationships.

I’m not saying that these issues are true for everyone one hundred percent of the time. I’m saying these issues are true for a majority, at varying levels. And that someone particularly at their worst, shows these characteristics in a very pronounced way.

So from this I would say that they’re unable to engage in mutual relationships.

Shared responsibility.

I assume this means that the people running these places put a high level of trust in those seeking services that they will conduct themselves around issues like not stealing, not being verbally abusive, not harming themselves or others ETC. Again I’d have to argue sadly that often this trust is misplaced, or asking too much. Again I can even say for myself when I’ve been in a crisis I would not trust myself, nor would I be trusted to do these things particularly around the self-harm. But also would not trust myself/ hold myself to the standard of being able to go to meals, take care of hygene, and be emotionally supportive/ there for others. As I’m totally overwhelmed I simply couldn’t do this. With one to one extensive support, a structured routine with some external controls, and a medication change things would look a lot different.

Of course there are exceptions. Everyone is different. I think in order to know if a person can work within this unique value system one would have to spend some time getting to know the person, their past history and interactions with others. To determine their abilitys and not just assume that because you wish they would behave in these positive ways/ be able to that they will.

Put simply, many people in real crisis, especially something like psychosis, being aggressive, complete withdrawal/ depression, overwhelming suicidal urges, would not do well in this setting. Some things they need that are not present here are: A very structured routine. Meals at certain times, being kept busy most of the day, with time to relax of course. People who are compassionate and empathetic, yet firm and provide some external controls. Knowing the person can not be safe with certain objects, making some allowances/ the ability to handle different behaviors/ the person’s unawareness professionally. Discussions about medications, coming off, getting new ones, as a calming agent, done with a psychiatrist on board and other medical staff present. This can all be done compassionately and with the person informed of everything.

Below are some sites that talk more about what’s provided in terms of support.

I have not looked into all of these. Only the ones in MA VT and NY

Afiya in western MA

http://www.westernmassrlc.org/afiya

Video:

https://www.youtube.com/watch?v=9x8h3LvEB04

Did not watch this full video. Have read the current information on the website

In VT Alyssum

https://www.alyssum.org/

Video

https://www.youtube.com/watch?v=p96LT0vz3F0

I did watch this whole video! I was very impressed with the setting and the people there. It was very well done.

I noticed there were a lot of older people, older than me, talking about parenting and things like that that I couldn’t relate to and it makes me wonder if this is more for people that are not young adults.

The two people I related most to were the woman with a brain injury (seeing a multiple disability experience was cool) and the 34 year old woman, since she was the youngest.

So from the video and my looking through the websites my understanding is this: They provide the raw materials that one would hope would engage the person in healing and it’s up to the person to make use of them.

They provide private rooms, which think is awesome. I’m not a nature or going outside girl at all! But was impressed with the peaceful setting, I could hear the river, the sound of people walking in the woods/ gardening ETC. I think that’s awesome.

They also had animals chickens and a little dog which I also love.

They have art materials, books, musical instruments, computer, and I assume other stuff.

And the people did seem totally compassionate and present for the people who were guests. I also liked that they did work with people about being supported with other traditional resources. Talking to/ finding a therapist/ doctor, solid plan around staying on meds or coming off (though I would think the doctor would have to approve that) ETC. So they weren’t just saying their support was the be all and end all.

I am extremely impressed with these projects. The people behind them have huge hearts and truly want to give others an experience that they could not get otherwise. Intentions are nothing but authentically wanting the best.

Where I see this kind of setting being amazingly useful is for people dealing with situations where they can not or are uncomfortable with managing day to day on their own. Where traditionally they would be either set up with people supposedly that come to your home, which often they don’t actually come or are not helpful. Or put in some kind of “supportive apartment program” where they’re given some ghetto apartment and again it’s claimed they get support. Which may or may not happen. Or a group home. Which depending on the place could be good, or very bad. Some places are even unlicensed!

There are therapeutic residential communities designed to be an alternative however they are thousands of dollars a month which is totally ridiculous to expect those in this population to afford!

Something like this would be perfect if there was some way for a person to pay perhaps several hundred dollars a month, and have this very in tune community with all these holistic resources as a safe home. And then to also have access to other clinical services if wanted/ needed.

That would be amazing I would totally one hundred percent be on board. I think people in that position of having this as their home, when not in terrible crisis would then allow them to be able to focus on a mutual relationship and learn the skills around that.

For overwhelming crisis, at the very least I’d want a clinician supervising everything to be sure of safety for everyone. I would not encourage things like glass used for art projects, knives, and other objects to be available with no restricted or monitored access. I would think you’d need to trust and know a person way better to have some of the stuff they do around and be safe. I think when in a good place, or even somewhat hard place, as I said these raw materials and purely peer relationships are amazing. In a more severe place I really feel it’s just not enough, expecting things from people that many can’t do. I feel my concerns are justified.

Would love to hear others thoughts. I’m extremely new to this idea of full peer support as an answer to mental health issues. I do see the value and would hope others see the value of clinical care when necessary. I would love to discuss this kind of setting being used as a true home for many people isolated and not managing day to day with what is out there that often misses the boat in so many ways.

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One thought on “Examining the concept of peer respites

  1. Hello. My name is Mary. I live I Georgia where we have a few respite centers. I also work for a mental health/substance abuse crisis response team. Knowing from experience, respites are great!! If the crisis is not life-threatening, then sometimes a “break” is a great option. I have seen and know the operators of these respite homes, they are top notch!! And sometimes it helps people to know they have a choice. But I also have some bias against the Georgia crisis centers who keep you for ‘three days’ and release you. Is that enough time?? It depends on if you have insurance.

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