What the Research Has Told Us About Peer-Run Respite Houses: The Second Story Story

Yana Jacobs
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The Second Story Peer Respite House, located in Santa Cruz, California, is completing their five-year funding cycle with a Mental Health Transformation Grant awarded by SAMHSA. The intent was to implement and evaluate the effectiveness of peer respites in promoting wellness and supporting individuals experiencing psychological distress through community-based alternatives to psychiatric emergency services.

When Second Story opened its doors in the fall of 2011, we were the first peer respite house in California, and the seventh peer respite in the nation. The experience of “transformation” has been alive and well in Santa Cruz County over the past five years as the community joined together, built new collaborations, flattened traditional hierarchies, and embraced the core values of Shery Mead’s model and practice of Intentional Peer Support.

As the author of the original SAMHSA grant, I had never actually visited a Peer Respite house. I had read about the few houses scattered around the country, each one slightly different from the other. I found each model was unique by virtue of the fact that peer-run respites were in their pioneer phase of development. Since there was no consistent, established model for Peer Respite Houses, I chose to draw upon some of my earlier personal work and experience at the original Soteria House.

Soteria was developed by a psychiatrist, Loren Mosher, who at the time was the Chief of Schizophrenia division at the National Institute of Mental Health. He saw that people were not improving, and were not recovering, from mainstream treatments. He created Soteria as a research project, to see what would happen if people are provided a safe place to be – with other people who basically were there to “be with” each other during extreme states such as psychosis.

People there got better with little to no medication. It was the human connection and “being with” that made the difference, and allowed people to move forward with their lives.

I felt a resonance when reading of the other respites, and found a similar philosophy was embedded in these various approaches to being with people during challenging times. The fundamental difference between Soteria House and peer respites was that Soteria didn’t require that the primary “treatment” model be support by people with their own lived experience of extreme states.

Unlike peer respites, which are open to individuals at any stage of their lives, Soteria was envisioned as an alternative to the hospital for people experiencing a “first break” psychosis.  Peer Respites have been developed as a more general alternative, providing respite when someone is self-identified as having a crisis and needing a safe and supportive environment for a short term.

I felt deeply committed, passionate, and certain that creating a space for people to come together and share their common experiences could only create a positive result.

Today this dream has been validated and confirmed via a presentation of research results by the evaluation team from the Human Services Research Institute (HSRI), led by Bevin Croft. The findings were presented to a room filled with County staff, providers from various agencies, peer staff, current and former program guests, family members, and neighbors.

While I sat and listened to Bevin present her findings I couldn’t hold back my tears.  Her report was so positive and affirming that all I could do was cry with joy.

The presentation consisted of findings from several aspects of the evaluation project, including an analysis of County service utilization data that found Second Story guests were significantly less likely to use inpatient and emergency services when compared with similar mental health service users who did not visit the respite (more information about those results can be found here). Bevin also presented some early results from a guest survey and in-depth interviews that focused on the individual guest experience of Second Story and its impact on their lives. On the whole, guests reported statistically significant improvements in wellness, quality of life, personal relationships and, importantly, connection to a community of peers after staying at Second Story, when compared to these factors before coming to the program.

Here are a few Quotes that were recorded by the evaluators upon surveying the guests at 2nd Story:

“I don’t feel ‘less than’ in this environment. I feel like across the table we’re all equals. Even though I’m not peer staff, still… [In traditional crisis services] I may have come out of this feeling like somehow I’m defective. You know, if this wasn’t around and there was just the hospital and crisis house, I would feel in those environments very mentally ill. Like, labeled that. Like, ‘These are mentally ill patients.’ And I’m not a patient. I’m a person. And I get treated like a full human being.”

“I really like that we [guests and staff] can have a real serious conversation between each other and exchange information from each other. It is not like a one-way talking… it is a two-way relationship and communication, and it’s really genuine… We’re just really real with each other. And they tell me when something’s not working for them… They’re real. It’s like a friendship instead of a very closed, cold-hearted professional support… There’s connection. There’s real connection at 2nd Story.”

“I’d say that [Second Story] gave you a sense of identity. It gave you a sense of belonging. It showed me that there are people whose minds work the way mind does who are in control of their minds, don’t let their minds control them—who are hugely intelligent and really run their own lives.”

Today the community came together to listen and learn about what works, what gives people hope, and what supports the journey of “recovery,” or discovery of oneself.  Mental Health Systems need to hear the evidence of what works and begin to implement peer-run respite homes in communities across the country.  The evidence is in!

So where do we go from here?  The research team will continue analyzing the data and will produce a series of materials that describe Second Story’s impact and document best practices for future peer respite programs. Establishing peer respites as an “evidence-based practice” seems to be required by “the mainstream” for both federal and state funding, and may provide the impetus for replication.

I’ve been pondering an article I read recently from Forbes, about the differences between “open networks” and “closed networks.” Second Story was designed intentionally to be an “open network,” involving a mix of people in various positions, from those with “lived experience” aka “peers,” County and Contract administrators, clinical providers, all joining together to make Second Story a reality.  While the house staff and manager are required to have “lived experience,” the non-profit agency that was selected to be the umbrella for the program was not a peer-owned and operated agency.

Thus we earned the title “hybrid,” according to the National Empowerment Center’s catalogue of different versions of peer respites nationwide. To me this design forced a dialogue to happen across all tables. Rather than creating a “closed network” of only people with lived experience to create and implement this new program model, diverse stakeholders were called to the table with the understanding that when they entered the house, they were in “our house,” one staffed and run by people with lived experience… and the power dynamics and hierarchies of patient and provider, diagnoses, and labels were left outside the door. This is where I believe the possibilities are profound for systems to begin to change. Where lessons are learned and eyes are opened. At the end of the day I heard one of the respite staff exclaim, “Hybrid pride!”

Second Story is a place where people – guests, peer staff, family and community members and those working within the traditional mental health system – find their common humanity and are called upon to be together for the common good.  A neighbor of Second Story shared with the group that there had been much concern and trepidation by the neighborhood when they learned that a mental health facility was in their midst. This is commonly known as “not in my backyard,” or “NIMBY.”

She went on to say that Second Story has proven to be a wonderful neighbor, responsive to the community when issues arise, and always wanting to help.  She feels honored to have this program in her community as they make “good neighbors.”  I believe that deep learning may be shared with the “old seasoned staff or providers” when they are able to see that mutuality and sharing personal stories creates connection, and connection – not the label/diagnoses and the pill – fills the emptiness, the void, confusion, and loneliness. The “open network” allows this learning to flow.

Dream One has been accomplished. Second Story has been promised ongoing funding from the Mental Health Services Act in California. This act was voted into legislation as a 1% tax on millionaires to help fund mental health programs statewide. Second Story has been embraced by the Santa Cruz Community mental health system as a vital and important model that must be supported and funded.

Dream Two? When all people are able to set aside their need to label and diagnose another human being in order to understand “what’s wrong,” and instead sit at a kitchen table to find out “what happened,” and share stories. This is my dream of what “mental health” will look like one day.

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10 COMMENTS

  1. I am very inspired by this! How wonderful that these results could be documented and presented to the public in such a meaningful way. Perhaps the success of this project could serve as a beacon for other communities. In Portland, Oregon, an organization called Folktime is trying to establish a peer run respite. I wish you and every other community the best of luck in establish more of these respite houses. They are a critical piece of the puzzle.

  2. I agree, what you’ve accomplished is exactly what’s needed – a caring community which offers love, acceptance, and actual listening ears. Keep it going, congratulations, and thank you for all you’re doing.

    Oddly, other than my dealings with the psychiatric industry, I’ve never met people with a compulsion to “label and diagnose another human being in order to find out ‘what’s wrong.’ Everyone else I’ve met in my life, other than psychiatric practioners, tends to “sit at a … table to find out ‘what happened,’ and share stories.”

    So I’m quite certain what you’re doing is the normal human approach to helping others, and mainstream psychiatry’s current approach of stigmatizing and tranquilizing people is the inappropriate one. Hopefully, they’ll realize this some day soon.

  3. Your quote that people could live together and, “…the power dynamics and hierarchies of patient and provider, diagnosis and labels, were left out the door” is what needs to be standard practice in order to replicate peer-run respite houses. To replicate them, we need a mutually agreed upon definition for a person. It sounds wild, but I think we need to define what a person actually is in order to define equal rights, equal opportunity, power, lack of power, respect, or anything to do with people.

    I believe the definition of a person is what a person does, not what he or she is. People only have the biological capacity to actively engage in one dynamic. A person senses and assesses internal and external information, forms conclusions about that information, then makes predictive decisions for what to do next in ways that make unique sense to his unique sensory, motor, and nervous system structures and functions.

    A person must have access to the full array of his cognitive and behavioral options or his brain goes into anxiety. Behavior modification is to the brain what an eye patch is the the eye. It restricts and inhibits, and can make people go into crazed fits of frustration.

    Similarly, telling a person he is personality disordered renders that person into the state of being a non person. It says, you cannot do what a ‘real’ person does to do to be a person. You exist as a sub-person until the time you can sense, conclude, and decide like ‘real’ people. If we use the process for how people reach decisions as the benchmark for how to understand them instead of the results, we could build a whole new system for understanding human thought and behavior.

    So equal rights means everyone has equal validity to sense, conclude, and decide in ways that make sense to him or her without being ridiculed or marginalized or forced to do so in ways that make sense to an authority. An authority can have power to organize an environment. An authority cannot have power over how another person senses, concludes, and makes decisions for what to do next. An authority cannot have the power to comment upon or change how those under him engage in their unique and biological ‘sense, conclude, and decide dynamic.’

    People can recover from trauma. They cannot recover from having their sensing, concluding, and predictive decision making capacities confused or controlled by people who have the power to do so.

    To reliably replicate optimal conditions and minimize systemic abuse in education, psychology, and community programs, I urge that we adopt a concrete definition of a person.

    Second Story is a great name for a great program. I would love to see all of our great ideas replicated reliably.