We are living in a (more or less) post-pandemic era that has predictably led to increases in lives interrupted by emotional distress and problems with substances. It’s ‘predictable’ because there was already an abundance of evidence prior to COVID-19 that quarantines lead to such negative outcomes. (This should not be read as an anti-quarantine sentiment so much as a harsh reality of difficult times and decisions).
Status quo approaches to supporting people through this collective psychological crisis were inadequate before the pandemic, and they certainly fall short now.
We need alternatives: real, intentional alternatives. More people than ever are desperate to find resources geared toward dignity, equity, and reviving some sense of personal power and control. Peer-run respite is one proven alternative that can be life changing and sometimes life-saving.
Amidst the pandemic, author Ann Bracken published ‘Crash: A Memoir of Overmedication and Recovery.” There she stated: “How do we deal with anything that’s stuck? Most of the time, the natural inclination is to push harder — an example of ‘more is better’ thinking. And while that approach is sometimes successful, you run the risk of damaging whatever you’re forcing.”
Historically, pushing harder is exactly what we have seen from our nation’s helping systems. A particular approach isn’t working? Try more of the same. In fact, let’s force that intervention that didn’t work through involuntary holds, or so-called “Assisted Outpatient Treatment” (aka involuntary outpatient commitment), and when it causes harm… Well, at least we did something!
Our inpatient facilities portray themselves as providing “treatment” when they instead specialize in containment. Data is ignored when it tells us that interventions offered through locked facilities — especially where force is used — commonly lead to poor outcomes (increased suicide and overdose risk, etc.). And, when a growing body of evidence suggests that reliance on long-term use of psychotropics appears to negatively affect the majority of people assigned to such a regimen, we look the other way.
Peer respite — alongside Open Dialogue, Soteria Houses, Alternatives to Suicide, Hearing Voices Network and more — is one of the most promising developments being woven into the tapestry of alternatives across the nation.
Peer respite typically looks like a home with two to six bedrooms where someone facing life-interrupting challenges (e.g., hearing distressing voices, suicidal thoughts, problems with substances, etc.) can stay instead of landing on a psychiatric unit or facing a similarly invasive intervention. The environment is non-clinical and peer-to-peer which means all employees — including leadership — identify as having faced similar challenges. More importantly, they have received intensive training enabling them to use wisdom gained through navigating those difficulties to support others. The goal is to transform “crisis” into learning opportunity, support someone to make meaning of their experiences, and build a path forward.
Evidence for peer respite is strong. A 2015 study demonstrated that people who stayed in peer respite show a 70% decrease in accessing inpatient and emergency room services. Other studies show increases in self-esteem, community connectedness, and self-reliance in moving through crisis. These appear alongside substantial cost savings.
Connecticut has been considering integration of peer respite into their network of supports for several years. In 2017, they looked to neighboring Massachusetts and the Wildflower Alliance (formerly Western Massachusetts Recovery Learning Community) to inform their process. Wildflower Alliance has operated Afiya Peer Respite since 2012. They have produced a peer respite film, and published the only comprehensive ‘how to’ handbook currently available. In 2021, the World Health Organization named Afiya as one of two-dozen exemplary, rights-based crisis alternatives in the world. Wildflower team members lent their expertise, and provided Connecticut with a 67-page report designed to support building the state’s first peer respite.
Yet years continued to slip by until, in March, 2022, the state held two peer respite “town halls.” Attended by well over 100 community members, they sent a clear message to the Department of Mental Health and Addiction Services (DMHAS): “We want peer respite, but it needs to be real peer respite rooted in established best practices and values.”
This aim was further supported by the Keep the Promise Coalition and other vocal advocates.
DMHAS finally released a Request for Proposals (RFP) this April. To say it was disappointing is an understatement. Although named “Evidence-Based Peer Respite,” the RFP calls for anything but.
They ignored the critical need for a homelike, non-clinical environment, instead designating a location on a clinical campus. Location and capacity requirements will force shared bedrooms which contradicts their stated commitment to trauma-informed practice, and dramatically reduces accessibility for domestic violence and rape survivors, as well as gender minorities.
The allotted budget combined with staffing level requirements won’t allow for sustainable pay rates or the sort of internal leadership structure required to even qualify as a peer respite. Perhaps most strangely, the RFP rules out stays from individuals leaving psychiatric units and emergency rooms even though hospital diversion is a primary purpose of the model.
Overall, the RFP demonstrates a complete lack of understanding of what it takes to build and maintain a peer respite. Worse, the state has demonstrated willingness to disregard and devalue the voice of precisely the group of people who should be leading this charge: Those who know what works because they have lived it.
Advocates and peer respite experts across the state and beyond plan to call for the RFP to be withdrawn and collaboratively rebuilt. Implications of ignoring this call are substantial.
Connecticut owes it to its citizens to support the creation of real alternatives, not just the appearance of ones. In the words of longtime psychiatric survivor and thought leader, Pat Deegan, “Help isn’t help if it doesn’t help.” And, it certainly isn’t help if it hurts.
Connecticut has the opportunity to provide real help in a format never before available to its residents. Let’s hope they don’t squander it.
Sera Davidow is a former Connecticut resident and Director of Wildflower Alliance in Western Massachusetts.