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June 4, 2015 by Yana Jacobs, LMFT

What the research has told us about Peer Run Respites- Second Story Respite, Santa Cruz, California

yana_touched_150dpiSecond Story Peer Respite House, located in Santa Cruz, California, is completing its five-year funding cycle with a Mental Health Transformation Grant awarded by SAMHSA. The intent of the grant was to implement and evaluate the effectiveness of peer respites in promoting wellness and supporting individuals experiencing psychological distress by providing a community-based alternative 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, building new collaborations, flattening traditional hierarchies and embracing 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 experience and work at Soteria House.

Soteria House was developed by a psychiatrist, Loren Mosher, who at the time was the chief of the Schizophrenia Division at the National Institute of Mental Health. He saw that people were not recovering from mainstream treatments, so he created Soteria as a research project to see what would happen if you provided a safe place for people to be with other people who basically were there to “be with” each other during extreme states. People 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 peer support by people with lived experience to be the primary “treatment” model. And unlike peer respites, which are open to individuals at any stage of their lives, Soteria was envisioned as an alternative to hospital for people experiencing a “first break” psychosis. Peer Respites have been developed as a more general alternative to provide respite when someone is self-identified as having a crisis and needing a safe and supportive environment to be in 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 was validated and confirmed through a community 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.
Findings included an analysis of county service utilization data showing Second Story guests were significantly less likely to use inpatient and emergency services 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 compared to before coming to the program. Here are a few quotes:

“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 mine 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, 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 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, to sit at a kitchen table and find out “what happened” and share stories. This is my dream of what “mental health” will look like one day.


Yana Jacobs began her journey in the mental health field as an art therapy student at UC Santa Cruz, writing her own major in “Art Therapy”. A field study/internship at Soteria House evolved into a full time job there. Thirty years later, after working in clinical services and program administration for the county mental health system, Yana brings her skills and experiences to the EXCELLENCE team where she helps our donors realize their philanthropic vision through donor-advised and incubator funds and provides assistance and oversight to our grantees.  Jacobs holds a Master’s degree in psychology and counseling from UC San Francisco.

yana@mentalhealthexcellence.org

8 thoughts on “What the research has told us about Peer Run Respites- Second Story Respite, Santa Cruz, California

  1. karen Taylor says:

    the same kind of findings came out of the research done on peer respite centres opened in the uk in the late 1990’s the Birmingham Anam cara was very successful and was a similar hybrid model, with cuts to health care in Birmingham as usual this wonderful service was the first to be closed. The health service never gives up its funding for external projects that work!
    a report was compiled by the Mental health foundation England here is the link http://www.mentalhealth.org.uk/content/assets/PDF/publications/being_there_crisis_update.pdf?view=Standard

    1. Yana Jacobs says:

      Thank you Karen for sharing the work that’s been done in the UK. I’ll share this with Bevin Croft from the Human Services Research Institute in Boston. I think showing cost effectiveness is a critical element for funders in order to emphasize the logic in keeping these programs funded.
      I too have seen peer staffed services often be the first to be cut during tight budget years. Clearly a short cut to thinking…but it’s our job to keep the message front and central that these programs are actually what make a positive difference in peoples lives, they aren’t “about” recovery, they are recovery!
      yana

    2. Hoku says:

      Hi there!

      I just encountered this article and your comment about the effectiveness of peer care in the UK.

      Unfortunately, the link you posted opens a faulty page, as if it’s been deleted.
      Do you know where I could find the same information?

  2. Toya Jackson says:

    Yana, you are a dynamin &compassionate woman. We are lucky to have you in our community. I look forward to seeing you address your next challenge. Simply inspiring.

  3. Yana Jacobs says:

    Thank you Toya for your kind words of support!

  4. Linda Ellen Lemaster says:

    Brava! Thank you for your vision n perseverance.

  5. Phil Schulman says:

    I’m grateful for the work and presence of Second Story! I had the great fortune of directing one of the early “Crisis Alternatives Programs”(Essex Co NY) that included a crisis phone support, community center meetings, mobile crisis and a respite apartment. With Bill Sullivan submitting the initial grant we were designed for the purpose of eliminating the county’s use of force and violence in its crisis response! We held a very strong position for people’s rights to self determination. I left to re-pursue parish ministry. I am participating in the creation of another Respite program. I intend to learn from your success. I’ll be in touch!

    1. Yana Jacobs says:

      Phil,
      Thank you for your kind words. Good to hear from you and the work you’ve done and hope to do in the future. I’d be happy to discuss the peer respite model and answer any questions. Feel free to give me a call or email when you’re ready for information.
      yana@femhc.org.

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