Peer Respite/Hospital Diversion: Why it Should be Everyone’s Concern

Peer Respite should be everyone’s concern because it is a model for how each of us can be like a drop of medicine, that is, we can become a remedy together for transforming our relationships and therefore transforming society.

My intent with this blog is to compare some lessons learned from my recent medical crisis response to a similar peer-run respite response. I hope, dear reader, that you can see for yourself how far we need to go to begin arriving at a trauma-informed, empowering, compassionate response to people in crisis.

Peer Respite

My use of the term peer respite comes from the first project of its kind in the world, the Stepping Stone respite. Stepping Stone was founded by Shery Mead in New Hampshire and, since 1997, has been completely run by people with the lived experience of having survived beyond the “mental health” system. The mission of Stepping Stone—and peer respites like it—is to transform crisis into an opportunity for personal discovery. In peer respite, we can learn to transcend the limitations imposed on us, become more empowered in our own lives, and create new, healthier ways of relating with others.

Since those early days, peers have developed other peer-run respites throughout the U.S., and the terms and the approaches have evolved. They are also referred to as hospital diversion houses or stabilization houses. But all peer respites divert people from being admitted a psychiatric institution and instead offer a voluntary, home-like, trauma-sensitive setting in the community where they are assisted through the crisis. Research data shows the significant benefit of this approach to care on many levels, including cost saving, reduced recidivism rates, and an increased sense of empowerment.

Peer respites are rapidly spreading across the United States and internationally. It is important, however, to recognize that each peer respite has its own set of corporate values, principles, policies, procedures, operations, and outcomes. My blog, Soteria House and Peer Respite Summit, provides some research data on peer respites.

Similar to peer respites, the Soteria model primarily uses peers for its staff and is founded on principles of voluntary stay and the recovery model, including minimal use of neuroleptic drugs (which are the first-line intervention in conventional psychiatric care). However, Soteria is a little different from peer respite; the original Soteria house was founded by a psychiatrist, not a peer, and as a research study it had specific guidelines that prevented participation by some groups of people.

The Soteria model is also spreading across the world. In Israel, for example, there are 12 "stabilizing houses" modeled on the Soteria House model. Current Soteria Houses are doing some things differently, sometimes by choice and sometimes because of their funding source and/or policy environment.

My Recent Medical Crisis

I recently experienced a medical crisis that led to a hospitalization. My experience of being hospitalized reminded me of the peer respite approach—a trauma-informed, empowering, compassionate response. I hope that as the conventional system tries to replicate what makes peer respite outcomes so significant, we don’t lose the heart of why this approach really matters and changes lives.

I write this blog from the comfort of my own home and grateful to have returned to being very healthy. My intention is to point out some comparisons between how I was treated during my medical crisis and how people are perceived and treated in a peer respite approach.

My story begins here: I had felt ill for several days and thought it was due to having eaten some bad food. Since I was far from home and out of state, I had spotty communication with a new telemedicine doctor and was not able to get into community-based urgent care. I thought I needed an antibiotic, which I thought would be easy to obtain, but it wasn’t.

At the same time, I was getting to know Joel better. We had begun a business relationship (online) one month earlier, but when we met in-person he could see that I needed assistance and he generously offered support. From the moment we met there was a spaciousness, an openness, a presence of relational awareness. This was not reduced to the three-dimensional transactions that were taking place, but more importantly what was happening in the space between us. When he spoke, the intent of his words and his context landed deeply in me, and when I spoke, I could tell my words and context were received by him. I sensed he was taking in the entire context of my situation as I was doing the same for him.

As time went on and I grew weaker and had increasing difficulty eating, the telemedicine doctor emailed that he didn’t think I had a bacterial stomach infection and maybe I had covid. Thus, urgent care was able to quickly set up a covid test and the next morning I got the positive test result. Joel and I had briefly spoken about the possibility of his driving me to the hospital, but that day we got more work taken care of (including some preparation for me to go to the hospital).

The next morning, I realized with every ounce of wisdom in my body, mind, spirit, and environment that I needed immediate medical attention. I simply told Joel to call 911 for an ambulance, which he did without question, without hesitation. He completely trusted my mind, my judgement, my intelligence, my decision.

When the ambulance arrived, the paramedics were completely focused on context and on me, my situation, and how could they get the stretcher into the bedroom where I was. They couldn’t—at least not very easily—so they tenderly asked if I could walk 8 feet to the stretcher. I said I could, but they were so focused on my safety they vigilantly touched or had their bodies and arms (one person on each side of me) ready to help me if I faltered. I deeply felt their care and thoughtfulness; it brings tears to my eyes now.

Why, you might ask? Sadly, I think about how different it would have been if I had been in emotional crisis rather than medical crisis. I think about what often happens when 911 is called because someone is having an emotional crisis, when their emotions get so big that the simmering tea kettle boils over and they ask for help in ways that may seem—and may be—unusual. Many dear readers know what happens when untrained or improperly trained professionals (e.g., law enforcement) or people get involved—sometimes it makes news headlines. And always, even when it does not result in the person in crisis being killed, there is additional trauma to the person in crisis as well as the responders and the witnesses.

I don’t want to overly reduce the complexity of a community situation when 911 is called for a mental health crisis, but the emergency response needs to involve (among other things, e.g., community safety) a compassionate approach to help the person in crisis feel seen, heard, validated, and respected so that the person is able to more effectively communicate their needs.

I told the emergency medical team what hospital to take me to and they did, and they did so without question even though two other hospitals were closer. Again, I thought—would they have done that if I were in emotional crisis, rather than medical crisis?

At the hospital the tenderness, respectfulness, thoughtfulness for my comfort and what I wanted continued. I knew that I was in the right place and therefore I could relax and let them do whatever they needed to do. I noticed the details as I was taken immediately into a covid isolation room in the emergency department. My life was in their hands and I could give my body to them to be cared for. I didn’t need to struggle any more. I didn’t need to force myself to drink more water to try and stay hydrated because the IV fluids did it for me—they were taking exquisite care of me—body, mind, emotions—the whole package, the whole context was respected in a deep and caring way. It’s exactly what would happen in a peer respite.

In the hospital, the staff listened with presence, being in the moment with me, which created more intimacy. They had great skill at being able to focus and put aside whatever else was going on outside “us.” The doctor spoke to me as an equal partner: very personable, he wasn’t hurried, he explained my health status and asked if I had any questions. The compassion was obvious. The nurse was observant—without needing to inquire beforehand, she simply brought a pair of purple (my favorite color) hospital pants/scrubs and caringly asked me if I wanted them. I think (between us as women) she knew I would want them.

After several hours of being hydrated I was ready to be released back into the world, away from the 24/7 buzz of a large emergency department with cinderblock walls, beeping machines, and sterile everything.

And after that, I wondered whether they would have behaved so caringly if I had been in emotional crisis. That’s why peer respite is needed: it’s the peer respite model that ensures that type of response to an emotional crisis.

The Peer Respite Model

In the peer respite model, the individual is always acknowledged to be in a contextual and relational field. This is not just about what words we say and the tone of voice we use, but it is also what happens in the space between us. Peer respites model mutual relational awareness by being a safe holding space and thus a healing space (assuming the staff and all levels of the organization are aligned with collective trauma-healing policies, procedures, and practices). I use the term “collective” trauma-healing because deep, meaningful and sustainable healing happens in relationship, in community. We are not islands, as much as we would like to be sometimes!

In a mutually respectful space (e.g., peer respite) tracking how information lands in the listener is key. When I am in emotional distress or crisis, I need to know deep in my central nervous system that I am being fully seen and heard. I track this in many ways, not only by the other person’s verbal and non-verbal communication but by whether they are aligned with me. Can I feel a resonant space? Can I feel them feeling me? If not, perhaps becausethey are busy, my communication is not received—it doesn’t land—then we don’t meet in a higher level of relational awareness and the situation takes on a whole different trajectory. Healing does not happen and more layers of trauma get layered on and our sense of separation, isolation, and fragmentation are reinforced. I sense that for some people there may be a relationship between how fast that person moves through life to get some result or outcome and how deeply their intent (awarely or unawarely) is to numb their own emotional pain.

If, however, the conditions are met, then we can deepen the relational awareness in this time and space where it becomes safe to feel and be honest and where there is more capacity to relate to our wounds. I don’t have to put the social mask on to protect myself against the constant barrage of micro-and macro-aggressions so ubiquitous in our society. Rather, I have an opportunity to thaw the parts of me frozen in a trauma response, the numb parts I could not feel or look at before. In a safe space, I trust myself and the other and can continue to integrate the fragments of myself on a path of becoming whole, increasingly unattached or liberated from the past.

In peer respites they hold a lot of space for listening so we may digest, reflect, and integrate formerly unintegrated trauma information and thus become more able to meet the world as it is instead of how we would like it to be. We can unravel our own intelligence. Trauma brings fragmentation—my real self gets disconnected from the social mask I must wear to survive in the traumatized waters that the world swims in. My trauma response is the intelligence that saved me. I need time and space to honor it and bring love to the places that have been exiled so I may bring about unification, releasing past attachments that no longer serve me. We don’t need so much protection any longer because we’ve found more safety in our own bones and in building the relationships that sooth and nurture us.

I was lucky enough to experience this during my hospitalization for COVID. The flow of my entire medical situation was much easier because I knew I was not alone. I had someone who really cared nearby for whatever assistance I needed. In addition to that, my support system, which I have built over many years, was electronically engaged with texts, phone calls, and emails, keeping me blanketed with love and information that helped my healing.

But that’s not always true for many people who are hospitalized after an emotional crisis. Often, their phones and email privileges are revoked. They are treated as a burden and not listened to—certainly not with the empathic relational awareness I’m describing.

But imagine a different community response to how people in extreme emotional states are treated in the community. Peer respite is a research-proven compassionate response. It is critical that this resource expand to every community across the country.

Peer respites elevate our status so we are full partners, making all the decisions about how we want our day or our life to be, and we get support in thinking and feeling our way through the process. Many areas of our society have chosen to not fully recognize people with a mental health label or people in emotional crisis as a full partner. Psychiatric care is one of those areas. Involuntary treatment and involuntary hospitalization remove any sense of agency. People are coerced into drug treatments after a quick meeting with a psychiatrist or a doctor who may not even really listen to their concerns.

My story shows how great quality medical attention can be like peer respite where I am treated as an equal. The contrast here is to the conventional psychiatric establishment or “mental health” system where typically force, coercion, and trauma are all too commonplace. We only have to look at the increasing suicide rates in the US (and overseas as well) to understand this. Resources are few and far between for providing the response, the approach, the compassion and the intelligent relational awareness that is needed.

And finally, peer respites promote the idea that we have sovereignty over our own bodies.

The emergency room doctor recommended that I get a COVID vaccination in a couple of months but he added, that would be a decision between me and my doctor. How different that is from the way people who have gone through an emotional crisis are treated! So often we are coerced or forced into taking medications and our concerns are minimized or ignored. Just the act of giving me a choice about my medical situation and my body felt so empowering.

I am pleased to know that an international group of like-minded souls have been moving together and are taking an evolutionary step forward by creating the first ever virtual International Summit on Peer Respite/Soteria Houses to share our wisdom, inspire, and give “nuts and bolts” steps to spread peer respites and Soteria houses.

The Summit is free and takes place every Sunday in October 2021. Over 600 people are registered from 42 US states and 37 countries for this interactive series. This is an all-voluntary effort, and just over $14,000 towards a $20,000 goal has been raised for future sustainability and information dissemination purposes.

If you would like to know more or to register for the free Summit, click here: https://www.alternatives-conference.org/peerrespitesoteriasummit

In closing, I share some questions that I often ponder:

How can we develop presence and stay connected so we can invite healing?

How can we support each other to be together in our process of change and growth?

How can we enhance our capacity to respond rather than react?

How can we learn to better sense our self and sense others in the space deeper than words?

How do we recognize where we feel depleted and tired as an alarm bell indication of when we need to press the reset button for our own balance, well-being, and health?

We can’t do this alone. We need each other. How do we walk this path together?

How do we become like a drop of medicine?

What steps will we take to create more compassion around us?

How do we learn to listen to what our higher self is whispering about next steps?


One response

  1. Grace Silvia (the visionary of the 1st virtual International Peer-Respite / Soteria House Summit) and I are almost finished completing a table comparing Peer-Respite Emergency Crisis Response to the Conventional Crisis Response which I think will address some questions that have been raised as well as make the points of the blog easier to understand.
    Stay tuned. more questions and discussion from the blog are occurring on the madinamerica blog site.

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