Transforming the Traditional Mental Health System Through Peer Staffed Respite Programs

von freakoutcrazy

by MadinAmerica

This is a brief description of the project design and some reflections on “lessons being learned” at Second Story, a Peer Run Respite service in California, funded by a SAMSHA Transformation Grant.  Peer staff are empowering each others’ lives through Intentional Peer Support.

The program is designed to accept guests who self-present. The focus is on clients of the system of care who are beginning to notice familiar signs and symptoms, that if left unattended often will end up in a full crisis, needing hospitalization.  Second Story invites people to come before they are in crisis, to take personal responsibility and prevent spiraling into a crisis, which often results in an involuntary hospitalization. This may result in losing one’s independent housing, employment and much psychic distress as a result of a crisis episode, after which one then is faced with the daunting task of rebuilding their life yet again.

Guests may stay up to 14 days. Guests accustomed to traditional mental health services first are struck by the awareness that they are “treated as adults” with an expectation that one takes personal responsibility for their needs, goals and care.  Once in the program the house is their home, a community of peer staff, people who have self identified with lived mental health experience.

Former guests often stop by to talk, and visit with current guests. Sometimes they ask to volunteer, to give back to the community by running a group, gardening, cleaning, cooking, whatever they wish to offer. They are growing their own support community.

All staff have been trained by Shery Mead, Chris Hansen and/or Beth Filson in the philosophy of  “Intentional Peer Support”, developed by Shery Mead and now recognized as a “promising evidence based practice”.  This model is a basic foundation that all peer staff have adopted. They are highly committed to staying true to IPS as a tool for listening; “being with” rather than “fixing” someone.  By creating a safe place, guests have an opportunity to work through their own challenges, patterns and issues. The Peer Staff continue to practice IPS among themselves using a “co-reflection” model created for supervision by Shery Mead.

What do I witness, notice and observe? I see people engaged in intense conversations, cooking and cleaning. Often people just come and spend lots of time sleeping.  Spontaneous music jams, board games around the kitchen table, or just watching TV. Taking walks, going on outings to museums and lectures, going to the doctor or for hikes in the mountains or along the ocean.

Some people maintain their job while returning to the house for support and community in the evening. Some go to school.  Normal life schedules outside of the house are supported and maintained if the guest so chooses.  Guests are free to come and go as they please, just letting someone know where they’re going and when they will return.  This may sound “normal”, and it IS, it’s not a program full of mental health formulaic groups and a mandatory schedule of activities that you are required to attend… but instead a place to “be with”, a  space to have support.

Some examples:

I’ve known clients who have been in the traditional system for 10 to 30 years. They are well known to the system, some have been labeled “Borderline Personality Disorder“ whose pattern when stressed and experiencing intense emotions has always been to cut on themselves or inflict some bodily pain, and go to the locked psychiatric hospital (as it’s “safe”). Now many of these same individuals are choosing to utilize 2nd Story, and after several admissions the old patterns begin to shift; most of these same individuals are no longer going to the hospital but instead coming to the house for a few days or weeks to get the needed support and engage in honest peer to peer dialogue.

People choose 2nd Story as it’s an opportunity to do life in a different way.  Disruption of their housing, employment or schooling is minimized when they come to 2nd Story.  People are transforming themselves, feeling empowered, blossoming and feeling their strength, shedding the stigmatizing labels and feeling okay to be who they are.

At a recent staff meeting I asked the staff if they felt comfortable broadening the criteria a bit to be able to work with people who may be freshly out of the hospital or a sub-acute setting. I suggested we focus on young people who may have just had a “first break,” were still in a vulnerable and fragile state (not acute) post hospitalization, and may be stabilizing on psychiatric medications for their first time.  Everyone was excited and open to this.

A few days ago I learned of a young man, 24 years old, whose family had taken him to the hospital. They had been struggling to stay with their son and keep him safe.  From the reports it sounded like he was in an extreme psychic distress, with auditory and visual hallucinations, and not able to sleep. This extreme state was scaring his family members. They felt helpless to do anything more but to take him to the psychiatric hospital. As they left him admitted to the hospital they told the hospital staff that he couldn’t return home (they were too scared) and felt he needed to go to a board and care.  When I heard about this young man, he had already been in the hospital for 2 weeks, had been “stepped down” to a sub acute crisis facility and was en-route to yet another sub-acute facility  where he could stay while the treatment staff  worked with him to get on various waiting lists for housing.

I felt compelled to see if we could intervene by extending an invitation to him to come to Second Story before he moved into the next phase of sub-acute treatment. I didn’t want him to be further exposed to the life of the traditional adult mental patient. I feared it would seem hopeless and, as so often happens with young people, despair would begin to set in as he learned to accept his diagnosis.  I was curious to see if he might move through this transition time from psychosis to finding insight from his experience and hopefully be able to get back on his life track; whatever his wishes and dreams might be.

I stopped by the house this evening to meet this young man. He had been at Second Story for only two days.  He was doing well; happy, beaming, having just returned from the ocean where he had walked with another staff member. He’s very busy reflecting, putting the pieces together, wanting to learn what this  experience was all about, trying to find meaning. He was having great insight into Mozart’s insanity by listening to his music, as well as Bach’s fugue.

It was wonderful to be with him as he was telling his story – while striving to make sense of it all.  He shared with me that while in the hospital he was given three different anti-psychotic medications which he was continuing to take on his own at the house. (Medications are not held and managed by peer staff, but rather guests who take medications must be able to self administer, and are provided a key to a bedside stand for storage while staying at the house.) He was finding relief, his mind was clearing and he was finally able to sleep.

He was grateful to be able to think clearly again as he had been extremely overwhelmed with voices, feeling scared, and not feeling “normal” for quite some time. He is now in a place where he can openly talk about what he was experiencing, and the peer staff understand. They can totally relate and as we sat and talked other staff members would share their stories of demons and voices and how they learned to live with this, how they feel special, and have at other times unraveled but the power of having a support system of family and friends who understand them has enabled them to live life to its fullest.

Some staff shared medication stories, some spoke of how they took extra good care of themselves with diet and exercise. Some said years later they worked with their psychiatrist to reduce their medications. Everyone had a different story and a different path, yet they all were respectful and supportive without judging or “advising.” The young man thanked me for paving the way for him to come to Second Story, he is clearly thriving and benefiting from this milieu.

I left feeling so happy that this new model of support is alive and having such a positive impact in our community.   I was able to witness the discovery of oneself through relationships with others. Once again, that old familiar “Soteria” like feeling warmed me as I felt the human connections. This is where the healing takes place. With or without medications, all are accepted – to be who they are.

After 30 plus years working “in the system” I have learned that we just don’t know…

We don’t know what causes these extreme states. Often, if we ask the right questions or listen carefully we learn that it’s triggered by trauma, or mind altering drugs from marijuana to hallucinogens, or sometimes it’s the developmental  transition into adulthood, which for many is easy and for others it’s not so easy. Researchers have yet to pin-point a brain related illness (often referred to as a chemical imbalance). We just don’t know.

We don’t know why these drugs provide relief to some yet not to everyone, why the medications work for a while and then stop…

I do know we must stay open, not rush to labels and diagnoses, but find a way to “be with” the person who is having a hard time, offer comfort, human compassion, listen and allow time to rest; whatever it takes. Medication can help with sleep and calming down after an extended extreme state; it’s another tool that can be helpful, even though no one really knows why. I say this cautiously as we do know that the long term effects of life on psychiatric medications will cause serious metabolic problems and major health risks.  We must allow time, provide human caring support, allow extended rest, and safe environments while the mysterious process works itself through…