Like most people in Minnesota, state Rep. John Poston, R-Lake Shore, had never heard about peer-run respite homes. But then he had a conversation with one of his constituents, Jode Freyholtz-London, executive director of Wellness in the Woods, a Verndale-based nonprofit devoted to helping rural Minnesotans get access to high-quality mental health care.
During her meeting with Poston, Freyholtz-London explained that respite homes are facilities that provide beds and specialized support for people in mental health crisis. Run by a team of certified peer support specialists, respite homes are a low-cost, non-medical mental health treatment option that can give people in crisis time to heal — and free up much-needed space in busy emergency rooms and psychiatric wards. Some 17 states, including Wisconsin, already have peer respite homes up and running, but there are none in Minnesota.
Because she is convinced that people in Greater Minnesota could benefit from peer-run respite homes, Freyholtz-London went to the state Capitol looking for lawmakers to author legislation that would provide startup funding for two rural respite programs.
She found a strong supporter in Poston, who said that he was impressed with the idea — and with the messenger.
“Jode is a real scrapper,” Poston said. “She isn’t going to give up. She’s tenacious. After talking with her, I was convinced that peer respite homes are an intriguing, smart idea.”
Poston was so convinced that he agreed to take his support to the next level, co-authoring House File 2301, a bill requesting an appropriation of $1.48 million to establish two peer-run respite programs in Greater Minnesota. Paul Utke, R-Park Rapids, co-authored a companion bill in the Minnesota Senate.
The state funding will be enough to get two homes started, Poston explained, but after that organizers are on their own.
While Poston believes that it’s unlikely his legislation will make it to the governor’s desk this session, he does have high hopes that two peer respite homes will eventually get funded in the state. “We got a late start,” he said, “and these things take time.” Poston hasn’t abandoned all hope that his bill could pass this session, but if it doesn’t, he promises to keep fighting.
“We hope to revisit it, maybe tweak it a bit and then come back in the policy session next year and get it over the finish line,” he said. “There is a lot of bipartisan support for this. We are hoping to open a couple of these houses as pilot programs in the near future.”
A clear need
Rural Minnesota communities have been hit hard by rising rates of mental illness. The region’s limited access to therapists, social workers, psychiatrists and inpatient treatment facilities means that area residents often struggle to find treatment for mental health concerns.
When a rural resident’s mental health reaches a crisis state, too many turn to local hospital emergency rooms simply because regional options for care are limited, Freyholtz-London said: “Emergency rooms aren’t the right place for most people in mental health crisis. The staff often isn’t trained to handle these types of cases. They’re too busy. And they’re too expensive.”
A peer-run respite home is a middle ground between a general practitioner’s office and an ER, she said. At a respite, people seeking help for mental health crisis can find support from peers who have had similar life experiences and are trained to lead others through recovery. The input process is streamlined compared to a hospital — usually a call and a screening conversation with a staff member — and rooms are often available with little or no wait. Respite visitors can come and go as they please, unlike a locked psychiatric ward. Many choose to sleep overnight and go to work during the day. Or they can just stay in and focus on their recovery.
“If you go to some big hospital like Regions you’re going to go through a big process just to get in there,” Poston said. “If you show up at a peer respite they’re going to say, ‘Come on in. We’re here for you. The coffee pot’s on. We’ll give you a hand.’”
Though the price tag for Poston’s bill may seem high, respite homes are actually much more affordable than hospital-based care, Freyholtz-London said.
Because they are staffed by peer-support specialists rather than by physicians or other high-cost medical professionals, respite homes keep their costs down. The programs are usually funded by federal block grants, and guest rooms are affordable, around $250 a night vs. thousands of dollars for a typical visit to the ER. Thanks to donors, guests stay free of charge.
While preparing to advocate for this bill, Wellness in the Woods staff visited a number of rural hospitals.
“In one small county we talked to the local hospital,” Freyholtz-London recalled. “They told us that they have about 600 mental health emergency room visits a year. It is not unusual for an emergency room visit there to cost upwards of $2,000. With peer respite, we could cut those costs by more than half.”
Poston said that the rural legislators he has talked to have largely been supportive of peer-run respite programs.
“The legislative response to this idea has been very positive,” he said. “Mental health in Greater Minnesota is a big issue. It’s hitting home in my neck of the woods today, especially in agriculture. In this economy, I can see where it might not be a bad thing to have a place where a stressed farmer can go to get away and rest for a few days. ”
In some communities, peer-run respite programs have cut the number of emergency room visits for mental health concerns, Freyholtz-London said. “In Lincoln, Nebraska, emergency room visits were reduced by 70 percent. They’ve also seen as much as a 30 percent decrease in mental health-related calls to law enforcement.”
If his bill is passed, Poston imagines that a peer-run respite home in his community will look like a normal home in a quiet neighborhood.
“There won’t be a big sign out front that says ‘Peer Respite’ or ‘Mental Health,’ or anything like that,” Poston said. “It is going to be pretty unassuming. Will people in the community know what it is or what’s going on in there? Sure they will. If they don’t they won’t know to use it. But I don’t think it will stick out. It will just feel normal and approachable. That’s the whole point.”
For people with mental illness, one of the most appealing things about peer-run respite programs is their flexibility, Freyholtz-London said. Unlike a hospital or a psychiatric facility, respites don’t have strict requirements about the kinds of guests that can be admitted.
“Individuals who want to stay at a peer respite don’t have to have a mental health diagnosis,” Freyholtz-London said. “They are a self referral. Some people have stressful things that happen in their life and they just need a break. They don’t have to have a medical definition of why that is.”
Some respites also welcome people dealing with addiction, though all have strict rules around drug or alcohol use. The homes are sober by design, Freyholtz-London said. Visitors must commit to abstinence while during their stay.
Peer-support specialists who staff respite homes focus on providing support and guidance for guests, drawing from their own experiences with mental illness to help visitors find their way to recovery.
Chris Uchello, legislative advocate for the peer-respite bill and a certified peer-support specialist, said that peers bring a unique and effective approach to treating mental illness.
“We come from different walks of life,” Uchello said. “We’re not therapists. We are just regular people who use our stories and experiences from when we were struggling to help other people in similar situations.”
Uchello moved to Minnesota several years ago. He was consumed by a series of physical and mental-health crises when he became suicidal. After a number of unsuccessful ER visits, he eventually ended up at Minneapolis’ Nancy Page Residence, a short-term residential mental health stabilization program run by People Incorporated. Nancy Page employs medical staff and provides services at a different level than a peer respite, but Uchello was still happy to be in a place that didn’t feel like a hospital.
“I stayed at Nancy Page for about six days,” Uchello said. “It helped me to get away from things. They got me set up with a psychiatrist. Eventually I grew to appreciate the feeling of just having people around me.”
During his stay at Nancy Paige, Uchello learned about Minnesota’s peer-support specialist certification programs. He eventually completed a two-week training through Wellness in the Woods and now uses his own experience of struggle and recovery from mental illness to help others. When Freyholtz-London told him that they were looking for a legislative advocate for this bill, Uchello was excited about the opportunity.
“Peer respite is an amazing option for people in mental health crisis,” he said. “In a psychiatric ward you are locked down for days or weeks. When you are locked down people lose jobs and housing. With peer respite people who stay there are allowed to go to work, take care of their affairs and then go back to the respite at night and spend time with their peers.”
Uchello is comfortable using his own experience in his advocacy, and he thinks it helps get his point across.
“When I talk to the legislators I’m not talking as a legislative advocate,” Uchello said. “I’m talking about it as a guy who was there.”
Respite homes are particularly important in rural areas, where psychiatric facilities are few and far between, Uchello said. “At any time, 25 percent of beds in a psych ward are taken up by people who don’t need to be there. With peer respite those who don’t need acute care can be in respite — and psychiatric beds an be freed up for people who really need them.”
He thinks that respite homes fill a gap in communities that struggle to treat residents experiencing mental health crisis.
“Any time you go to a hospital with mental health symptoms, they’ll turn you away if you are not suicidal or in a serious crisis,” Uchello said. In rural communities especially, “they just don’t have the hospital beds. When people in crisis are discharged from the ER, they just go home and get worse. The lucky ones might go back to the hospital but only when they reach the suicide stage. The unlucky ones just become another statistic.”
Up and running in Wisconsin
The first peer-run respite homes were opened on the West Coast, but the concept has spread nationwide. Wisconsin has embraced the concept of peer-run respite homes; there are now three open to all Wisconsin residents — in Appleton, Menomonie and Madison — with a fourth available for residents of Milwaukee County. A fifth, focused on mental health care for veterans, is slated to open in Milwaukee.
Menomonie’s peer-run respite is called Monarch House. It is a four-bedroom home on a mixed-residential street on the city’s north side.
Monarch House Program Director Victoria Welle is a state-certified peer specialist and a trainer for intentional peer support. Welle explained that the home, which is owned by a nonprofit called the Wisconsin Partnership for Housing Development, accommodates up to four guests at a time, all in private rooms.
“It is important that people have their own private space,” Welle said.
Monarch House looks just like other houses in the neighborhood. “We’ve chosen not to put a sign up,” Welle said. This decision, Welle explained, “varies from respite to respite. We wanted to make this place as homelike as possible. We just have a sign in the window with our butterfly logo. When people are looking for us we say, ‘It’s the big white house with the butterfly logo.’”
Welle said that peer-run respites are a good option for people in mental health crisis. When Welle personally struggled with mental illness, the experience of hospital-based treatment was a mix of helpful and harmful.
“I didn’t have a good experience in psychiatric facilities,” Welle said. “I always thought I’d like to create a home or a retreat, something different from a medical facility where you were locked away. I was so excited when someone I met at a conference approached me and asked if I would be able to apply for a position in a peer-respite program.”
At Monarch House, Welle said, the entrance process is relatively simple. “We talk over the phone individually with people. Then staff can get to know more about their situation, and decide if this is a good option for them.”
If staff determines that Monarch House is a good match, Welle explained, “We let them know about us and what they can expect from a stay here. We say what we are able to offer in terms of support. We explain that all the folks who work here have histories of being on a process of healing or recovery, and we’ll provide support for them.”
Though there usually isn’t a wait for a room, Welle explained, “We’re not able to take people on a walk-in basis. They have to call ahead.”
The house has a kitchen with basic food supplies. People choose when and what they want to eat. “They can bring in their own food as well,” Welle said. The home’s overall operating budget is $441,000 a year.
A typical stay usually lasts 1-5 days. “We make it clear that everyone who stays here treats everyone else with mutual respect and unconditional high regard,” Welle said. “If they are not able to hold those values they would not be able to stay as a guest.”
The knowledge and history of the peer support specialists is key to Monarch House’s success, Welle said. “A lot of that comes from our own life experience of navigating mental health systems and things like figuring out how to find a therapist in this area, how do I get connected to housing services, all those things that can happen when crisis interrupts our lives.”
Personal experience can be more effective than medical experience, Welle said. “It’s one thing for a therapist to say, ‘Things are going to get better.’ To talk to a peer who is living a life as proof that things do get better is much more effective than any ‘expert’ telling you, ‘If you follow these instructions this will happen.’”
In a peer-run respite, people in crisis can interact with people who’ve been through crisis and come out the other side, Welle said. “I do believe from my own life that there were times when a single conversation where I felt understood impacted me in way that made a big difference down the line.”
A stay in a peer-run respite offers those conversations over and over, Welle added: “It is an opportunity for connection, to get to know other people who have survived and thrived. It is seeing living examples of hope and possibility.”