What are peer-run respite centers? Why some CT lawmakers are pushing for alternative to psychiatric facilities

When Jennifer Tirado ran into the woods during a mental health crisis, the officer who chased after her told Tirado she had two options: she could either come with him willingly, or he would have to restrain her.

Either way, Tirado knew she would be going to the hospital.

“In that moment, I didn’t feel like I had a choice,” Tirado said.

For Tirado and so many others who struggle with suicidal ideation, self-injury and other psychiatric conditions, encounters with involuntary commitment are fraught with “false choices” — experiences within the mental health system that Tirado said often result in more harm than healing.

Tirado is part of a coalition of advocates in Connecticut working to establish peer-run respite centers as an alternative to hospitalization when individuals experience a mental health crisis.

Unlike locked inpatient facilities, peer respites provide voluntary, nonclinical, community-based support in a home-like environment that allows guests to maintain connections to their support networks as they heal.

There are no curfews, folks can come and go from the house as they please. People can continue to work, meet with loved ones and keep up their regular activities while they receive support from trained peer specialists who have experienced similar mental health challenges.

Senate Bill 370, which currently awaits a vote in the Senate, would add eight peer respites to the state.

The bill, which comes at an annual price tag of $5.5 million, sailed through the Public Health Committee in a unanimous vote after a public hearing in which testifiers expressed their unanimous support for the proposal.

If passed by the General Assembly, the legislation would require the Department of Mental Health and Addiction Services to develop a network of eight peer-run respite centers in Connecticut — one in each of the state’s five mental health regions, and three additional affinity-specific centers dedicated to the transgender, queer, intersex and gender non-conforming community, the Black, Indigenous and People of Color community, and the Spanish speaking community.

At least 15 states are currently home to peer respites, according to advocates who believe the peer model could transform Connecticut’s mental health landscape.

‘That can change the trajectory of someone’s life’

Dr. Leigh Nathan told Connecticut lawmakers that if she “could design a place for people to find aid during an emotional crisis, it would look exactly like (the peer respite centers) proposed in this bill.”

Every day, Nathan sees the impact of severe injury from emotional distress — many of her patients are the survivors of recent suicide attempts.

As a practicing psychiatrist at Hartford Hospital and the clinical lead of person-centered care at the hospital’s psychiatric facility, the Institute of Living, Nathan said she often thinks about what the health care system could do differently to prevent self-injury.

Nathan said that when she asks patients, “If you had a person to talk to about this (who) wasn’t a doctor … do you think maybe you wouldn’t have made this attempt?” the answer is often “yes.”

Nathan said that every patient’s circumstance is different and that speaking to a clinical provider about thoughts of suicide or self-harm will not automatically result in an involuntary hospitalization. She stressed that such outcomes are supposed to occur only when providers have real concerns that actual harm could happen.

However, Nathan said that for many patients, the very possibility of an involuntary hospitalization often stops them from discussing their feelings altogether.

Nathan said she has seen patients who have begged to be admitted into inpatient facilities and others who have been adamant about not wanting to go.

She said both experiences are valid. Some find the treatment beneficial, for others it is a double-edged sword.

“There’s this expression of, ‘It’s not about the destination, it’s about the journey,’” Nathan said. “Some people may get to a place where they’re feeling better, but they had to go through some really uncomfortable experiences like a locked psychiatric hospital, for example, to get there.”

Nathan said she is hopeful that peer respite centers will be an avenue for “people to get to the destination of feeling better without going through an involuntary treatment setting.”

“This is the kind of thing that can change the trajectory of someone’s life,” Nathan said.

As a community support coordinator for Toivo Center in Hartford, Jennifer Tirado serves as a peer educator and coordinator for Connecticut’s Alternatives to Suicide Network.

It is a peer-run support group, which shares a similar ideological framework to peer respite, allows individuals to speak openly about their experiences with suicidal thoughts and self-harm, without the fear that someone will pick up the phone and call 911.

Tirado said that people are “less likely to end their lives if they have somewhere where people can empathize with them and validate their experiences.” However, she said traditional clinical frameworks cannot always offer that to patients.

“The system relies so much on crisis involvement, crisis services (and) getting someone to the hospital as soon as they mention suicide,” Tirado said. “It sets us up so even if we’re at our worst moments, we don’t even want to tell our clinicians, we don’t want to tell our doctors because we know what’s going happen.”

Tirado that while some people seek out inpatient facilities for healing in times of crisis, others find the environment traumatizing.

When a patient is admitted, Tirado said it is not uncommon for staff to take away their clothes, cell phones, and other personal items. At times, she said the ability to go outside and have fresh air is also limited.

As a result, Tirado said patients can feel cut off from the world and their autonomy.

“(In) inpatient, you have much less choice over even what goes in your body,” Tirado said. “I’ve had a doctor tell me that I had to take a medication, even if it didn’t make me feel comfortable, if I wanted to go home.”

Jordan Fairchild, the executive director of Keep the Promise Coalition, said that trauma can be compounded for members of marginalized communities.

“For marginalized folks, trans folks, Black and Brown folks, Spanish speakers, there’s a huge problem with microaggressions and outright aggressions that really demonstrate a lack of cultural competence of the system,” she said.

Fairchild, who identifies as a trans woman of color, said she is “terrified to approach the clinical mental health system.”

“A lot of folks in my own community have experienced misgendering, deadnaming, mocking by hospital workers, having their hormone replacement therapy taken away from them, having their gender-affirming clothing taken away from them (and) being forced to attend groups with people who have been harassing them on the basis of their gender identity,” she said.

Fairchild said these experiences make it more difficult for people to heal and reach out for help.

“Recovery is impossible if you don’t feel safe,” Fairchild said.

Between 2017 and 2021, 2,001 people in Connecticut died by suicide, according to the Department of Public Health. The department said that during this period, the state recorded 6,750 hospital admissions for suicide attempts.

In 2017, a meta-analysis published by the National Library of Medicine and JAMA Psychiatry found that the suicide rate among patients discharged from psychiatric facilities was approximately 100 times the global average.

In contrast, Fairchild said that respite center data suggests that peer-run models result in more positive outcomes for individuals who struggle with their mental health. Guests report improved emotional and coping skills and are more likely to return to their communities after their stay.

According to research published by the American Psychiatric Association, individuals who stayed at peer respite centers were 70% less likely to use inpatient or emergency services than nonrespite users.

Fairchild and other advocates said that the peer respite model is also among the most cost-effective care options. According to an analysis of Department of Public Health hospitalization statistics by the Keep the Pro. The coalition said a seven-day stay at Afiya, a peer respite in Northampton, Massachusetts, costs just $3,196.

When Afiya opened in 2012, it was the first peer respite in the state. Today, it is one of four.

The home sits in a residential neighborhood. The free program accommodates up to three guests at a time who can stay for up to seven nights. Between one to two advocates are on staff at all times to provide 24/7 access to peer support.

Ephraim Akiwa, the executive director, has worked for Afiya since day one.

Today, Akiwa, who identifies as trans and queer, is in the process of opening his own peer respite for the LGBTQIA+ community.

Akiwa said he considers Afiya “a sacred space.”

Over the last 12 years, Akiwa said the home has provided refuge to hundreds of individuals. To this day, not a single person has taken their life at Afiya and there have been only three incidents where 911 was called due to a medical emergency, Akiwa said.

He said it is not uncommon to hear former guests come back and say “I don’t know what I would’ve done if I hadn’t come here” or “I don’t know if I’d still be here if I hadn’t come here.”

Akiwa said that one of the peer respite model’s greatest strengths is that it provides a space where discussing suicide and self-harm is not pathologized or taboo.

“We can openly talk about our lived experience,” Akiwa said. “I think sometimes people think that that’s maybe a lot bigger than it is … but often it’s just enough for somebody to feel not alone.”

Akiwa said more spaces that help foster these conversations are “the thing that’s missing in the system in a lot of ways.”

Akiwa said that talking about suicidal ideation and exploring the reasons why someone wants to die can “give a lot of room for people to make meaning of their own lives and what they’re looking for.”

“The creation of spaces that really allow the fullness of being a human being is what is going to enable a lot of people to feel like they can continue to be in this world,” Akiwa said.

If you or someone you know is in mental health distress or is thinking of suicide, please call or text 988 for the 988 Suicide & Crisis Lifeline, or chat www.988lifeline.org. In an emergency, call or text 911.

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