If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing \u201c988,\u201d or the Crisis Text Line by texting \u201cHOME\u201d to 741741.<\/em><\/p>\n

Aimee Quicke has made repeated trips to emergency rooms, hospitals, behavioral health facilities, and psychiatric lockdowns for mental health crises \u2014 including suicidal thoughts \u2014 since she was 11.<\/p>\n

The 40-year-old resident of Le Mars, Iowa, has bipolar and obsessive-compulsive disorders. \u201cSome of the visits were helpful and some were not,\u201d she said. \u201cIt was like coming in and going out and just nothing different was happening.\u201d<\/p>\n

Then she heard about Rhonda\u2019s House, a rural peer respite program that opened on the other side of the state in 2018, through acquaintances in her community.<\/p>\n

That facility, and dozens of others like it established nationwide over the past 20 years, offers a short-term, homelike, nurturing environment for people who are experiencing a mental health crisis but don\u2019t need immediate medical attention. At respites, patients are treated like guests, proponents say, and can feel heard and keep their dignity without having to relinquish their clothes and other belongings.<\/p>\n

During her weeklong stay at Rhonda\u2019s House, which founder and executive director Todd Noack referred to as \u201ca bed-and-breakfast facility for emotional distress,\u201d Quicke made many breakthroughs, working on her self-esteem and gaining better coping skills. If she hadn\u2019t found the program, she said, \u201cI don\u2019t think I would have come out of 2020.\u201d<\/p>\n

Public health professionals say respite facilities can potentially play a big role in addressing a national mental health crisis that accelerated dramatically during the covid-19 pandemic, especially when it comes to suicide prevention.<\/p>\n

\u201cIt\u2019s a really important piece of the larger puzzle of how to improve health care and reduce suicide risk, because there is a \u2018traffic jam\u2019 in suicide prevention,\u201d said Jane Pearson, chair of the National Institute of Mental Health Suicide Research Consortium.<\/p>\n

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Respites rely on trained peers to provide care, and often serve patients who might otherwise visit overburdened ERs, psychiatric institutions, and therapists. Today there are 42 community-based respite programs spread across 14 states, including new ones opened recently in Tacoma, Washington, and Grand Rapids, Michigan. Most are nonprofits governed by a patchwork of state guidelines, and they\u2019re funded by a mixture of local, state, and federal grants.<\/p>\n
Experts say the programs fill a void, though there is little hard data on their effectiveness. Paolo del Vecchio, director of the Office of Recovery at the federal Substance Abuse and Mental Health Services Administration, said peer-run respites have proven themselves as an \u201cevidence-based model of care,\u201d with positive effects including reduced hospitalizations and increased engagement with community support services.<\/p>\n
A 2015 study published online in the journal Psychiatric Services found that people who sought respite were 70% less likely<\/a> to use inpatient emergency services than non-respite users.<\/p>\n
Still, del Vecchio said, more research is needed to analyze how the programs are working and troubleshoot problems. SAMHSA is conducting a cost-benefit analysis of respite programs that officials hope to release this summer.<\/p>\n
Pearson said she would like to see more research on who uses respites, how they are advertised, clients\u2019 reasons for seeking them, and whether they deliver what they promise.<\/p>\n
Respites can be especially important in rural America, where suicides increased 46% from 2000 to 2020, compared with 27.3% in urban areas, according to the Centers for Disease Control and Prevention. Rural residents also have 1\u00bd times the rates of ER visits for self-harm as urban residents.<\/p>\n
Del Vecchio hopes greater awareness can help bring the promising respite approach to the states with the highest suicide rates, including Wyoming, Montana, Alaska, and New Mexico.<\/p>\n
Rhonda\u2019s House, in Dewitt, Iowa, has provided care to 392 people over the past five years, and recently moved into a three-story, five-bedroom house with two baths. Peer specialists in Iowa must complete 40 hours of training plus six hours of ethics counseling, and then work 500 hours to become eligible to take a state certification test.<\/p>\n
For Quicke, Rhonda\u2019s House was a lifesaver during a brutal 2020. The pandemic had isolated her from her support system, her brother-in-law died, her long-term partner moved out, and her mother had open-heart surgery.<\/p>\n
\u201cThere was a lot of chaos. A lot of family fights broke out. That\u2019s when I took off \u2014 packed a bag and left for respite,\u201d said Quicke. \u201cThere was nowhere else closer to go.\u201d<\/p>\n
She drove six hours from her home to Rhonda\u2019s House, where she found 24-hour help that you \u201cjust can\u2019t get from an emergency room or hospital.\u201d<\/p>\n
Unlike traditional hospital staffers, peers are available to speak with guests whenever they are needed, which Quicke appreciated since she has \u201ca lot of panic and anxiety in the night and it\u2019s frightful.\u201d She also found it easy and comforting to speak with peers with \u201clived experience,\u201d or firsthand experience with mental health challenges.<\/p>\n
Allowing people to reach out for help without being judged is a crucial feature of the respite model, said Paul Pfeiffer, a psychiatrist at the University of Michigan\u2019s medical center. He cautioned against regulations that would make them more like hospitals, noting that many people in trouble avoid getting help because they fear being locked up in a psychiatric facility.<\/p>\n
Quicke said she learned a lot during her stay at Rhonda\u2019s House. \u201cI always thought I was co-dependent. I learned I just need me and my dogs. I learned wellness tools and that I can be strong and resourceful and resilient,\u201d she said. She described being more conscious of her triggers and said she had \u201cmore routines to help with sleep hygiene.\u201d<\/p>\n
When Quicke left, respite staffers connected her with community resources close to her home, near the Nebraska border. They also encouraged her to call if she needed help again and told her she could return for another stay after 60 days \u2014 giving her time to work through her challenges and freeing up space for others in the meantime.<\/p>\n
\u201cPeer respite works 8 out of 10 times,\u201d said Noack, the executive director. \u201cSome people do have to leave to get another level of care, but nothing is ever perfect.\u201d<\/p>\n
The average cost of staying at Rhonda\u2019s House is $428 a day \u2014 far less than the thousands of dollars a hospital stay typically costs. Noack\u2019s respite does not bill insurance but covers the cost with state and regional contracts, as well as donations, like many other respites.<\/p>\n
Some respites receive Medicaid funding. As this type of care grows, more states will explore Medicaid and other funding sources, said del Vecchio.<\/p>\n
A few weeks ago Quicke became discouraged after a job rejection. She thought about going back to Rhonda\u2019s House but said she channeled what she learned there during her stay.<\/p>\n
\u201cI was able to use my coping skills to get through it,\u201d she said.<\/p>\n
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