Peaceful and Free or “like Having a Zoo Run By the Monkeys?: A Qualitative Assessment of Consumer Experiences in Peer-Run Respites

Introduction:  Peer-run respites are voluntary, short-term residential programs designed to support individuals experiencing or at risk of experiencing a psychiatric crisis by providing an alternative to psychiatric emergency department. Although the benefits of peer-based mental health services have been established, less is known about the benefits of participating in a peer-run respite. This qualitative study aims to understand the experiences of persons who have stayed at two newly implemented peer-run respites by exploring the benefits and challenges of staying at a peer-run respite, and their reflections on whether the peer-run nature of the respites was beneficial

Methods: Semi-structured interviews were conducted with respite guests near the end of their stay and again six months later. Peer interviewers who had received 2 full days of training in semi-structured interviewing, and human subjects protections conducted interviews. Interviews were recorded and transcribed verbatim. Case study analysis and cross case analyses were conducted to understand variation in guest experiences within and between programs. Illustrative quotes were entered into a case summary matrix with each program representing a case.  Supporting data including specific quotes were entered in fields (columns) of the matrix. Within and between case comparisons using constant comparative methods were then conducted.

Results: Baseline and follow-up interviews were conducted with 27 respite guests.  Respondents were majority women (n=16), and Black (n= 15), with average age of 48 (range=20-56).  Guests sought out the respite to temporarily escape a range of stressful situations related to mental illness, homelessness, and past trauma. Among the benefits guests reported included the respites’ communal environment, which involved living as a group, team building tasks which fostered the development of interpersonal and coping skills and, ultimately, supportive relationships with other guests. Benefits related peer-run nature of the center included the normalization of mental illness, a sense of hope surrounding recovery, and the avoidance of the “authoritative” nature of inpatient services.  However, several participants questioned the credibility of peers.  Some participants expressed the concern surrounding both the staff’s preparedness to handle guests in a psychiatric crisis and were troubled that nobody was “truly” in charge.

Discussion:  Peer run respites are places where guests can come support one another and develop skills and relationships needed to participate in community life. That some guests did not trust the credibility of peer-staff suggests the need for peer providers to find ways to earn trust of participants, as well as a need for ongoing training of respite staff.  Although this study’s qualitative approach and inclusion of peer interviewers was effective for collecting and understanding the experiences of respite guests, future research is needed to understand whether and how these guests’ perspectives align with guests of other respites, to understand the extent to which credibility of peer-staff is a concern of guests.  Future research should be done in a participatory manor that involves the perspectives of respite guests and peer staff.