Peer-Run Respite Approaches to Supporting People Experiencing an Emotional Crisis

Psychiatric crisis response service providers focus primarily on an individual’s behaviors or symptoms, often without considering underlying stressors, risk factors, and social inequities. In peer-run respite programs, by contrast, emotional crisis is defined as a universal experience that happens when circumstances exceed a person’s current capacity to effectively cope with them, especially when appropriate resources and the adaptations needed for the person in distress to thrive are not accessible. The way a person responds to a crisis may be viewed in psychiatric crisis response services as pathological but in peer-run respites as a valid and meaningful coping mechanism that is protecting the person from trauma or challenging circumstances that stem from a range of social inequities.

The goal of psychiatric crisis response services is primarily to reduce or eliminate symptoms and modify behavior to rapidly stabilize the person in crisis, usually with psychopharmaceuticals and professional supports for managing a so-called mental illness. The goal of peer-run respites is to create a mutually respectful space where compassion is offered, individual choice is honored, and the guest can realize they are not alone. By providing a safe environment, peer-run respites allow guests to feel supported, find meaning in the crisis experience, regain emotional balance, reclaim their power, and determine their next steps.

Psychiatric crisis response service providers tell the person in crisis what they think is best for the person and expect the person’s compliance with interventions and programs that may or may not meet the person’s genuine emotional needs or align with the person’s values. In contrast, peer-run respite staff help each guest to consider available options and to identify and practice new skills to meet their needs, care for their body, and return to a life that aligns with their values.

In psychiatric crisis response services, decisions are guided by professionals, because the person in crisis is believed to be unfit to manage their life. This directive approach may be experienced by the person in crisis as a violation, and, in response, the person may withdraw from treatment; grudgingly comply with it; or act out in anger because they are not being seen, heard, or understood. The peer-run respite approach embraces the philosophy of “power with” rather than “power over.” Decisions are guided by guests in crisis, whose knowledge of themselves and their situation is honored. By listening, exploring guests’ experiences and perspectives, and supporting them in thinking and feeling their way through the crisis, the peer-run respite staff encourage guests to take charge of their own lives, even when that means venturing into unknown territory and tolerating uncertainty.

Psychiatric crisis response service providers evaluate the person in crisis with the goal of identifying ways of minimizing or eliminating what they perceive to be problematic behaviors, feelings, or ideas, primarily by using psychiatric drugs or other types of confinement. A peer-run respite serves as a safe space in which peer-run respite staff can “be with” the guest in crisis—listening to the guest, exploring together the literal or symbolic meaning of the crisis, and supporting the guest as they move toward meeting their expressed needs and desires. Peer-run respite staff are acutely aware of the impact of their own words and actions and communicate in ways that are authentically validating, inviting openness with regard to reflecting on inner experiences and allowing the guest to move through the crisis while also considering their hopes and intentions for the future.

Psychiatric crisis response service providers view behaviors and emotions as the outcomes of a chemical imbalance, although this view is shifting with a growing awareness of the role of trauma in emotional crisis (9). Peer-run respite staff view trauma as a central factor contributing to most life-interrupting crises. Trauma may be individual, intergenerational, or communal. Racism, sexism, poverty, and other forms of systemic oppression are sources of trauma that affect people’s lives and are often perpetuated by the health care, education, political, and criminal legal systems. In peer-run respites, guests who have experienced trauma are supported so that they have the security and space to trust their wisdom, come to their own understanding of their experience, and determine their next steps.

Many challenges are inherent to implementing trauma-informed approaches in psychiatric crisis response services. Sometimes, people are committed to psychiatric crisis response services against their will. Inpatient environments are generally sterile and structured around safety and risk management. Strategies to ensure physical safety sometimes lack emotional safety. Psychiatric crisis response sometimes results in violent intervention, including lethal force, which affects not only the person in crisis but also witnesses, families, and the entire community.

Peer-run respites use trauma-informed approaches and environments. Guests seek support on a voluntary basis. Program environments are designed with consideration of spatial elements that provide physical, environmental, and emotional safety in a homelike setting. In a qualitative study of former guests of peer-run respites, many respondents cited the cleanliness, safety, privacy, and homelike setting of the respite—with its noninstitutional veneer and the availability of a kitchen, living room, and bathroom and many standard household appliances—as contributing to their relaxation and recovery (2). Peer-run respite staff are trained and supported to be sensitive and effective in their ability to communicate with other people. Practicing and refining attunement (i.e., a feeling of spaciousness and presence) deepen the ability of peer staff and the guest to be aware of each other’s feelings, making it possible for all parties to respect each person’s emotions and helping the guest feel cared for and listened to.

Psychiatric crisis response service providers are trained to maintain a professional distance (e.g., by setting boundaries) from individuals in crisis. Peer-run respite staff are trained and supported to practice attunement (as described above), which enhances their capacity to be more sensitive and effective in interacting, communicating, and connecting with guests and other staff members. The attunement process, which to us represents an essential aspect of the emotional healing process, helps people let go of any feelings or thoughts that interfere with being present and listen to the others with whom they are cocreating a safe space that invites deeper mutual learning. This process provides the opportunity for a guest and staff to gently explore memories and emotions that may come up if the guest is interested in doing so. The safety of the relationship provides an opportunity for the guest to explore what meaning the crisis and the guest’s emotions may hold and thus to digest and integrate the experience. This relationship also enhances the guest’s sense of empowerment and willingness to be creative in exploring new pathways for living. Furthermore, forming a bond with the staff allows the guest to tap into inner resources for finding calmness and feeling connected. Many people find that the ongoing practice of this process leads to feeling more grounded in their body and deepens their relationships with themselves and other people. This process empowers people to further explore their relationships and practice responding in supportive ways that are aligned with their deepest intentions and values. An individual’s highest potential is recognized—not only for healing but also for cocreating the relationships and the collective spaces envisioned. The authentic quality of relationships is critical to cocreating transformative, mutually respectful spaces.