Amy Smith's "Knock Your Socks Off" Peer Run Services Report
PEER RUN SERVICES
A Report for Colorado BRSS TACS (Bringing Recovery Supports to Scale Technical Assistance Center Strategy)
June 15, 2012
Prepared by Amy Smith crazydiamondUSA@gmail.com
Best viewed electronically
Disclaimer: I have no knowledge regarding peer services in the substance use community, although I do consider 12-Step programs to be the granddaddy peer support of them all! This report focuses on peer support in the C/S/X community.
Colorado was the first state in the nation to employ peers in the service delivery system. “In the spring of 1986 the Colorado Division of Mental Health began a pilot project to train and employ individuals with chronic mental illness to provide case management services to other mental health consumers. The project's goal was to have the four community mental health centers in Denver employ 20 consumers who would share ten full-time jobs with the title of consumer case management aide. Job-sharing would provide employers with a way to ensure coverage if a case management aide decompensated and would also allow case management aides to have flexible work schedules.
The Division of Mental Health recognized that people with extended experience as consumers in the mental health and social services systems have acquired usable expertise. The organizers of the project believed that consumers would be able to establish rapport more quickly with other consumers, especially those who are reluctant to accept traditional mental health services. In addition, over the last decade, new developments and refinements in psychiatric rehabilitation have brought about improved outcomes for persons with chronic mental illness.
Mental health consumers with chronic mental illness were trained for employment as case management aides in a psychiatric rehabilitation project in Denver.
The project incorporated cooperative arrangements between the mental health system and vocational rehabilitation and occupational education agencies. The process used to recruit, select, train, and employ the consumer case management aides is described. Eighteen of the 25 trainees who began the training completed the program, and 17 moved on to employment as case management aides. At two-year follow-up, the 15 trainees who were still employed as case management aides had required a total of only two bed-days of psychiatric hospitalization since the training ended.”
1. Many RATC graduates are still employed in the Colorado service delivery system today, in various roles. Sadly, today, Colorado is one of the lowest-ranking states in the nation in terms of peer-run services. While other states have developed peer-delivered services ranging from peer respite, vocational assistance, crisis services, residential care, mutual peer support and many other varied models, Colorado peers tend to be employed as peer specialists employed by mental health centers or managed care organizations.
At this writing, there are two true peer-run organizations in Colorado, Friendly Harbor Drop-In Center in Pueblo, Colorado, and the Depression/Bipolar Support Alliance of Colorado located in Colorado Springs. Both are operated by peers, who control all aspects of the businesses. Neither organization compensates its employees; they are 100% volunteer run. To be clear, a legitimate peer-run enterprise controls all aspects of the organization. Typically, peer-run organizations maintain a balance of peer board members at a minimum of 51%. SAMHSA requires a peer-run organization to be controlled by peers at all levels, including fiscal oversight.
According to The Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities, peer-run services are:
• Peer-delivered services are services provided by individuals who identify themselves as having mental illnesses, are receiving or have received mental health services for their mental illnesses, and deliver services for the primary purpose of helping others with mental illnesses.
• Peer-delivered services may also include partnering with non-peers, but peers still maintain control of the service. These may be called peer-partnership services.
• Peer-run or -operated services are services that are planned, operated, managed by people with psychiatric disorders.
• Peer employees are individuals who identify as peers and are hired by non-peer agencies, e.g., community mental health centers. Peers may be hired into designated peer positions or traditional clinical positions.
• Peers serve as case managers, outreach workers, and mobile crisis workers, among other possibilities. 4.)
The United States has hundreds of peer-run service delivery organizations of all types, and of great diversity. For the purposes of this quick study, I will limit my discussion to peer-run respite services. I will also include a brief overview of some other peer services of particular interest to Coloradans in the closing statements.
In 2009, Massachusetts passed HB 3584, which requires the Massachusetts Department of Mental Health (DMH) to conduct a feasibility study about establishing peer-run respites as progressive alternatives to mental hospitals.
2. M-POWER is a member run organization of mental health consumers and current and former psychiatric patients in Massachusetts.
According to M-POWER:
“A peer-run respite is a safe house, where people learn to manage emotional crises in a warm, welcoming, home-like environment, in contrast to locked psychiatric wards, which are institutional and impersonal. Peers find compassion and understanding from a trained peer staff, where they can new skills for recovery. Programs, such as the Wellness Recovery Action Plan prevent relapse, and Peer Specialist certification promote employment.
What are the benefits of peer-run respites?
Studies show peer-run respites have clear advantages over mental hospitals. A California study showed "significantly greater improvement" and "satisfaction was dramatically higher" than with a locked psychiatric ward. Self-harm and violence is actually more likely on locked psychiatric wards because of the pressured atmosphere.
The cost of a peer-run respite is cost only about $250 per person per day, whereas psychiatric hospitals cost $1,000 per day or more. Over a year, a 3-bed peer respite saves $1 million. Creating 3 respites-in Central, Western and Metro-Suburban Mass.-will save $3 million. Savings are realized on hospital costs, ER visits, police time and ambulance costs. Peer-run respites also save additional money by increasing peers’ independence, so people use less costly mental health services in the future.
Who is eligible to enter peer-run respite programs?
Anyone who is experiencing a mental health crisis, but not deemed dangerous to others, will be eligible to go into a peer-run respite. In New Hampshire and Georgia’s progressive, peer-run respites even self-injurious and actively suicidal people are welcome. Peer-run respites would be part of a menu of crisis service options, complementary to existing programs. Participation in all peer-run services is completely voluntary.
Are there successful examples of peer-run respites?
Currently, there are 14 programs-in New York (2), Maine, New Hampshire, West Virginia, Ohio, California and Georgia and 6 overseas. New programs are starting in Vermont, New Mexico, Nebraska and Alaska.
How are other peer-run respites funded?
In some states peer-run respites are funded by federal SAMSHA block grants. In Georgia, 2-bedrooms cost about $300,000 per year, including a drop-in center and 24-hour crisis telephone support. In New York, a 5-bedroom program, with crisis telephone support, costs about $270,000 per year. House Bill #3584 calls for a DMH study to explore options, including funding.”
3. Founded in 2001, VOCAL is the Virginia Organization of Consumers Asserting Leadership, a nonprofit organization of people in mental health recovery.
VOCAL is a statewide community, support network, social change movement and self-help education program. The organization was created by and for people who have experienced emotional turbulence, mental health crisis, or extreme states of consciousness (commonly labeled as "mental illness”). VOCAL is currently 100% peer-run. All staff and board members identify as people in mental health recovery. VOCAL provides technical assistance, resources and supports for anyone wishing to develop, implement or strengthen a peer-run program. I believe there are about 35 peer-run orgs in Virginia at this time. From their website:
“VOCAL Program Membership is free and open to all peer-run programs in Virginia.
What is a peer-run program?
Peer-run programs are grassroots, self-help programs led by and for people in recovery from mental illness.
For example, at a peer-run drop-in center, the Board of Directors would be all or mostly people who have been diagnosed with mental illness (often called “peers”). The staff would also be peers who can offer first-person understanding, hope, and practical skills. They demonstrate the unique value of having “been there” and thriving since.
As people who have personally experienced mental illness, we work to create programs that respect the inherent worth and dignity of each individual, regardless of their current or past mental state, medical diagnosis, or use of medications.
Where can I find help for starting or running a peer-run program?
Many people begin their programs as small recovery groups that eventually may grow into larger programs or centers. If you are interested in learning to lead a mental health recovery group, we invite you to learn more about our Recovery Facilitator Trainings. Scholarships are available.
VOCAL also offers consulting and trainings for peer-run groups and centers in Virginia. We provide support in program development, strategic planning, forming a new group, and other areas of nonprofit management. To find out more, click here to learn more.
How are peer-run programs different than traditional services?
Peer-run programs are accessible, affordable and focus on self-determination and empowerment.
Peer programs generally have an “open door” with no intimidating paperwork, lengthy lines, disclosure requirements, waiting lists, required appointments, or threat of forced treatment.
Many programs are open on weekends and evenings – times when other mental health programs may be closed, and people may have nowhere to turn but hospitals or jails.
Many of us have found that peer-run programs can be “lifeline” and “safe haven” – especially for those who are homeless, experiencing severe mental illness, extremely isolated, unable to navigate the social service systems, or intentionally avoiding other services because of negative or abusive experiences in the past.
How can peer-run programs create recovery?
Peer-run programs believe that recovery from mental illness is possible. At peer-run programs, people break out of the roles of being “patients” and into roles as peers, advocates, support people, program organizers, and community leaders.
Many of us have found that joining a peer program was a turning point in our own personal process of mental health recovery. At a peer program, you will find staff and board who are peers, people who have gone through similar experiences. Programs are held in a safe environment where people can feel accepted and equal, and find opportunities for leadership, empowerment, and self-advocacy.
How can peer-run programs help transform the mental health system?
Peer-run programs are fertile grounds to create skilled and knowledgeable peer leaders – people who can educate providers, serve valuable roles on policy-making councils, act as mentors and role models to other peer advocates; and help create a recovery-orientated mental health system.
Peer-run programs can also provide a voice for people in the institutional environment (where people are typically at their most powerless). This can lead to improvements in quality of care, patient safety & patients’ rights.
Peer-operated programs have been shown to reduce participants’ use of outpatient services and physician visits, reducing the workload of these professionals, and helping create a system where people can and do recover.
Peer-run programs can serve as both complements and alternatives to traditional mental health programs, helping reach hard-to-reach populations, and helping create a system where all people have choice and option to find the kind of care that works best for them.
How can peer-run programs save the system money?
Studies show participants in peer-run programs spend less time in hospitals, use fewer crisis services and can often reduce their use of psychiatric medication, all of which reduce government costs.
Peer-run programs support people in recovery and can reduce their use of hospital, crisis, and other expensive services. A report from the Centre for Addiction and Mental Health in Canada includes a collection of studies:
One study demonstrates that the mean number of days in hospital dropped from over 48 to under 5 after participants became involved with a Peer-Operated Program.
Another study showed that Peer-Operated Programs saved more than $12 million in reduced hospital stays for three hospitals over the course of one year.
Another study showed that people with mental health problems who described themselves as "lonely" and were partnered with a peer mentor used an average of $20,300 less per person in hospital and emergency room services in the year after discharge.
There are many different types of peer-run alternatives to psychiatric hospitalization. Successful peer-run respites are currently operating in New Hampshire, Maine, W. Virginia, Ohio, Georgia, Alaska, New York, Nebraska, Arizona and North Carolina. In addition, programs are being developed in other states including Massachusetts, California, and New Mexico.”
4. It is important to note the word “recovery” carries many meanings around the world. Generally, the Consumer, Survivor/Ex-patient Movement (C/S/X) believes that recovery includes emancipation from the system completely.
I work very closely with the National Empowerment Center (NEC) in Lawrence, Massachusetts. From their website:
“Our Mission
To carry a message of recovery, empowerment, hope and healing to people with lived experience with mental health issues, trauma, and and/or extreme states.
Purpose
As a consumer/survivor/expatient-run organization, we carry out our mission with authority, as each of us is living a personal journey of recovery and empowerment. We are convinced that recovery and empowerment are not the privilege of a few exceptional leaders, but rather are possible for each person with lived experience. Whether on the back ward of a state mental institution or working as an executive in a corporation, we want people who are mental health consumers/survivors/ex-patients to know there is a place to turn to in order to receive the information they might need in order to regain control over their lives and the resources that affect their lives. That place is the National Empowerment Center.”
9. The National Empowerment Center maintains a list of peer-run respite services:
2nd Story Respite House
Website: www.secondstoryhouse.org
Contact: 831-466-0967
Visit 2nd Story's facebook page at www.facebook.com/2ndStoryRespite#!/2ndStoryRespite
2nd Story is a Peer Run Respite House designed to complement the services of other more traditional services in Santa Cruz County, CA; and to provide an alternative for people who are in distress and hoping to avoid a crisis and/or hospitalization. Founded in March 2011, we are funded with a five year SAMHSA Transformation grant that contains a research component to study the efficacy of Intentional Peer Support. Our staff has been trained in Intentional Peer Support with the aim to create a setting based on trauma informed principles. We are located in a convenient neighborhood, offer a comfortable home-like environment, and encourage people to share in household tasks. We have a maximum stay of 14 days and can accommodate up to 8 people. We are staffed 24 hours a day with the hope of creating open and trusting conversations that explore such questions as, "how did we get here?" and "what might we look like going forward?"
Alyssum, Inc.
Website: www.alyssum.org
Location: Rochester, Vermont
Contact: Gloria van den Berg, alyssum.ed@gmail.com
Phone: 802-767-6000
Open as of November 21, 2011, the mission of Alyssum is to provide a peer operated non- medical holistic approach to mental wellness and recovery for Vermonters who are experiencing emotional crisis. This alternative to psychiatric hospitalization provides a safe, mutually supportive, non- judgmental, educational and self- empowering environment. Alyssum affords individuals the opportunity to engage in the principles of wellness, recovery and peer support and to emerge from crisis with wisdom and the personal responsibility skills for living well.
Foundations: A Place for Education and Recovery
1707 Cleveland Ave., NW, Canton, OH
Contact: 330-454-2888
Funded by the county mental health board, the Foundations program includes educational and support groups, trainings, and opportunities for volunteers to be part of the organization. People are referred to the program by their service provider and usually stay 1-3 days. Three respite bedrooms are available; guests in the respite choose what they need to do for their own support and recovery. Many people become volunteer peer workers after being released. Suicidal people are referred to a crisis center. This is a clinically oriented respite program, overseen by the community mental health center and staffed by consumers.
Georgia Peer Support and Wellness Center - Decatur
Website: www.gmhcn.org/wellnesscenter/decatur.html
Location: 444 Sycamore Drive, Decatur, GA
Contact: Jayme Lynch, wellnesscenter@gmhcn.org
Phone: 404-371-1414
Funded by the Georgia Department of Human Resources Division of Mental Health, Consumer Relations and Recovery Section.
The Peer Support and Wellness Center is a peer-run alternative to traditional mental health day services and psychiatric hospitalization that opened January 30, 2008. A 24-hour warmline for peer support over the phone is available at the number listed above. The Center is open from 9 a.m. to 7:30 p.m. seven days per week for wellness activities that many people attend. The Peer Support and Wellness Center has three respite bedrooms, which can be occupied by participants who need extra support for up to seven days and prefer not to be in a hospital setting. The
Peer Support and Wellness Center is a project of the Georgia Mental Health Consumer Network. [Visit their website]
Georgia Peer Support, Wellness, and Respite Center - Bartow County
Website: www.gmhcn.org/wellnesscenter/bartow
Location: 201 N. Erwin St., Cartersville, GA
Contact: James Guffey, wellnesscenter@gmhcn.org
Phone: 770-276-2019
Funded by the Georgia Department of Human Resources Division of Mental Health, Consumer Relations and Recovery Section.
The Peer Support and Wellness Center is a peer-run alternative to traditional mental health day services and psychiatric hospitalization that opened January 30, 2008. A 24-hour warmline for peer support over the phone is available at the number listed above. The Center is open from 9 a.m. to 7:30 p.m. seven days per week for wellness activities that many people attend. The Peer Support and Wellness Center has three respite bedrooms, which can be occupied by participants who need extra support for up to seven days and prefer not to be in a hospital setting. The Peer Support and Wellness Center is a project of the Georgia Mental Health Consumer Network. [Visit their website]
Georgia Peer Support, Wellness, and Respite Center - White County
Website: www.gmhcn.org/wellnesscenter/white
Location: 46 Knaus Drive, Cleveland, GA
Contact: Clint Taylor, wellnesscenter@gmhcn.org
Phone: 706-865-3601
The Peer Support and Wellness Center is a peer-run alternative to traditional mental health day services and psychiatric hospitalization that opened January 30, 2008. A 24-hour warmline for peer support over the phone is available at the number listed above. The Center is open from 9 a.m. to 7:30 p.m. seven days per week for wellness activities that many people attend. The Peer Support and Wellness Center has three respite bedrooms, which can be occupied by participants who need extra support for up to seven days and prefer not to be in a hospital setting. The Peer Support and Wellness Center is a project of the Georgia Mental Health Consumer Network. [Visit their website]
KEYA HOUSE
Lincoln, Nebraska, Mental Health Association of Nebraska, 888-902-2822
Website: http://keya.mha-ne.org
Keya House is a peer-run respite program offering an alternative support system to psychiatric hospitalization. Keya House provides a comfortable, clean, furnished four-bedroom house in a quiet and safe neighborhood. Trained peer companions who are compassionate, understanding, and empowering offer self-help and proactive recovery tools to regain and maintain wellness. They understand the need for support in these difficult times, and offer strength, hope, and knowledge about recovery to those individuals who need a supportive and healing environment.
ROSE HOUSE HOSPITAL DIVERSION PROGRAM by PEOPLe Inc. - Milton, NY
Location: 1616 Route 9W, Milton, NY
Contact: Vanessa Turner, Hdiversion@aol.com
Phone: 845-795-2346
Cost per day: $657 for 1-5 people; $132 per person per day if house is at full occupancy.
Website: http://login.npwebsiteservices.com/PEOPLE/HospitalDiversion.asp
Rose House is an innovative and unique “hospital diversion” model whereby persons seeking temporary residential care/respite care can stay from one to five nights in a warm, friendly, safe and supportive home-like environment where they are taught to use new recovery and relapse prevention skills. Rose House’s services are designed to help ‘at risk’ individuals to break the cycle of learned helplessness and recidivism and to move away from what are often long histories of cycling from home to crisis to hospital, year after year. This is achieved through twenty-four hour peer support, self-advocacy education, self-help training and mutual understanding. In addition to the Rose House, PEOPLe, Inc. has developed a continuum of peer-operated services that are collaboratively integrated with the community mental health service delivery system; these include peer emergency room services, peer-run crisis support warmline, and an in-home companion program. All services are free to recipients.
ROSE HOUSE HOSPITAL DIVERSION PROGRAM by PEOPLe Inc. - Putnam County, NY
Location: 63 Kent Lake Ave., Carmel, NY
Contact: John Culligan, Hdiversion@aol.com
Phone: 845-225-7469
Cost per day: $657 for 1-5 people; $132 per person per day if house is at full occupancy.
Website: http://login.npwebsiteservices.com/PEOPLE/HospitalDiversion.asp
Rose House is an innovative and unique “hospital diversion” model whereby persons seeking temporary residential care/respite care can stay from one to five nights in a warm, friendly, safe and supportive home-like environment where they are taught to use new recovery and relapse prevention skills. Rose House’s services are designed to help ‘at risk’ individuals to break the cycle of learned helplessness and recidivism and to move away from what are often long histories of cycling from home to crisis to hospital, year after year. This is achieved through twenty-four hour peer support, self-advocacy education, self-help training and mutual understanding. In addition to the Rose House, PEOPLe, Inc. has developed a continuum of peer-operated services that are collaboratively integrated with the community mental health service delivery system; these include peer emergency room services, peer-run crisis support warmline, and an in-home companion program. All services are free to recipients.
STEPPING STONE PEER SUPPORT & CRISIS RESPITE CENTER
Website: www.steppingstonenextstep.org
Established in 1995, Stepping Stone is an active peer center open 7 hours a day Monday through Saturday with a variety of activities for clients and with two bedrooms for those who choose to stay as respite guests. People who choose to say as guests stay overnight from one to seven days and are welcome to bring their pets. This is an alternative to psychiatric hospitalization, serving individuals with overwhelming feelings including those who feel so badly that they do not want to continue living. Guests are free to come and go. Some continue to go to work and stay overnight at Stepping Stone. Guests bring and cook their own food and can have 24-hour peer support available to them. Stepping Stone Crisis Respite Program creates an opportunity for people to learn from, and be supported in making the transition from crisis to wellness. Within the context of a mutually responsible relationship, and with the help of consumer staff’s experiential knowledge and training, those who sincerely wish to overcome their difficulties can greatly reduce the use of more restrictive hospital settings, including involuntary admissions. All services are free to New Hampshire residents.
SWEETSER PEER SUPPORT & LEARNING & RECOVERY CENTER
Website: www.sweetser.org/peers.aspx
Location: 174 Mere Point Road, Brunswick, Maine 04011
Contact: Ron Welch, 207-373-4273
Funded by Maine Department of Health and Human Services, Sweeter’ Endowment and Mid Coast United Way.
Established in 2002, Peer Crisis Respite services are available to individuals who are experiencing a period of intensified emotional distress. Support is provided in one of three beds at Maine’s only Peer Crisis Respite program. Peer Support Specialist utilize the principles of Recovery and Intentional Peer Support to support the guest who is experiencing a mental health crisis to resolve the crisis situation; to assist the individual to view the crisis as an opportunity for growth, change, and transformation; to consider proactive ways for the individual to manage future crises. Volunteers and community participants are also available during the hours the Learning & Recovery Center is open to engage in mutual conversations centered on Recovery and personal growth. Programs offered include recovery focused groups and art groups. Staff are paid Certified Peer Support Specialist with a history as a consumer of mental health services and recovery work, using an Intentional Peer Support model based on the work of Shery Mead, www.mentalhealthpeers.com. Warmline: 866-771-WARM (9276) - Local crisis number: 800-400-2506.
VOICES OF THE HEART, INC.
Serves Washington and Warren County, NY, 508-747-8404 www.voicesoftheheart.net
The Respite Program offered by Voices of the Heart, Inc is available to individuals experiencing emotional distress. Offering an alternative to emergency hospital services and hospital admissions, the Respite Program is a community and people centered hospital diversion program. The program is different from other forms of crisis response as it starts with the idea that crisis is an opportunity to grow in relationship and change old patterns. The program offers honest, caring, mutually supportive and responsible relationships. This is done in by sharing a home and community–like environment where people are supported to work through the emotional crisis.
WEST VIRGINIA MENTAL HEALTH CONSUMERS’ ASSOCIATION
WV MH Consumers’ Association, 910 Quarrier St., Charleston, WV 25301, 304-345-7312
Contact: Lee Horton, Director of Community Supports
Funded by the West Virginia State Bureau and the state legislature. WVMHCA has three houses for 20 guests in dormitory style living: Holly House, Almost Home and New Beginnings. The program offers a continuum of support and wraparound services. The program philosophy is that “with a roof over your head, food on your table and some change in your pocket and you can start your recovery.” People are encouraged to find employment, volunteer, or seek addiction services if needed.“
5. It is interesting to note many of these services have a trauma-informed perspective or a wrap-around philosophy; both important focuses in Colorado.
Finally, one of my very favorite peer-run organizations is in Kansas, Wellness Wordworks.
6. Wellness Wordworks was founded by Corinna West in 2008. Corinna is an entrepreneur, a spoken word poet, and a catalyst for change. To see her personal website about recovery from psychiatric diagnosing, bicycling across country, or motivation speaking opportunities, go to http://CorinnaWest.com. You may have seen a Wellness Wordworks yellow “Cut Our Budget” t-shirt at a meeting here in Colorado- many Kansans attended the NEC Conference in Denver last April “Expanding Our Vision: Positive Outcomes from Around the World”.
7. Another big favorite of mine is SOAR Case Management Services in Dane County, Wisconsin. Founded by Jenifer Koberstein- Malloy, who now works at Arapahoe/Douglas Mental Health Network, SOAR is peer-run yet has a mixed workforce, and provides intensive, mobile-based case management services to high-end utilizers. SOAR has been around for over ten years and was recently awarded a new contract with the county.
THANK YOU for the opportunity to work on this planning committee! Please know that I have contacts at all the listed facilities and if there is anything you would like to know more about, please let me know. In addition, these folks would be more than happy to phone conference with us, or host a visit.
Remember, the National Association of State Mental Health Program Directors (NASMHPD) states in their report,:
“What Helps and What Hinders”, “Peer Support is THE most effective
mental health intervention”.
In the United States, there is no more effective intervention, no more cost-efficient service you can deliver.
Thank you!
Amy Smith
June 17, 2012
1.) Pat Risser, Mental Health Consultant http://www.patrisser.com/CMAs.html Retrieved June 15, 2012
2.) http://friendlyharbor.org/fhcontent.html
3.) http://www.rockymountaindbsa.org/
4.) The Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities http://tucollaborative.org/comm_inclusion/peer_support.html Retrieved June 15, 2012
5.) http://www.m-power.org/
6.) http://www.m-power.org/peer_run_respite Retrieved June 14, 2012
7.) Virginia Organization of Consumers Asserting Leadership http://www.vocalvirginia.org/#/about-peer-run-programs/4533896351 Retrieved June 13, 2012
8.) VOCAL http://www.vocalvirginia.org/#/about-peer-run-programs/4533896351 Retrieved June 13, 2012
9.) National Empowerment Center http://www.power2u.org/what.html Retrieved June 16, 2012
10.) NEC http://www.power2u.org/peer-run-crisis-services.html Retrieved June 17, 2012
11.) Wellness Wordworks http://wellnesswordworks.com/ Retrieved June 17, 2012
12.) http://expanding-our-vision.eventbrite.com/ Retrieved June 16, 2012
13.) http://www.danecountyhumanservices.org/MentalHealth/Adult/community_support.aspx Retrieved June 16, 2012
14.) NASMHPD http://www.nasmhpd.org/general_files/publications/ntac_pubs/reports/MHSIPReport.pdf Retrieved June 12, 2012
A Report for Colorado BRSS TACS (Bringing Recovery Supports to Scale Technical Assistance Center Strategy)
June 15, 2012
Prepared by Amy Smith crazydiamondUSA@gmail.com
Best viewed electronically
Disclaimer: I have no knowledge regarding peer services in the substance use community, although I do consider 12-Step programs to be the granddaddy peer support of them all! This report focuses on peer support in the C/S/X community.
Colorado was the first state in the nation to employ peers in the service delivery system. “In the spring of 1986 the Colorado Division of Mental Health began a pilot project to train and employ individuals with chronic mental illness to provide case management services to other mental health consumers. The project's goal was to have the four community mental health centers in Denver employ 20 consumers who would share ten full-time jobs with the title of consumer case management aide. Job-sharing would provide employers with a way to ensure coverage if a case management aide decompensated and would also allow case management aides to have flexible work schedules.
The Division of Mental Health recognized that people with extended experience as consumers in the mental health and social services systems have acquired usable expertise. The organizers of the project believed that consumers would be able to establish rapport more quickly with other consumers, especially those who are reluctant to accept traditional mental health services. In addition, over the last decade, new developments and refinements in psychiatric rehabilitation have brought about improved outcomes for persons with chronic mental illness.
Mental health consumers with chronic mental illness were trained for employment as case management aides in a psychiatric rehabilitation project in Denver.
The project incorporated cooperative arrangements between the mental health system and vocational rehabilitation and occupational education agencies. The process used to recruit, select, train, and employ the consumer case management aides is described. Eighteen of the 25 trainees who began the training completed the program, and 17 moved on to employment as case management aides. At two-year follow-up, the 15 trainees who were still employed as case management aides had required a total of only two bed-days of psychiatric hospitalization since the training ended.”
1. Many RATC graduates are still employed in the Colorado service delivery system today, in various roles. Sadly, today, Colorado is one of the lowest-ranking states in the nation in terms of peer-run services. While other states have developed peer-delivered services ranging from peer respite, vocational assistance, crisis services, residential care, mutual peer support and many other varied models, Colorado peers tend to be employed as peer specialists employed by mental health centers or managed care organizations.
At this writing, there are two true peer-run organizations in Colorado, Friendly Harbor Drop-In Center in Pueblo, Colorado, and the Depression/Bipolar Support Alliance of Colorado located in Colorado Springs. Both are operated by peers, who control all aspects of the businesses. Neither organization compensates its employees; they are 100% volunteer run. To be clear, a legitimate peer-run enterprise controls all aspects of the organization. Typically, peer-run organizations maintain a balance of peer board members at a minimum of 51%. SAMHSA requires a peer-run organization to be controlled by peers at all levels, including fiscal oversight.
According to The Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities, peer-run services are:
• Peer-delivered services are services provided by individuals who identify themselves as having mental illnesses, are receiving or have received mental health services for their mental illnesses, and deliver services for the primary purpose of helping others with mental illnesses.
• Peer-delivered services may also include partnering with non-peers, but peers still maintain control of the service. These may be called peer-partnership services.
• Peer-run or -operated services are services that are planned, operated, managed by people with psychiatric disorders.
• Peer employees are individuals who identify as peers and are hired by non-peer agencies, e.g., community mental health centers. Peers may be hired into designated peer positions or traditional clinical positions.
• Peers serve as case managers, outreach workers, and mobile crisis workers, among other possibilities. 4.)
The United States has hundreds of peer-run service delivery organizations of all types, and of great diversity. For the purposes of this quick study, I will limit my discussion to peer-run respite services. I will also include a brief overview of some other peer services of particular interest to Coloradans in the closing statements.
In 2009, Massachusetts passed HB 3584, which requires the Massachusetts Department of Mental Health (DMH) to conduct a feasibility study about establishing peer-run respites as progressive alternatives to mental hospitals.
2. M-POWER is a member run organization of mental health consumers and current and former psychiatric patients in Massachusetts.
According to M-POWER:
“A peer-run respite is a safe house, where people learn to manage emotional crises in a warm, welcoming, home-like environment, in contrast to locked psychiatric wards, which are institutional and impersonal. Peers find compassion and understanding from a trained peer staff, where they can new skills for recovery. Programs, such as the Wellness Recovery Action Plan prevent relapse, and Peer Specialist certification promote employment.
What are the benefits of peer-run respites?
Studies show peer-run respites have clear advantages over mental hospitals. A California study showed "significantly greater improvement" and "satisfaction was dramatically higher" than with a locked psychiatric ward. Self-harm and violence is actually more likely on locked psychiatric wards because of the pressured atmosphere.
The cost of a peer-run respite is cost only about $250 per person per day, whereas psychiatric hospitals cost $1,000 per day or more. Over a year, a 3-bed peer respite saves $1 million. Creating 3 respites-in Central, Western and Metro-Suburban Mass.-will save $3 million. Savings are realized on hospital costs, ER visits, police time and ambulance costs. Peer-run respites also save additional money by increasing peers’ independence, so people use less costly mental health services in the future.
Who is eligible to enter peer-run respite programs?
Anyone who is experiencing a mental health crisis, but not deemed dangerous to others, will be eligible to go into a peer-run respite. In New Hampshire and Georgia’s progressive, peer-run respites even self-injurious and actively suicidal people are welcome. Peer-run respites would be part of a menu of crisis service options, complementary to existing programs. Participation in all peer-run services is completely voluntary.
Are there successful examples of peer-run respites?
Currently, there are 14 programs-in New York (2), Maine, New Hampshire, West Virginia, Ohio, California and Georgia and 6 overseas. New programs are starting in Vermont, New Mexico, Nebraska and Alaska.
How are other peer-run respites funded?
In some states peer-run respites are funded by federal SAMSHA block grants. In Georgia, 2-bedrooms cost about $300,000 per year, including a drop-in center and 24-hour crisis telephone support. In New York, a 5-bedroom program, with crisis telephone support, costs about $270,000 per year. House Bill #3584 calls for a DMH study to explore options, including funding.”
3. Founded in 2001, VOCAL is the Virginia Organization of Consumers Asserting Leadership, a nonprofit organization of people in mental health recovery.
VOCAL is a statewide community, support network, social change movement and self-help education program. The organization was created by and for people who have experienced emotional turbulence, mental health crisis, or extreme states of consciousness (commonly labeled as "mental illness”). VOCAL is currently 100% peer-run. All staff and board members identify as people in mental health recovery. VOCAL provides technical assistance, resources and supports for anyone wishing to develop, implement or strengthen a peer-run program. I believe there are about 35 peer-run orgs in Virginia at this time. From their website:
“VOCAL Program Membership is free and open to all peer-run programs in Virginia.
What is a peer-run program?
Peer-run programs are grassroots, self-help programs led by and for people in recovery from mental illness.
For example, at a peer-run drop-in center, the Board of Directors would be all or mostly people who have been diagnosed with mental illness (often called “peers”). The staff would also be peers who can offer first-person understanding, hope, and practical skills. They demonstrate the unique value of having “been there” and thriving since.
As people who have personally experienced mental illness, we work to create programs that respect the inherent worth and dignity of each individual, regardless of their current or past mental state, medical diagnosis, or use of medications.
Where can I find help for starting or running a peer-run program?
Many people begin their programs as small recovery groups that eventually may grow into larger programs or centers. If you are interested in learning to lead a mental health recovery group, we invite you to learn more about our Recovery Facilitator Trainings. Scholarships are available.
VOCAL also offers consulting and trainings for peer-run groups and centers in Virginia. We provide support in program development, strategic planning, forming a new group, and other areas of nonprofit management. To find out more, click here to learn more.
How are peer-run programs different than traditional services?
Peer-run programs are accessible, affordable and focus on self-determination and empowerment.
Peer programs generally have an “open door” with no intimidating paperwork, lengthy lines, disclosure requirements, waiting lists, required appointments, or threat of forced treatment.
Many programs are open on weekends and evenings – times when other mental health programs may be closed, and people may have nowhere to turn but hospitals or jails.
Many of us have found that peer-run programs can be “lifeline” and “safe haven” – especially for those who are homeless, experiencing severe mental illness, extremely isolated, unable to navigate the social service systems, or intentionally avoiding other services because of negative or abusive experiences in the past.
How can peer-run programs create recovery?
Peer-run programs believe that recovery from mental illness is possible. At peer-run programs, people break out of the roles of being “patients” and into roles as peers, advocates, support people, program organizers, and community leaders.
Many of us have found that joining a peer program was a turning point in our own personal process of mental health recovery. At a peer program, you will find staff and board who are peers, people who have gone through similar experiences. Programs are held in a safe environment where people can feel accepted and equal, and find opportunities for leadership, empowerment, and self-advocacy.
How can peer-run programs help transform the mental health system?
Peer-run programs are fertile grounds to create skilled and knowledgeable peer leaders – people who can educate providers, serve valuable roles on policy-making councils, act as mentors and role models to other peer advocates; and help create a recovery-orientated mental health system.
Peer-run programs can also provide a voice for people in the institutional environment (where people are typically at their most powerless). This can lead to improvements in quality of care, patient safety & patients’ rights.
Peer-operated programs have been shown to reduce participants’ use of outpatient services and physician visits, reducing the workload of these professionals, and helping create a system where people can and do recover.
Peer-run programs can serve as both complements and alternatives to traditional mental health programs, helping reach hard-to-reach populations, and helping create a system where all people have choice and option to find the kind of care that works best for them.
How can peer-run programs save the system money?
Studies show participants in peer-run programs spend less time in hospitals, use fewer crisis services and can often reduce their use of psychiatric medication, all of which reduce government costs.
Peer-run programs support people in recovery and can reduce their use of hospital, crisis, and other expensive services. A report from the Centre for Addiction and Mental Health in Canada includes a collection of studies:
One study demonstrates that the mean number of days in hospital dropped from over 48 to under 5 after participants became involved with a Peer-Operated Program.
Another study showed that Peer-Operated Programs saved more than $12 million in reduced hospital stays for three hospitals over the course of one year.
Another study showed that people with mental health problems who described themselves as "lonely" and were partnered with a peer mentor used an average of $20,300 less per person in hospital and emergency room services in the year after discharge.
There are many different types of peer-run alternatives to psychiatric hospitalization. Successful peer-run respites are currently operating in New Hampshire, Maine, W. Virginia, Ohio, Georgia, Alaska, New York, Nebraska, Arizona and North Carolina. In addition, programs are being developed in other states including Massachusetts, California, and New Mexico.”
4. It is important to note the word “recovery” carries many meanings around the world. Generally, the Consumer, Survivor/Ex-patient Movement (C/S/X) believes that recovery includes emancipation from the system completely.
I work very closely with the National Empowerment Center (NEC) in Lawrence, Massachusetts. From their website:
“Our Mission
To carry a message of recovery, empowerment, hope and healing to people with lived experience with mental health issues, trauma, and and/or extreme states.
Purpose
As a consumer/survivor/expatient-run organization, we carry out our mission with authority, as each of us is living a personal journey of recovery and empowerment. We are convinced that recovery and empowerment are not the privilege of a few exceptional leaders, but rather are possible for each person with lived experience. Whether on the back ward of a state mental institution or working as an executive in a corporation, we want people who are mental health consumers/survivors/ex-patients to know there is a place to turn to in order to receive the information they might need in order to regain control over their lives and the resources that affect their lives. That place is the National Empowerment Center.”
9. The National Empowerment Center maintains a list of peer-run respite services:
2nd Story Respite House
Website: www.secondstoryhouse.org
Contact: 831-466-0967
Visit 2nd Story's facebook page at www.facebook.com/2ndStoryRespite#!/2ndStoryRespite
2nd Story is a Peer Run Respite House designed to complement the services of other more traditional services in Santa Cruz County, CA; and to provide an alternative for people who are in distress and hoping to avoid a crisis and/or hospitalization. Founded in March 2011, we are funded with a five year SAMHSA Transformation grant that contains a research component to study the efficacy of Intentional Peer Support. Our staff has been trained in Intentional Peer Support with the aim to create a setting based on trauma informed principles. We are located in a convenient neighborhood, offer a comfortable home-like environment, and encourage people to share in household tasks. We have a maximum stay of 14 days and can accommodate up to 8 people. We are staffed 24 hours a day with the hope of creating open and trusting conversations that explore such questions as, "how did we get here?" and "what might we look like going forward?"
Alyssum, Inc.
Website: www.alyssum.org
Location: Rochester, Vermont
Contact: Gloria van den Berg, alyssum.ed@gmail.com
Phone: 802-767-6000
Open as of November 21, 2011, the mission of Alyssum is to provide a peer operated non- medical holistic approach to mental wellness and recovery for Vermonters who are experiencing emotional crisis. This alternative to psychiatric hospitalization provides a safe, mutually supportive, non- judgmental, educational and self- empowering environment. Alyssum affords individuals the opportunity to engage in the principles of wellness, recovery and peer support and to emerge from crisis with wisdom and the personal responsibility skills for living well.
Foundations: A Place for Education and Recovery
1707 Cleveland Ave., NW, Canton, OH
Contact: 330-454-2888
Funded by the county mental health board, the Foundations program includes educational and support groups, trainings, and opportunities for volunteers to be part of the organization. People are referred to the program by their service provider and usually stay 1-3 days. Three respite bedrooms are available; guests in the respite choose what they need to do for their own support and recovery. Many people become volunteer peer workers after being released. Suicidal people are referred to a crisis center. This is a clinically oriented respite program, overseen by the community mental health center and staffed by consumers.
Georgia Peer Support and Wellness Center - Decatur
Website: www.gmhcn.org/wellnesscenter/decatur.html
Location: 444 Sycamore Drive, Decatur, GA
Contact: Jayme Lynch, wellnesscenter@gmhcn.org
Phone: 404-371-1414
Funded by the Georgia Department of Human Resources Division of Mental Health, Consumer Relations and Recovery Section.
The Peer Support and Wellness Center is a peer-run alternative to traditional mental health day services and psychiatric hospitalization that opened January 30, 2008. A 24-hour warmline for peer support over the phone is available at the number listed above. The Center is open from 9 a.m. to 7:30 p.m. seven days per week for wellness activities that many people attend. The Peer Support and Wellness Center has three respite bedrooms, which can be occupied by participants who need extra support for up to seven days and prefer not to be in a hospital setting. The
Peer Support and Wellness Center is a project of the Georgia Mental Health Consumer Network. [Visit their website]
Georgia Peer Support, Wellness, and Respite Center - Bartow County
Website: www.gmhcn.org/wellnesscenter/bartow
Location: 201 N. Erwin St., Cartersville, GA
Contact: James Guffey, wellnesscenter@gmhcn.org
Phone: 770-276-2019
Funded by the Georgia Department of Human Resources Division of Mental Health, Consumer Relations and Recovery Section.
The Peer Support and Wellness Center is a peer-run alternative to traditional mental health day services and psychiatric hospitalization that opened January 30, 2008. A 24-hour warmline for peer support over the phone is available at the number listed above. The Center is open from 9 a.m. to 7:30 p.m. seven days per week for wellness activities that many people attend. The Peer Support and Wellness Center has three respite bedrooms, which can be occupied by participants who need extra support for up to seven days and prefer not to be in a hospital setting. The Peer Support and Wellness Center is a project of the Georgia Mental Health Consumer Network. [Visit their website]
Georgia Peer Support, Wellness, and Respite Center - White County
Website: www.gmhcn.org/wellnesscenter/white
Location: 46 Knaus Drive, Cleveland, GA
Contact: Clint Taylor, wellnesscenter@gmhcn.org
Phone: 706-865-3601
The Peer Support and Wellness Center is a peer-run alternative to traditional mental health day services and psychiatric hospitalization that opened January 30, 2008. A 24-hour warmline for peer support over the phone is available at the number listed above. The Center is open from 9 a.m. to 7:30 p.m. seven days per week for wellness activities that many people attend. The Peer Support and Wellness Center has three respite bedrooms, which can be occupied by participants who need extra support for up to seven days and prefer not to be in a hospital setting. The Peer Support and Wellness Center is a project of the Georgia Mental Health Consumer Network. [Visit their website]
KEYA HOUSE
Lincoln, Nebraska, Mental Health Association of Nebraska, 888-902-2822
Website: http://keya.mha-ne.org
Keya House is a peer-run respite program offering an alternative support system to psychiatric hospitalization. Keya House provides a comfortable, clean, furnished four-bedroom house in a quiet and safe neighborhood. Trained peer companions who are compassionate, understanding, and empowering offer self-help and proactive recovery tools to regain and maintain wellness. They understand the need for support in these difficult times, and offer strength, hope, and knowledge about recovery to those individuals who need a supportive and healing environment.
ROSE HOUSE HOSPITAL DIVERSION PROGRAM by PEOPLe Inc. - Milton, NY
Location: 1616 Route 9W, Milton, NY
Contact: Vanessa Turner, Hdiversion@aol.com
Phone: 845-795-2346
Cost per day: $657 for 1-5 people; $132 per person per day if house is at full occupancy.
Website: http://login.npwebsiteservices.com/PEOPLE/HospitalDiversion.asp
Rose House is an innovative and unique “hospital diversion” model whereby persons seeking temporary residential care/respite care can stay from one to five nights in a warm, friendly, safe and supportive home-like environment where they are taught to use new recovery and relapse prevention skills. Rose House’s services are designed to help ‘at risk’ individuals to break the cycle of learned helplessness and recidivism and to move away from what are often long histories of cycling from home to crisis to hospital, year after year. This is achieved through twenty-four hour peer support, self-advocacy education, self-help training and mutual understanding. In addition to the Rose House, PEOPLe, Inc. has developed a continuum of peer-operated services that are collaboratively integrated with the community mental health service delivery system; these include peer emergency room services, peer-run crisis support warmline, and an in-home companion program. All services are free to recipients.
ROSE HOUSE HOSPITAL DIVERSION PROGRAM by PEOPLe Inc. - Putnam County, NY
Location: 63 Kent Lake Ave., Carmel, NY
Contact: John Culligan, Hdiversion@aol.com
Phone: 845-225-7469
Cost per day: $657 for 1-5 people; $132 per person per day if house is at full occupancy.
Website: http://login.npwebsiteservices.com/PEOPLE/HospitalDiversion.asp
Rose House is an innovative and unique “hospital diversion” model whereby persons seeking temporary residential care/respite care can stay from one to five nights in a warm, friendly, safe and supportive home-like environment where they are taught to use new recovery and relapse prevention skills. Rose House’s services are designed to help ‘at risk’ individuals to break the cycle of learned helplessness and recidivism and to move away from what are often long histories of cycling from home to crisis to hospital, year after year. This is achieved through twenty-four hour peer support, self-advocacy education, self-help training and mutual understanding. In addition to the Rose House, PEOPLe, Inc. has developed a continuum of peer-operated services that are collaboratively integrated with the community mental health service delivery system; these include peer emergency room services, peer-run crisis support warmline, and an in-home companion program. All services are free to recipients.
STEPPING STONE PEER SUPPORT & CRISIS RESPITE CENTER
Website: www.steppingstonenextstep.org
Established in 1995, Stepping Stone is an active peer center open 7 hours a day Monday through Saturday with a variety of activities for clients and with two bedrooms for those who choose to stay as respite guests. People who choose to say as guests stay overnight from one to seven days and are welcome to bring their pets. This is an alternative to psychiatric hospitalization, serving individuals with overwhelming feelings including those who feel so badly that they do not want to continue living. Guests are free to come and go. Some continue to go to work and stay overnight at Stepping Stone. Guests bring and cook their own food and can have 24-hour peer support available to them. Stepping Stone Crisis Respite Program creates an opportunity for people to learn from, and be supported in making the transition from crisis to wellness. Within the context of a mutually responsible relationship, and with the help of consumer staff’s experiential knowledge and training, those who sincerely wish to overcome their difficulties can greatly reduce the use of more restrictive hospital settings, including involuntary admissions. All services are free to New Hampshire residents.
SWEETSER PEER SUPPORT & LEARNING & RECOVERY CENTER
Website: www.sweetser.org/peers.aspx
Location: 174 Mere Point Road, Brunswick, Maine 04011
Contact: Ron Welch, 207-373-4273
Funded by Maine Department of Health and Human Services, Sweeter’ Endowment and Mid Coast United Way.
Established in 2002, Peer Crisis Respite services are available to individuals who are experiencing a period of intensified emotional distress. Support is provided in one of three beds at Maine’s only Peer Crisis Respite program. Peer Support Specialist utilize the principles of Recovery and Intentional Peer Support to support the guest who is experiencing a mental health crisis to resolve the crisis situation; to assist the individual to view the crisis as an opportunity for growth, change, and transformation; to consider proactive ways for the individual to manage future crises. Volunteers and community participants are also available during the hours the Learning & Recovery Center is open to engage in mutual conversations centered on Recovery and personal growth. Programs offered include recovery focused groups and art groups. Staff are paid Certified Peer Support Specialist with a history as a consumer of mental health services and recovery work, using an Intentional Peer Support model based on the work of Shery Mead, www.mentalhealthpeers.com. Warmline: 866-771-WARM (9276) - Local crisis number: 800-400-2506.
VOICES OF THE HEART, INC.
Serves Washington and Warren County, NY, 508-747-8404 www.voicesoftheheart.net
The Respite Program offered by Voices of the Heart, Inc is available to individuals experiencing emotional distress. Offering an alternative to emergency hospital services and hospital admissions, the Respite Program is a community and people centered hospital diversion program. The program is different from other forms of crisis response as it starts with the idea that crisis is an opportunity to grow in relationship and change old patterns. The program offers honest, caring, mutually supportive and responsible relationships. This is done in by sharing a home and community–like environment where people are supported to work through the emotional crisis.
WEST VIRGINIA MENTAL HEALTH CONSUMERS’ ASSOCIATION
WV MH Consumers’ Association, 910 Quarrier St., Charleston, WV 25301, 304-345-7312
Contact: Lee Horton, Director of Community Supports
Funded by the West Virginia State Bureau and the state legislature. WVMHCA has three houses for 20 guests in dormitory style living: Holly House, Almost Home and New Beginnings. The program offers a continuum of support and wraparound services. The program philosophy is that “with a roof over your head, food on your table and some change in your pocket and you can start your recovery.” People are encouraged to find employment, volunteer, or seek addiction services if needed.“
5. It is interesting to note many of these services have a trauma-informed perspective or a wrap-around philosophy; both important focuses in Colorado.
Finally, one of my very favorite peer-run organizations is in Kansas, Wellness Wordworks.
6. Wellness Wordworks was founded by Corinna West in 2008. Corinna is an entrepreneur, a spoken word poet, and a catalyst for change. To see her personal website about recovery from psychiatric diagnosing, bicycling across country, or motivation speaking opportunities, go to http://CorinnaWest.com. You may have seen a Wellness Wordworks yellow “Cut Our Budget” t-shirt at a meeting here in Colorado- many Kansans attended the NEC Conference in Denver last April “Expanding Our Vision: Positive Outcomes from Around the World”.
7. Another big favorite of mine is SOAR Case Management Services in Dane County, Wisconsin. Founded by Jenifer Koberstein- Malloy, who now works at Arapahoe/Douglas Mental Health Network, SOAR is peer-run yet has a mixed workforce, and provides intensive, mobile-based case management services to high-end utilizers. SOAR has been around for over ten years and was recently awarded a new contract with the county.
THANK YOU for the opportunity to work on this planning committee! Please know that I have contacts at all the listed facilities and if there is anything you would like to know more about, please let me know. In addition, these folks would be more than happy to phone conference with us, or host a visit.
Remember, the National Association of State Mental Health Program Directors (NASMHPD) states in their report,:
“What Helps and What Hinders”, “Peer Support is THE most effective
mental health intervention”.
In the United States, there is no more effective intervention, no more cost-efficient service you can deliver.
Thank you!
Amy Smith
June 17, 2012
1.) Pat Risser, Mental Health Consultant http://www.patrisser.com/CMAs.html Retrieved June 15, 2012
2.) http://friendlyharbor.org/fhcontent.html
3.) http://www.rockymountaindbsa.org/
4.) The Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities http://tucollaborative.org/comm_inclusion/peer_support.html Retrieved June 15, 2012
5.) http://www.m-power.org/
6.) http://www.m-power.org/peer_run_respite Retrieved June 14, 2012
7.) Virginia Organization of Consumers Asserting Leadership http://www.vocalvirginia.org/#/about-peer-run-programs/4533896351 Retrieved June 13, 2012
8.) VOCAL http://www.vocalvirginia.org/#/about-peer-run-programs/4533896351 Retrieved June 13, 2012
9.) National Empowerment Center http://www.power2u.org/what.html Retrieved June 16, 2012
10.) NEC http://www.power2u.org/peer-run-crisis-services.html Retrieved June 17, 2012
11.) Wellness Wordworks http://wellnesswordworks.com/ Retrieved June 17, 2012
12.) http://expanding-our-vision.eventbrite.com/ Retrieved June 16, 2012
13.) http://www.danecountyhumanservices.org/MentalHealth/Adult/community_support.aspx Retrieved June 16, 2012
14.) NASMHPD http://www.nasmhpd.org/general_files/publications/ntac_pubs/reports/MHSIPReport.pdf Retrieved June 12, 2012