hill country observerThe independent newspaper of eastern New York, southwestern Vermont and the Berkshires


News & Issues February-March 2018


A new model of care

Region’s peer-respite homes offer alternative approach to mental health


The weekly staff meeting at Alyssum, a peer-respite house in Rochester, Vt., is unlike any other gathering of its kind. The focus is on team building through an approach called “co-supervision.”Courtesy photoThe weekly staff meeting at Alyssum, a peer-respite house in Rochester, Vt., is unlike any other gathering of its kind. The focus is on team building through an approach called “co-supervision.”Courtesy photo


Contributing writer


For many people in the grip of a scary emotional crisis, the local hospital emergency room has become the first stop in the quest for help.

But the typical modern emergency room doesn’t offer the comforting, healing setting needed by people battling demons in their head or feeling that there’s no longer a point to living. Worse, there’ve been a series of reports in Vermont recently of mental health patients who wound up confined in hospital emergency departments for days as they awaited a bed in the psychiatric ward or a transfer to another facility.

For people at their most emotionally vulnerable, hospital emergency rooms have one chief attraction: They are unable to turn away desperate people.

In recent years, though, the search for more appropriate settings for people in crisis has led the development of an alternative known as “peer-respite” homes that don’t operate under the medical model. These homes are an outgrowth of the peer-support movement, a civil rights initiative forged by psychiatric survivors that challenges some long-held assumptions about mental illness.

The word “peer” in peer-respite facilities refers to the fact that the people who staff and run these programs bring lived experience to their work. They’re people who’ve found their own paths forward from past emotional traumas, and many have been psychiatric patients.

The peer-support concept is based on a spirit of equality and reciprocity: The staff members at peer-respite homes are not meant to hide behind professional roles -- and those who stay at them are not to be dismissed as crazy patients.


Three states, three projects
Locally, Vermont, western Massachusetts and eastern New York now all have small peer-respite houses where people in crisis can stay for about a week as an alternative to hospitalization. These facilities are designed to provide a homelike, non-coercive and non-medical environment in which visitors can find support and grow. And in contrast to what many patients experience at a hospital mental health unit, people who seek help at a peer respite can’t be held against their will – and their thoughts are not subject to professional scrutiny or judgment.

“Our focus is for crisis to be a point of change,” explained Gloria van den Berg, the executive director at Alyssum, Vermont’s only peer-respite facility.

The word alyssum, the name of a small flower, is derived from Greek meaning “away from madness.” The peer-respite center in Rochester, Vt., about 30 miles northeast of Rutland, opened in 2011. It has two bedrooms where guests typically stay for six or seven days.
“We’ve had a number of guests -- ones who were sent here because no one else knows what to do with them -- go back transformed,” van den Berg said. “Alyssum is about doing things differently and demonstrating that.”

Alyssum serves people from every county in Vermont. Its occupancy rate for 2017 was 82 percent, and in other years a rate of more than 90 percent has been typical.

As one of the state’s hospital diversion programs – and the only one run by peers – Alyssum hosts many people in acute crisis.

“We can handle a certain level of intensity,” van den Berg said.
Massachusetts’ only peer-respite program opened in Northampton in August 2012. It’s named Afiya, after the Swahili word for physical, emotional and spiritual health and wellness.

“We only have three bedrooms, and we’re serving all of western Massachusetts,” a region with 800,000 people, said Andy Beresky, Afiya’s house coordinator.

A third peer-respite center in the region, Rose House in Glens Falls, N.Y., draws from a much smaller geographical area: Warren and Washington counties. The center’s 2017 statistical report indicates that 67 individuals logged a total of 110 visits to the three-bedroom facility, though the report doesn’t specify the average length of stay.

The three area peer-respite programs are free to guests. The centers are funded by their states, sometimes with federal Medicaid funds. A visit to a peer-respite program is far less costly than a hospital stay, and many people who have experienced both settings say the peer-respite model is more likely to yield a positive, healing experience.


A woman finds refuge
Pam Spiro Wagner, a visual artist and award-winning poet who now lives in Brattleboro, spent 40 years in and out of mental hospitals. Diagnosed with schizophrenia in college, she made it through part of medical school before she had to withdraw.

Wagner described a pattern of emotional abuse she endured in her formative years. Later it extended into her adult life in the form of internal voices that became mean and countless times told her to hurt herself.

Wagner said that when she moved from Connecticut to Vermont in 2014, she was determined to break the cycle of institutionalization and abuse and save her own life. When hospitalizations threatened to become the pattern once again, an unconventional therapist promised to help her to avoid that trap.

Witnessing the toll that repeated hospitalizations took on Wagner’s spirit, the therapist kept her word. The next time Wagner found herself in an acute crisis, in October 2016, she went to Alyssum instead. She returned the following spring. She has not been hospitalized again.
“At Alyssum, voices were coming at me pretty hard,” Wagner recalled in an interview at her Brattleboro apartment, which doubles as her art studio. “I was crying. I was not talking. I burned my face while I was there. A staff member started holding me and crying.”

Even in childhood, Wagner recalled, she would stop speaking for long periods. She earned the nickname Silent Sam.

But at Alyssum, things were different. Her therapist told a staff member that Wagner could sing. So the staff and the other guests immediately started sing-talking, as though they were performing the recitative in an opera.

After a couple of days of this, Wagner resumed talking.


Stressing self-determination
When a person wants to stay at a peer-respite facility, they must first call and discuss their interest with a staff member. They cannot be “placed” there by a family member or anyone else.
At Alyssum and Afiya, staff members talk to interested guests in advance of a stay and try to determine if the program is a good fit for the person’s needs. Staff members say they try to make sure each guest is well informed about what to expect -- and about what the respite program expects from them.

“You need to be responsible and self-determined,” van den Berg said. “We’re not nurses or police. If they want someone to fix them and manage their life, we’re not the organization they need.”

Alyssum goes a step further in its screening compared with the region’s other peer-respite programs: It asks prospective guests for the phone number of an outside reference. Initially this step was required by the town of Rochester as a condition of the zoning variance for the project.
The first year, the town required the reference be a psychiatrist or therapist. Later, the town loosened the requirement, allowing the reference to be anyone who knows the person well in a professional capacity, including a peer worker, nurse or employer. Alyssum’s staff members now see this system as a way to minimize potential problems at the respite house.


Andy Beresky, house coordinator, and Micah Matthias, director, at Afiya, a peer-respite house in Northampton that serves all of western Masssachusetts. photo by Sera DavidowBuilding a team spirit
Employee turnover in the mental health field tends to be high, but Alyssum stands out for the longevity of its staff. More than half of its nine full-time staff members have worked at Alyssum for between three and six years.

Andy Beresky, house coordinator, and Micah Matthias, director, at Afiya, a peer-respite house in Northampton that serves all of western Masssachusetts.photo by Sera Davidow

One reason for this may be that the work is personally rewarding. Alyssum has minimal hierarchy, and staff members have a lot of freedom to follow their intuition. Everyone receives training for all aspects of the job, and generally no one has more responsibility than anyone else.
To make a decision, such as whether to invite a prospective guest to stay at Alyssum, a staff member talks it over with a colleague. The staff even puts together the work calendar collaboratively, rather than having it imposed from above.

Van den Berg said that when she came to Alyssum at the tail end of the planning process for its Rochester facility, she inherited a budget in which staff members were to be paid meager per-diem rates. If there were a lull without guests, the staff would go without pay.

But she said she was able to get more funding, partly from state monies freed up when Hurricane Irene forced the permanent closing of the Vermont State Hospital in Waterbury. Now, she said, the program’s staff members all receive a decent salary.

Every Wednesday morning, staff members assemble at a round table for a three-hour staff meeting that is unlike any other. Its main focus is team building through an approach called “co-supervision,” or co-sup for short. Emotions and support are shared freely, laughter is abundant, and the weekly meeting is central to Alyssum’s success as a program and a caring community.
Van den Berg, Alyssum’s first and only executive director, said she was recruited for the job by the organization’s board president. At first she said she didn’t feel qualified for the job, and she protested that she knew nothing about mental health.

But van den Berg had relevant life experience. She was a survivor of child pornography who had been raped by her father and his friends and subjected to ritual abuse. She had gone through a long healing journey, and she served as the legal guardian for her sister, who had become as a chronic psychiatric patient.

When she applied for her job, van den Berg, following the Alyssum board’s instructions, outlined her trauma history and explained what she had learned from it and how she had transformed her life. To this day, that’s how all job candidates apply to work at Alyssum.


Reclaiming an identity
The seed for Rose House, the peer-respite center in Glens Falls, was planted in 1994, when Steve Miccio was hospitalized for eight days for what he described as a “very serious manic episode.” His brother took him to an emergency room where, he remembers, a guard stood over him.

“They put me into a small room and left me there for hours,” Miccio recalled. “They wouldn’t let my brother come in.”

Miccio, 59, said the experience undermined his sense of self.
“I went into the hospital as Steve Miccio,” he said. “I came out as a mental patient.”
At the time of his hospitalization, Miccio, who had majored in psychology in college, was in his mid-30s and working “in the developmental disability world.” He had recently received a promotion, but his employer’s attitude toward him changed after his hospitalization.
“My boss told me I had a choice,” he said. “I could be bumped down to doing direct care or I could leave. That was my first experience with stigma.”

He left and found another job in the same field. Later, to make ends meet, he took a second job doing psychological assessments at a hospital emergency room, where he said he worked at making people comfortable.

About 18 years ago, Miccio was hired as the executive director of PEOPLe Inc., a peer-run organization in the mid-Hudson region of New York. The acronym stands for Projects to Empower and Organize the Psychiatrically Labeled.

Miccio said he was still haunted by his own experience of hospitalization when he first heard of the peer-respite concept and a short-lived experiment with it. Then he discovered an existing peer-respite program in New England.

That program was Stepping Stone, a peer center that opened in 1995 in Claremont, N.H. Stepping Stone hosts a variety of activities from Monday through Saturday and has two bedrooms where participants may choose to stay overnight as respite guests.

Miccio said he rejected the Stepping Stone model because he imagined a place where anyone could go. He designed a prototype for his own concept of peer-respite and secured grant funding to open the first Rose House in 2001. Today his organization, which has grown to 90 employees, operates four Rose Houses, ranging in size from three to six bedrooms, and provides various other services.

The first three Rose Houses were created to serve Putnam, Orange, Ulster and Dutchess counties. In 2015, the organization ventured 100 miles north to establish Rose House Warren Washington in Glens Falls. It’s PEOPLe Inc.’s first venture in non-contiguous territory.
In the recent years another peer-run organization, called Voices of the Heart, had established a peer-respite facility for Warren and Washington counties in two adjacent apartments in Hudson Falls. But the group disbanded amid financial problems.


Shaped by experience
Afiya, the peer-respite center that serves Berkshire County, is a program of a larger cutting-edge organization called the Western Massachusetts Recovery Learning Community. The RLC, as it’s known, operates centers in Pittsfield, Greenfield, Springfield and Holyoke. Its 40 employees mainly serve as peer advocates and trainers.

Some members of the RLC go into psychiatric wards and other institutional settings to provide support as “community bridgers.” The organization’s activities generate awareness that leads some people to Afiya.

Often people staying at Afiya try out groups offered by the RLC. They have names like Alternatives to Suicide and Hearing Voices and are facilitated by peers to provide a safe, attentive space for grappling with difficult emotional challenges.

Afiya’s house coordinator, Andy Beresky, has worked there for more than five years, the longest he’s ever stayed in the same job. Beresky, 42, came to Afiya before it opened and took part in creating the respite center “from the ground up.”

A year before he got a job, Beresky himself had ended up in a hospital psychiatric ward. He hadn’t been sleeping enough and had gone to an emergency room “because of a genuine health problem” that he was pretty upset about. After getting his medical issue under control, the hospital’s staff suggested he talk with a crisis counselor. Beresky said that, unbeknownst to him, the person had been sent to evaluate him.

The counselor acknowledged Beresky wasn’t “psychotic or delusional” but nonetheless recommended he be admitted to the hospital’s psychiatric unit. Beresky said he had no intention of going, but after he was given the drug Ativan for anxiety, he finally agreed. Although he was assured that the stay was voluntary and that he could leave if he wanted, Beresky said that proved not to be true.

“They didn’t tell me that they would keep me for 72 hours for observation or that they’d shine a flashlight in my eyes every 15 minutes,” Beresky said. “I realized that this was not a restful environment. I decided to play ball and be the perfect inpatient so I could get out.”

Soon after he was admitted, Beresky said, the hospital staff tried to give him the antipsychotic medication Seroquel.

“They said, ‘We don’t know what mind-state people are in when they’re admitted,’” Beresky recalled. “One kid looked out for me. He told me how to avoid Seroquel and how to change the food menu.

“I had to meet with a psychiatrist,” he said. “He said, ‘It seems like you’ve been through a lot, so I’m going to double your meds to numb you up.’”

Beresky said the experience marked a turning point.

“Before I was hospitalized, I used to look at problems as being me, not my environment,” he said. “But I realized that the way I was living wasn’t working for me. If I’m sad, it’s because some of my emotional needs are not being met.”

When he was released from the hospital, Beresky said he immediately quit his stressful job as a cook. Almost a year later, he saw an ad for the job at Afiya and applied.
“I thought, if this had been in existence, I never would have had to go through the hospitalization,” he said.

In February Beresky will be taking a new job as director of peer services at a traditional mental health agency. He anticipates that it will give him the ability to challenge the system. And he wants to “give folks at Afiya the chance to grow and take on more responsibility,” he said.


Space and support
Afiya is in a residential neighborhood, and guests can choose to remain engaged with the community during their stay. They can walk or bicycle to services or to meet friends, or they can take a bus or drive their car. Sometimes people go to work or their college classes while they’re at Afiya. Others remain indoors for the duration of their stay.

Beresky said he conceives of the work of Afiya as breaking down divisions.
“We don’t want any barriers between people who have come here and those who work here,” he said.

For that reason, the program doesn’t use words like “staff” or “guest” to describe those staying or working at Afiya. In the same vein, Afiya does not write case notes on people who stay there, only a communication log that helps keep the team on the same page. When these logs are no longer relevant, they’re shredded.

“We don’t consider Afiya a service – it’s a support – and we don’t see ourselves as service providers,” Beresky said. “We hold the space. It’s really open-ended. We trust that people are adults, and rather than tell them what they should be doing, we brainstorm with them and meet them where they’re at.”

Any staff member at Afiya can have an initial conversation with a prospective guest to see if it’s a good fit. Visitors must agree to abide by Recovery Learning Community’s “defining principles,” which are intended to make Afiya a safe and nurturing space. These include values like self-determination, creating a healing environment, mutuality and respect.

Micah Matthias, Afiya’s director, explained that the program stands out because it gives visitors the space and support to determine for themselves what works for them.

“When folks are coming to stay at Afiya, it’s less about lists of ‘thou shalls’ and ‘thou shall nots’ than shared values,” Matthias said.

So when conflicts arise in the house, the staff and guests discuss the organization’s values and try to base decisions on them.

If someone has complaints about someone else at Afiya, Beresky said, “We do not silence them. Sometimes there is conflict, and it’s helpful to hear people’s concerns.”


Differing stances on medication
When people who are on psychiatric drugs come to a peer-respite house, they must be able to take them on their own, or in the case of Afiya, they may arrange for friends or family to assist them if necessary. Staff members at these facilities are not allowed to administer medications.
Beresky and others said Afiya respects people’s choices on medication and treatment. But the project also seeks to introduce visitors to ideas and choices that they might not be aware of.
“If anything, we’re just trying to give people other options besides the medical model,” Beresky said. “We don’t shy away from conversations about medications. Sometimes a lot comes out of a very simple conversation, especially for people who are less embedded in the system.”
Some people are drawn to Afiya specifically because they see it as a path for weaning themselves off medications.

“A lot of folks come to us because they’re experiencing withdrawal symptoms from tapering off their meds,” Beresky said.

Matthias said some who are drawn to Afiya have avoided involvement with psychiatric treatment -- or are trying to break free from it.

“People often come to stay at Afiya as a way to avoid any further engagement with the mental health system,” Matthias explained.

Alyssum has a different take on the issue. The Vermont peer-respite facility welcomes people who are on or off psychiatric drugs, but not in between. Instead, the program asks visitors to remain stable on whatever drugs they’re currently taking, if any.

Asked about the Rose House approach to psychiatric drugs, Miccio said simply, “We’re not pro- or anti-medication.”


Limited resources
Beresky reported that Afiya turns away five times as many people as it accepts.
“We generally have full occupancy and a full waiting list,” he said, adding that the waiting list is capped at three to keep wait times under a week.

Although guests can return, they’re asked to wait a month before requesting another stay.
“It often takes a lot of persistence for someone to get to stay here,” Matthias said. “If you are having the worst week in your life, how long can you keep on getting on the phone every day to see if you can come?”

Financial constraints prevent the program from offering more competitive wages for its 10-person team.

“In this political climate, it’s hard to get money for programs like this when politicians want to build walls and fund fighter jets,” Beresky said.

He would like to see more peer-respite houses as well as some that offered longer-term stays.
“Not everyone resolves what they’re going through in a week,” Beresky said.

Another issue is that Afiya’s house isn’t always conducive to people’s needs. It has thin walls and close neighbors.

“If we have someone who is loud and explosive, they might bother others in the house,” Beresky said. “But anger is a legitimate emotion, and sometimes people have to express themselves. We might say, ‘Let’s see how loud you can be in the basement.’”


Tighter control
Unlike Alyssum and Afiya, Rose House Warren Washington did not give permission for its employees to be interviewed or for an on-site visit for this story. At PEOPLe Inc., only Miccio is empowered to speak to reporters.

Miccio attributed that restrictive policy to a decision by the organization’s board of directors and a desire to avoid having incorrect information given out by employees.
Miccio said Rose House helps people look at their crisis from a differe

nt point of view and teaches them coping mechanisms. He described an educational approach intended to empower people to make their own decisions. Motivational interviews, he said, show guests that the answers lie within, and listening skills are key.

“We want them to embrace life,” he said.
The Rose House in Glens Falls has two full-time employees -- the site director and a senior peer companion – and five or six part-time employees, Miccio said.

Most employees work 20 to 30 hours a week. Many of these part-timers are still under restrictions of disability benefits, he said, while some also have full-time jobs.

PEOPLe Inc. is in a cycle of continuous growth, and the organization’s mission statement proclaims that it aims “to be a global leader in wellness.”

In a phone interview, Miccio talked about expanding the organization’s reach and said he has been able to count on politicians’ support because of his agency’s track record.

Miccio also serves as the crisis-training director for Ulster, Dutchess and Putnam counties, a position in which he’s responsible for a 40-hour training program for police officers in how to deal with people in mental health crisis. He said police officers in those counties sometimes stop by the local Rose House to say hi – a surprising practice given that, for some peer-respite guests, police might be associated with past traumatic episodes.

In contrast with Alyssum and Afiya, which give staff members a great deal of autonomy in their interactions with guests, Miccio described a much more top-down system at Rose House. He said, for example, that employees “learn when is the appropriate time to share their mutuality.”
“All Rose House employees go through our in-house training,” Miccio said.

New employees also shadow more experienced staff members for a time, and PEOPLe Inc. contracts with an online educational corporation to provide training modules.