Evidence for Peer-Run Crisis Alternatives

Anecdotal evidence clearly shows that the vast majority of mental health consumers prefer peer-run services to inpatient hospitalization, and a growing number of evaluations and studies are confirming this.

According to a study in the American Journal of Community Psychology, The Turning Point Community Crisis Residential Program in Sacramento, California participated in a research/demonstration project from 1993-1997 that compared cost and outcome to a locked, inpatient psychiatric facility. The study compared the effectiveness of the unlocked, mental health consumer-managed, crisis residential program (CRP) to a locked, inpatient psychiatric facility (LIPF) for adults for severe psychiatric problems. Participants in the CRP experienced significantly greater improvement on interviewer-rated and self-reported psychopathology than did participants in the LIPF condition; service satisfaction was dramatically higher in the CRP condition.

Below is a partial list of studies demonstrating the efficacy of peer-run crisis services. If you know of a study that should be included, please contact us via our contact form.

Mosher, L.R., (1999). Soteria and Other Alternative to Acute Psychiatric Hospitalization: A personal and Professional Review, The Journal of Nervous and Mental Diseases, 187 (3); 142-149.

Article Abstract: The author reviews the clinical and special social environmental data from the Soteria Project and its direct successors. Two random assignment studies of the Soteria model and its modification for long-term system clients reveal that roughly 85% to 90% of acute and long-term clients deemed in need of acute hospitalization can be returned to the community without use of conventional hospital treatment. Soteria, designed as a drug-free treatment environment, was as successful as anti-psychotic drug treatment in reducing psychotic symptoms in 6 weeks. In its modified form, in facilities called Crossing Place and McAuliffe House where so-called long-term “frequent flyers” were treated, alternative-treated subjects were found to be as clinically improved as hospital-treated patients, at considerably lower cost. Taken as a body of scientific evidence, it is clear that alternatives to acute psychiatric hospitalization are as, or more, effective than traditional hospital care in short-term reduction of psychopathology and longer-term social adjustment. Data from the original drug-free, home-like, nonprofessionally staffed Soteria Project and its Bern, Switzerland, replication indicate that persons without extensive hospitalizations (<30 days) are especially responsive to the positive therapeutic effects of the well-defined, replicable Soteria-type special social environments. Reviews of other studies of diversion of persons deemed in need of hospitalization to “alternative” programs have consistently shown equivalent or better program clinical results, at lower cost, from alternatives. Despite these clinical and cost data, alternatives to psychiatric hospitalization have not been widely implemented, indicative of a remarkable gap between available evidence and clinical practice. [Click to view study]

First Report On National Survey Of Peer-Run Organizations

The first report for public dissemination on the National Survey of Peer-Run Organizations is now available for download here. This report briefly describes the survey methods used and sheds light on organizational operations of 380 peer-run programs which participated in the study. More information about the project can be found here.

Please email Misha Kessler at misha@LERNetwork.org for printed copies and Laysha Ostrow at laysha@LERNetwork.org with questions.

Reports on Medicaid reimbursement and participation in health homes will be available in the near future.

Peer-Run Crisis Respites 

Self Reliance and Belonging: Guest Experiences of a Peer Respite By Bevin Croft, Anne Weaver, and Laysha Ostrow (PDF, 9 pages)

Impact of the 2nd Story Peer Respite Program on Use of Inpatient and Emergency Services By Bevin Croft, M.A., M.P.P., and Nilüfer Isvan, Ph.D. (PDF, 580KB, 6 pages)

Peer Respite Programs for Mental Health Crises: Research and Practice Initiatives in the United States by Laysha Ostrow, MPP, PhD candidate (PDF, 610KB, 37 pages)

Mental health crisis may be better served in homelike environment instead of traditional ER, says study (PDF, 142KB, 2 pages)

A review of the model and opportunities for future developments in research and innovation by Dan Fisher and Laysha Ostrow (PDF, 346KB, 12 pages)

Evaluating Peer-Operated Crisis Care Alternatives by Laysha Ostrow (PDF, 319KB, 31 pages)

Organizational Dynamics at a Peer Respite: A Focused Ethnography of an Emergent Strategy by Erica Fletcher and Adriane Borrosco (PDF, 25 pages)

Characteristics of Peer Respites in the United States: Expanding the Continuum of Care for Psychiatric Crisis by Morgan Pelot and Laysha Ostrow (PDF, 6 pages)

Grassroots Empowerment Project Statewide Listening and Dialog Sessions

Peer Developed Vision of Peer-Run Respites (PDF, 626KB, 5 pages)
Work Group Consensus Statements (PDF, 194KB, 2 pages)

Peer-Run Warmlines

Sustaining Recovery through the Night: Impact of a Peer-Run Warmline by Rebecca Spirito Dalgin, Simmone Maline, and Peter Driscoll

Project Warmline. Someone Calls. Someone Listens by the Community Counseling Solutions

A Longitudinal Analysis of the Influence of a Peer Run Warm Line Phone Service on Psychiatric Recovery by Rebecca Spirito Dalgin, M. Halim Dalgin, Scott J. Metzger

This article focuses on the impact of a peer run warm line as part of the psychiatric recovery process.The study highlights the complexity of psychiatric recovery and that nonclinical peer services like peer run warm lines may be critical to the process. (PDF, 660 KB, 7 pages)

David Romprey Oregon Warmline (PDF, 3.03MB, 26 pages)

A Cost Avoidance Analysis of the David Romprey Oregon Warmline by Tammy Ray, M.Ed/Ed.s (PDF, 1.223MB, 22 pages)

Bologna, Michael J. and Pulice, Richard T.

The impact of a consumer-run hospital diversion program on quality of life and recovery- Executive Summary (PDF, 219KB, 6 pages)

Burns-Lynch, Bill, and Salzer, Mark S.

Adopting Innovations: Lessons from a peer-based hospital diversion program. Community Mental Health Journal, Vol. 37, No. 6, December 2001. (PDF, 498KB, 8 pages)

Creating Replicable and Sustainable Peer Support Services

Beth Epps, Med, OptumHealth Public Sector; Chyrell Bellamy, PhD, MSW, Yale School of Medicine

A peer support initiative in Wisconsin and Tennessee has been shown to be effective in helping consumers with serious and persistent mental illness (SPMI) decrease the number of days spent in inpatient hospitalization and help them transition into the community. Click here to read more about the study.

Crisis Services: Effectiveness, Cost-Effectiveness, and Funding Strategies

A 2014 publication by the Substance Abuse Mental Health Services Administration (PDF, 1.02MB, 55 pages)

Croft, B., Weaver, A., & Ostrow, L. (2020). Self-reliance and belonging: Guest experiences of a peer respite. Psychiatric Rehabilitation Journal. Advance online publication.

Impact Statement:

Impact and Implications—Findings suggest “key ingredients” for peer respites: A homelike environment, voluntary and self-determined supports, and peer staff who possess the capacity for developing healing and genuine connections with guests while also promoting shared responsibility and self-reliance. This work contributes to a theory of change for peer respites: By providing a “break” from stressful life situations alongside mutual support, peer respites offer a viable alternative to traditional crisis services. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Click here to read more about the study.

Eklund, M, and Hansson, L., (2001). Determinants of Satisfaction with Psychiatric Services: A Cross-sectional Study Among Schizophrenic Outpatients, Nordic Journal of Psychiatry 55:413-418.

Article Abstract: This was a cross-sectional study investigating factors related to satisfaction with care among long-term mentally ill patients diagnosed with schizophrenia, selected from an outpatient register. Demographic factors, personality variables, and health-related factors were related to their satisfaction with care. Satisfaction with care showed no relationships to demographic factors such as age, living conditions, or civil status. However, significant associations indicated that patients who had never been hospitalized for mental illness, who were native Swedes, or who had an independent living rated their satisfaction with care higher. Personality, measured with the Temperament and Character Inventory, showed a relationship to satisfaction with care on only one dimension, self-directedness, of seven. Some of the results indicated a relationship between subjective measures and satisfaction with care, and some did not, but, taken together, the findings suggested a partial influence from a subjective factor on both subjective measures of well-being and on satisfaction with care. However, associations between interviewer-rated measures of health-related variables and satisfaction with care proposed that the better-functioning patients were more satisfied with the care, in turn indicating that the services better suited these patients. Thus, assuming that the influence of treatment was controlled for through the selection of long-term mentally ill subjects, this study pointed to two determinants of satisfaction with care: a selectively working subjective factor and the services being better designed for the better-functioning patients.

Georgia Mental Health Consumer Network, Peer Support and Wellness Center Overview, Development and Operations

Includes the results of an evaluation conducted with peers. (PDF, 351KB, 16 pages)

Bevin Croft, M.P.P., et al – Service Use Implications of a Peer-Run Respite Program

Designed to serve as alternatives to traditional acute and inpatient psychiatric emergency services, peer-run respites are hypothesized to lower system costs through reductions in inpatient and emergency care. This analysis tested that hypothesis, examining whether inpatient and emergency service use differs for individuals who did and did not use the program over a two-year period. The peer-run respite in this study offers short term 24-hour residential support for mental health service users experiencing self-defined crises.

Service Use Implications of a Peer-Run Respite Program (PDF, 283KB, 1 Page)

Greenfield, TK, Stoneking, BC, Humphreys, K, Sundby, E, and Bond, JA (2008). Randomized Trial of a Mental Health Consumer-Managed Alternative to Civil Commitment for Acute Psychiatric Crisis . American Journal of Community Psychology 42 (1/2):135-144.

Article announcing study: www.medicalnewstoday.com/articles/118619.php

Click here to read the full text of the article (PDF, 205KB, 10 Pages)

Systematic Review of the Evidence in Support of Peer Respites by Emily Cutler and Nev Jones

Poster Presentation on “Peer-Run and Peer-Staffed Crisis Services: A Systematic Review” – presented at the Florida Counseling Association on October 4, 2019

Lora, a., Rivolta, N., and Lanzara, D., (2003). Patient Satisfaction with Community Based Psychiatric Services, International Journal of Mental Health, 32: 32-48.

Article Abstract: A survey is conducted to examine the satisfaction of patients with community-based psychiatric services in Italy. The survey provides useful data for understanding the patients’ needs and expectations, so that the services can be modified accordingly.

Cheryl MacNeil, Ph.D. and Shery Mead, M.S.W. – Discovering the Fidelity Standards of Peer Support in an Ethnographic Evaluation

Abstract: In our current study we undertake an ethnographic exploration of a peer support program as a first step in deriving fidelity standards for a peer support program. We set out to identify the program dimensions from the multiple points of view of those involved. The remainder of this paper will provide a brief theoretical overview of peer support (for more extensive information see Mead, Hilton, & Curtis, 2000), describe the specific model of trauma informed peer support we studied, and offer findings related to the development of fidelity standards for peer programs. [Click to view study] (PDF, 93KB, 18 Pages)

Peters, Janet. (2009) The Real Ke We Way Story. Wellink Trust, Te Hononga Ora.

KWW is a peer delivered ‘Recovery House’ (i.e. staff have lived experience of mental distress and recovery). KWW caters for people who are experiencing psychiatric distress and is an alternative to inpatient care in an acute psychiatric unit. Peer services are a growing part of an evolving quality mental health system given the growing international and national recognition as ‘best practice’.

The Real Key We Way Story (PDF, 575KB, 20 pages)

Pfeiffer et al. (2019). Development and Pilot Study of a Suicide Prevention Intervention Delivered by Peer Support Specialists.

Suicide rates in the United States have been increasing in recent years, and the period after an inpatient psychiatric hospitalization is one of especially high risk for death by suicide. Peer support specialists may play an important role in addressing recommendations that suicide prevention activities focus on protective factors by improving hope and connectedness. The present study developed a peer specialist intervention (PREVAIL) to reduce suicide risk, incorporating components of motivational interviewing and psychotherapies targeting suicide risk into recovery-based peer support. A randomized controlled pilot study was conducted to assess the acceptability, feasibility, and fidelity of the intervention.

Development and Pilot Study of a Suicide Prevention Intervention (PDF, 275KB, 23 pages)

Mona M. Shattell, PhD, RN et al – A Recovery-Oriented Alternative to Hospital Emergency Departments for Persons in Emotional Distress: “The Living Room”

Persons with severe mental illness experience episodic crises, resulting in frequent visits to hospital emergency departments (EDs). EDs, however, are not the most effective treatment environments for these individuals who might better be served elsewhere in an environment based on recovery-oriented framework. The purpose of this study is to describe the lived experience of guests (persons in emotional distress) and staff (counselors, psychiatric nurses, and peer counselors) of a community, recovery-oriented, alternative crisis intervention environment—The Living Room (TLR).

A Recovery-Oriented Alternative to Hospital Emergency Departments for Persons in Emotional Distress: “The Living Room” (PDF, 144KB, 9 Pages)

Beth C. Stoneking, Tom K. Greenfield, and Jason Bond

Presentation on “Randomized Outcomes to Mental Health Consumer Operated Crisis Residential Alternative to Psychiatric Facility– April 10-May1, 2009 (PDF of PowerPoint, 315KB, 10 pages)

Toprac MG, Sherman PS, Holzer CE, et al: Texas Crisis Alternatives Project: Cost-Effectiveness of 9 Crisis Residential Modalities: Final Report. Houston, Texas Department of Mental Health and Mental Retardation, 1996

Summary: This study compared hospitalization with a complex set of eight different crisis alternative programs in Texas and reported lower cost for the alternative programs. These authors found that most individuals who received alternative care did just as well, if not better, than those who received the usual hospital stay. [Click to read executive summary of the study] (PDF, 68KB, 12 Pages)

Whittle, J., (1992). Determining the Need for Community Alternatives to Preventing Unnecessary Admissions to an Inpatient Psychiatric Unit, Journal of Community and Applied Social Psychology, 2: 17-24.

Article Abstract: Admissions to an adult psychiatric inpatient unit were monitored for a period of 4 months in order to determine the necessity for those admissions. Staff considered that 34-58 per cent of admissions would have been unnecessary if appropriate alternatives had been available in the community. The study was repeated using a different methodology and 50 per cent of admissions were then considered unnecessary. As these results are based on post-hoc judgments, made with some knowledge of outcome, the conclusions are drawn cautiously. Implications regarding the development of services are considered.

Research on New Zealand’s Key We Kay

The Real Key We Way Story (PDF, 575KB, 20 pages)

The Characteristics of Good Peer Support (PDF, 403KB, 40 pages)

Journeys of Clinicians Who Embrace Peer Workers in Their Practice (PDF, 594KB, 27 pages)

Peer Support Outcomes and Value for Money (PDF, 1.12MB, 32 pages)