How rural mental health breaks fit into the health care puzzle

This story was originally published by KFF Health News.

Aimee Quicke has made repeated trips to emergency rooms, hospitals, behavioral health facilities, and psychiatric lockdowns for mental health crises, including suicidal thoughts since she was 11 years old.

The 40-year-old resident of Le Mars, Iowa suffers from bipolar and obsessive-compulsive disorder. Some of the visits have been helpful and some have not, he said. It was like going in and out and nothing different was happening.

Then she heard about Rhondas House, a rural peer relief program that opened across the state in 2018, through acquaintances in her community.

That facility, and dozens of similar ones established nationwide over the past 20 years, provide a short-term, family-friendly, educational environment for people who are experiencing a mental health crisis but don’t need immediate medical attention. During breaks, patients are treated as guests, advocates say, and can feel heard and maintain their dignity without having to give up their clothes and other belongings.

During her week-long stay at Rhondas House, which founder and executive director Todd Noack called a bed and breakfast for emotional distress, Quicke made a lot of progress, working on her self-esteem and learning better coping skills. If he hadn’t found the schedule, he said, I don’t think I would have made it out of 2020.

Public health professionals say respite facilities have the potential to play an important role in addressing a national mental health crisis that has accelerated dramatically during the Covid-19 pandemic, especially when it comes to suicide prevention.

It’s a really important piece of the larger puzzle of how to improve health care and reduce suicide risk, because there’s a traffic jam in suicide prevention, said Jane Pearson, president of the National Institute of Mental Health Suicide Research Consortium.

Rescues rely on trained colleagues to provide care and often serve patients who might otherwise visit emergency rooms, psychiatric institutions, and overburdened therapists. Today, there are 42 community-based respite programs spread across 14 states, including new ones recently opened in Tacoma, Washington, and Grand Rapids, Michigan. Most are nonprofits governed by a patchwork of state guidelines and are funded by a combination of local, state, and federal grants.

Experts say the programs fill a void, though there’s little hard data on their effectiveness. Paolo del Vecchio, director of the Office of Recovery at the Federal Substance Abuse and Mental Health Services Administration (SAMHSA), said peer-led respites have proven to be an evidence-based model of care, with positive effects including reduced hospitalizations and increased engagement with community support services.

A 2015 study published online in the journal Psychiatric Services found that people who sought relief were 70 percent less likely to use hospital emergency services than users without relief.

However, del Vecchio said, more research is needed to analyze how the programs work and fix the problems. SAMHSA is conducting a cost-benefit analysis of respite programs that officials hope to release this summer.

Pearson said he would like to see more research on who uses the respites, how they are advertised, why customers seek them out, and if they deliver on what they promise.

The respites may be especially important in rural America, where suicides rose 46 percent from 2000 to 2020, compared to 27.3 percent in urban areas, according to the Centers for Disease Control and Prevention. Rural residents also have one-and-a-half times the rates of emergency room visits for self-harm as urban residents.

Del Vecchio hopes that increased awareness can help bring the promising truce approach to states with the highest suicide rates, including Wyoming, Montana, Alaska and New Mexico.

Rhondas House, in Dewitt, Iowa, has provided care for 392 people over the past five years and recently moved into a three-story, five-bedroom, two-bath home. Peer specialists in Iowa must complete 40 hours of training plus six hours of ethics counseling, then work 500 hours to become eligible to take a state certification test.

For Quicke, Rhondas House has been a lifesaver during a brutal 2020. The pandemic had cut her off from her support system, her brother-in-law died, her longtime partner moved out, and her mother had open-heart surgery.

There was a lot of chaos. Many family quarrels broke out. That’s when I took off, packed my bags and headed off for a reprieve, Quicke said. There was nowhere else closer to go.

She drove six hours from her home to Rhondas House, where she found around-the-clock help you can’t get from an emergency room or hospital.

Unlike traditional hospital staff, peers are available to talk to guests whenever they need to, which Quicke appreciated as he has a lot of panic and anxiety during the night and is scary. He also found it easy and comforting to talk to peers who had lived or first-hand experience with mental health issues.

Allowing people to ask for help without being judged is a crucial feature of the respite model, said Paul Pfeiffer, a psychiatrist at the University of Michigan Medical Center. He warned against regulations that would make them more like hospitals, noting that many people in need avoid getting help because they fear being locked up in a psychiatric facility.


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Quicke said he learned a lot during his stay at Rhondas House. I always thought I was codependent. I’ve learned that I only need me and my dogs. I learned the tools for wellness and that I can be strong, resourceful and resilient, he said. She described being more aware of his triggers than she was and said she had more routines to help with sleep hygiene.

When Quicke left, respite staff put her in touch with community resources near her home near the Nebraska border. They also encouraged her to call if she needed help again and told her she could come back for another stay in 60 days, giving her time to overcome her own challenges and freeing up space for others in the meantime.

The peer truce works eight times out of 10, said Noack, the executive director. Some people have to leave to get another level of care, but nothing is ever perfect.

The average cost of staying at the Rhondas House is $428 a day, far less than the thousands of dollars a hospital stay typically costs. Noacks’ reprieve does not bill for insurance but covers the cost with state and regional contracts, as well as donations, like many other replies.

Some respites receive Medicaid funding. As this type of assistance grows, more states will explore Medicaid and other sources of funding, del Vecchio said.

A few weeks ago Quicke became discouraged after being turned down for a job. He considered returning to Rhondas House, but said she channeled what he learned there during his stay.

I was able to use my coping skills to get through it, she said.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is a major operating program of KFF, an independent source of research, survey and health policy journalism. Find out more about KFF.

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