Imagine a small house — usually four to six bedrooms, often with a kitchen and a porch — where, when you feel a crisis coming on, you can call ahead, drive over, and stay for a few days. There are no nurses, no locked doors, no pajamas with the hospital logo. The people supporting you have all been through psychosis or hospitalization themselves. That is a peer respite, and there are about 30 of them in the United States.
A peer respite is a short-term, voluntary, peer-staffed home that offers an alternative to psychiatric hospitalization for people in emotional distress, typically for stays of one to seven days.
The core ingredients
Peer respites differ from one another, but the model has consistent ingredients:
- Small and home-like — a residential house, not a clinical building.
- Peer-staffed — every staff member is a person with lived experience of mental illness, often a certified peer support specialist.
- Voluntary — guests choose to come and can leave at any time.
- Short-term — typically one to seven days, sometimes longer.
- Free or very low cost — usually grant- or Medicaid-funded for the guest.
- No medication management — guests bring and self-administer their own medications.
The National Empowerment Center maintains a directory and a research base on US peer respites. The most studied is Stepping Stone Peer Respite in New Hampshire, which has operated since 1995 and inspired many of the newer programs.
What a stay actually looks like
A first-time guest is usually screened by phone — a conversation, not a medical assessment. If there is an opening, they are invited over. The arrival is informal: a tour, a cup of tea, a conversation about what they are hoping for from the stay. There are no group therapy schedules or symptom checklists. Guests cook their own meals, do their own laundry, sleep when they need to sleep.
The work happens in conversation — long ones, often at the kitchen table, often late at night. A peer staff member who has been hospitalized themselves can hold space for fear, grief, paranoia, or psychosis without medicalizing it. The presence of someone who has been there is, by all accounts, the active ingredient.
Outcomes — what we know
Research on peer respites is small but consistent. A widely cited study of California peer respites (Croft and Isvan, 2015) showed that respite use was associated with substantially lower odds of psychiatric hospitalization in the year following the stay. Guest satisfaction is high. Cost per day is roughly a fraction of an inpatient bed (often $200–$400 per day vs. $1,500–$3,000 for inpatient).
The limits of the evidence are real — peer respites are voluntary, so the people who use them differ from those who get hospitalized involuntarily, and randomized studies are difficult. But the pattern across studies is favorable enough that SAMHSA's crisis care guidelines recommend peer respites as part of a robust crisis system.
Who peer respites are for
Most respites accept adults who:
- Are experiencing increased emotional distress, suicidal thoughts without immediate plan, or early signs of psychotic relapse
- Are willing to be there voluntarily
- Can manage their own basic activities of daily living and medications
- Are not actively intoxicated or in immediate medical danger
- Are not in active homicidal crisis
Who they are not for
Peer respites do not replace inpatient care for people who are immediately dangerous to themselves or others, who need medical detoxification, who require involuntary medication, or who need 24/7 medical monitoring. The model intentionally does not provide what a hospital provides.
How they are funded
Funding has historically been a struggle. Most peer respites started with state mental-health block grants, county funding, or foundation support. The 2021 American Rescue Plan Act and subsequent expansion of Medicaid mobile crisis benefits have begun to make Medicaid reimbursement viable for peer respite stays in some states. Even so, the total US capacity remains small — roughly 30 respites and about 200 beds.
Related models worth knowing
- Soteria houses — Loren Mosher's 1970s model, similarly residential and peer-supported but specifically for first-episode psychosis.
- Living Room model — peer-staffed walk-in crisis space, usually for shorter visits.
- Open Dialogue — a Finnish family-network approach used in some US peer respite settings.
How to find one
The National Empowerment Center directory is the most current US listing. NAMI affiliates and county behavioral-health crisis lines often know the closest options. 988 counselors are increasingly trained to mention peer respites where they exist.
If you or your loved one is actively suicidal with means and intent, in medical crisis, or showing signs of severe disorganization that requires medication adjustment, call 988 or 911 — a peer respite is not the right setting.
The bigger picture
Peer respites are still a niche option in the US crisis system. But for the right person at the right moment, they offer something hospitals cannot — a calm, autonomous, deeply human space in which to have a hard week, supported by people who know what it is like to be where you are. That alone has changed many trajectories that the hospital system was never going to change.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.