For decades the only options offered to most people in psychiatric crisis have been the same two: stay home and try to ride it out, or go to the emergency room. The middle has been mostly empty. Peer respite houses are an attempt to fill that middle. They are small residential settings — usually a regular house in a neighbourhood — where someone in crisis can stay for a few days to a few weeks, in a calm domestic setting, supported by staff who themselves have lived experience of mental illness and recovery.
Peer respite houses are short-term, voluntary, home-like crisis stays run primarily by peers with lived experience — designed as a step before, or instead of, psychiatric hospitalisation.
What a peer respite actually looks like
Most peer respites have between 4 and 10 beds. They look like ordinary houses — bedrooms, a shared kitchen, a living room, a porch. Guests can come and go (within reasonable rules), cook their own food, sleep when they want, and have visitors. There is no mandatory groups schedule, no medication management, no doctors on staff. Staff are typically peer support specialists trained through state certification programmes; many have spent time in hospitals themselves.
What you do during a stay is largely up to you. Many guests rest, sleep, talk through what is happening with peer staff, and reset routines like eating and showering. Others spend time outside, journal, take walks, or process recent events with someone who has been through similar things. The implicit theory is that crisis is often a response to a brain and life that have been pushed past their limits, and that a quiet space with non-judgmental company is sometimes the right intervention.
Where the model came from
The intellectual roots of peer respite reach back to the Soteria houses developed by psychiatrist Loren Mosher in the 1970s, which provided a non-coercive residential alternative to hospitalisation for people in early psychosis. Soteria-style programmes still operate in a handful of countries. The modern peer respite movement in the US was significantly shaped by people who came through the consumer/survivor movement of the 1980s and 1990s, and by SAMHSA's investment in peer-led services through programmes documented at SAMHSA's recovery resources.
The evidence
Studies of peer respite are still relatively early-stage compared to traditional crisis services, but the available evidence is encouraging. Research published in Psychiatric Services and other peer-reviewed journals has consistently found:
- High guest satisfaction
- Substantially reduced use of psychiatric inpatient and emergency services in the year after a respite stay
- Cost savings compared to hospitalisation
- Comparable or better measures of recovery and self-determination
Peer respites are not appropriate for every situation — they are for voluntary stays without active medical instability — but for the population they serve, the data suggests they often work better than the alternative.
Who they are for
Most peer respites accept adults who:
- Are in psychiatric distress but not in immediate medical danger
- Are willing to come voluntarily and engage with peer staff
- Are medically stable (not actively detoxing, no acute medical needs)
- Are not actively violent or unsafe to other guests
Some peer respites are designed specifically for people with serious mental illness like schizophrenia. Others serve a broader population. They are typically free or low-cost; some are funded by state Medicaid waivers, others by county block grants.
What a peer respite is not
- Not a hospital. No physicians, no medication management, no medical procedures. If you need a medication change, that has to happen with your outside prescriber.
- Not a long-term housing programme. Stays are typically 1 to 14 days.
- Not a substitute for ongoing treatment. Peer respites work best when you have an outside care team you can return to.
- Not for involuntary commitment. Guests come and go freely; if you are at risk of being a danger to yourself or others in a way that cannot be managed in a home setting, the hospital is safer.
How to find one
Peer respite coverage in the US is uneven. Some states (notably Georgia, New York, California, Massachusetts, Pennsylvania) have several. Others have none. To find one near you:
- The National Empowerment Center maintains a peer respite directory.
- Call your state mental health authority and ask about peer-run crisis services.
- Ask your peer support specialist if you have one.
- Some 988 and mobile crisis teams know the local options and can refer.
Practical tips for a stay
- Bring a few comfortable clothes, your own toiletries, and any current medications in their original bottles.
- Bring books, a journal, music — most respites encourage you to make the room feel like yours.
- Tell your prescriber and care team you are going so they can support continuity.
- Plan a discharge — where you will go, who will check in on you, what your first appointment back looks like.
- Be honest with peer staff. Their value comes from being able to actually meet you where you are.
You are actively suicidal with a plan, experiencing an acute medical emergency, severely intoxicated or in withdrawal, or unable to keep yourself or other guests safe in a home setting. In those cases, a hospital or crisis stabilisation unit is the right next step.
What it can change
Many people who have used peer respite describe it as the first time they were treated as a person rather than a patient during a crisis. For people whose previous hospitalisations have been traumatic — and a great many people with schizophrenia carry exactly that history — the difference is significant. A non-coercive option does not replace medical care, but it widens the menu of what a hard week can look like.
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.