Crisis or respite houses tend to offer a smaller scale residential alternative for people in crisis, sometimes designed for specific groups, including women, minority ethnic groups and homeless people (see Gooding et al., 2018, pp.67-77). Such alternatives to hospitalisation may be staffed predominately or even entirely by those who have used services or faced involuntary psychiatric interventions, or may be staffed by typical mental health professionals (such as psychiatrists, psychologists, social workers, and so on)—or a mixture of the two. Only one example of a respite house was submitted for the purposes of this compendium.
Bochum Crisis Rooms – Bochum, Germany
The Bochum Crisis Rooms provides assistance for people experiencing 'psychosocial crises and acute mental and psychiatric emergencies' (Submission 27). In 2001, the Landes-verbandes Psychiatrie-Erfahrener (the LPE NRW), the regional umbrella organisations of people with experience using mental health services, set up a contact point for people experiencing crisis. In 2013, ‘crisis rooms’ were added, which have subsequently allowed for overnight accommodation. There had always been the possibility of spontaneous overnight stays in the rooms of the drop-in centre—an option that appears to be rare in self-advocacy and in the formal mental health system (Submission 27). The drop-in centre and crisis rooms in Bochum are located in three separate flats on different floors of a high rise building: the largest flat on the second floor contained a crisis room for one person in addition to the drop-in centre; a second flat offers additional crisis accommodation; and a third flat exists for administrative work and groups.
People in acute crises can move to the accommodation options for up to three months and be supported by mental health practitioners, including psychiatrists (Submission 27). Every crisis support is individual and tailored to each person; there is no fixed plan. In principle, all people who are in or visit the drop-in centre are involved in the crisis work in Bochum. The roles change almost automatically, and there are different forms of remuneration and voluntary work. The crisis rooms were funded by various health insurance companies from 2013 to 2017, and as of mid-2017, the North Rhine-Westphalia Welfare Foundation has taken over the funding.
Soteria House – International
The Soteria model is a type of respite house, sometimes described as a ‘Therapeutic Community Residence’, of which one aim is to prevent hospitalisation (Submission 27). Soteria facilities are typically small, residential settings for responding to people experiencing psychosis, and reportedly appear in Switzerland, Germany, Sweden, Budapest and Denmark (Calton et al., 2008). The approach consists of a small, community-based, residential treatment environment with strong use of peer and allied professional staffing rather than clinical staff. Soteria House reportedly focus on empowerment, peer support, social networks, and mutual responsibility (Submission 27). It tends to involve minimal use of psychotropic medication based on the personal choice of each resident. In the US, the Department of Mental Health Vermont, has stated that 'further analysis may be warranted to assess how Vermont's future support and implementation of the Soteria model can reduce the need for involuntary medication for individuals experiencing a psychiatric crisis' (Vermont Department of Mental Health Services, 2017, p.5).
Weglaufhaus, "Villa Stöckle" – Berlin, Germany
The Weglaufhaus is a non-profit respite house for homeless people experiencing crises that has operated in Berlin, Germany, since 1989 (Submission 21). Half of its staff members are people who have themselves experienced using psychiatric services or being subject to involuntary psychiatric interventions. The Weglaufhaus’ main function is to provide support, safety and shelter for people in need of psychosocial support, helping them build a solid foundation for their self-chosen future (Submission 21). Residents need to be at least 18 years-old, homeless, in need of 24/7 support, and legally in a position to receive social welfare from the German government.
Weglaufhaus is part of the World Network of Users and Survivors of Psychiatry. Residents are usually seeking to avoid an involuntary hospitalisation, or broadly looking for an alternative to psychiatry that does not use coercion. According to Submission 21, the respite house has several characteristics:
- Diagnoses are not used. There is no coercion. Psychiatrists are not allowed in the house
- Psychotropic drugs can be discontinued, but don’t have to be.
- The work done by the team is as transparent as possible to the residents. Residents can view their files. They can also attend staff meetings.
- The work is based on the ‘antipsychiatric approach’ and biased towards the residents.
- The focus of the work is on supporting the selfdetermination of the residents.
- There is a floor for trans*, nonbinary and intersex people.
- “Traditional” social work, like helping people to get back into social welfare, health insurance, legal status and consultation.
There is an open day at the house once per week for former residents, and a monthly association meeting. Some German-language research exists on the Weglaufhaus.