NORTH CAROLINA – On a patio tucked behind an old brick two-story house, Susan Hart sat on a glider surrounded by lush green plants under the glow of string lights. She wondered aloud what it would have been like to check herself into a place like this instead of a psychiatric hospital 20 years ago.

This place, “Retreat @ the Plaza,” opened in Charlotte in early August and is run by Promise Resource Network. It’s designed to be an alternative to hospitalization for people experiencing mental health distress. It’s the first peer-run respite house in North Carolina, meaning it’s completely staffed by people who have experienced mental illness, psychiatric hospitalizations, homelessness, incarceration, substance use or a combination of these.

The peer-run respite facility is free to participants and is designed to be a completely voluntary alternative for people who would otherwise seek mental health crisis care through the emergency room and possibly be involuntarily committed to a hospital.

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Peer-run respite centers were introduced in the United States in the 1990s, and Promise Resource Network’s respite is modeled after one in Massachusetts called Afiya. A peer-run respite center is a non-clinical, completely voluntary service operated by people with their own stories of mental health recovery, trauma, hospitalization, incarceration, substance use, homelessness or some combination of these.

A guest can stay at the respite house in Charlotte for up to 10 days, where one-on-one peer support is available 24/7, as well as access to all of PRN’s other classes and supports which are located next door.

“Because of its success in decreasing emergency and crisis need for services by 70 percent, there are now 40 respites in the country in 12 states,” Allen-Caraco said. “We’re 41.”

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During the past decade, the World Health Organization (WHO) has regularly promoted the goal of improving “global mental health.” While it has often told of the importance of social support and other non-drug alternatives, its efforts helped spread a biomedical standard of care. Western ideas regarding diagnoses, the biological underpinnings of psychiatric disorders, and the regular use of psychiatric drugs have been promoted. Critics of this effort speak of it as a medical colonization.

Today, June 10, the World Health Organization released a 300-page document titled “Guidance on Community Mental Health Services: Promoting Person-Centred and Rights-Based Approaches.” To a large degree, the authors embrace an agenda for change—and a reconception of mental health—that readers of Mad in America will find familiar. The best- practice services highlighted in the document include Open Dialogue as practiced in Tornio, Finland; Soteria Berne in Switzerland; Afiya House in Western Massachusetts; Basal Exposure Therapy in Norway; and Hearing Voices Support Groups, among others.

The WHO guidance emerged from a group at the United Nations led by Michelle Funk, who is head of the Policy, Law, and Human Rights unit at the WHO Department of Mental Health and Substance Abuse. Much as Dainius Pūras, during his time as the UN Special Rapporteur for Health, called for a revolution in mental health, this WHO document calls for wholesale change.

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The WHO guidance tells of a need for societies to develop mental health services that are non-coercive and abide by the human rights principles set forth in the CRPD, and that promote the person-centered recovery described above. The publication features 22 such programs. While “none is perfect,” the authors write, “these examples provide inspiration and hope as those who have established them have taken concrete steps in a positive direction towards alignment with the CRPD.”

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