By Taylor Knopf

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. 

Hart, 58, still remembers how the metal doors of Holly Hills, a psych hospital in Raleigh, locked behind her when she was at one of her lowest points. The inviting front porch of the respite house with its hanging ferns, rocking chairs and bright blue door was a stark contrast to those memories. 

“When you’re in a psych hospital, they take everything — down to your shoelaces — for your protection. Then they slap a diagnosis on you,” Hart explained. “I got worse before I got better.” 

Alternatively, the doors at the respite house are not locked. Guests are able to come and go to the store, their job, school or wherever they want to be.

“I think this would have definitely been a healing place,” Hart said. “You’re still part of the community and not on lockdown. In this space, you can feel the warmth, the encouragement, the safety.”

Susan Hart sits on a lawn glider checking out the new space at Promise Resource Network’s peer-run respite, an alternative to hospitalization for people experiencing mental health struggles. Photo credit: Taylor Knopf

Now, Hart is in a much better place in her recovery from more serious mental health issues. She supports others through PRN’s warm line, a non-crisis support line run by people who have experienced their own mental health struggles. 

Finding a different way

Mental health treatment for some in North Carolina has devolved into little more than crisis care. More and more, patients experiencing mental health distress have found themselves on the other end of a petition for involuntary commitment, a legal mechanism that allows them to be held against their will, handcuffed and transported by law enforcement, strip searched and forced to take medication. 

Involuntary commitment petitions increased by 91 percent across the state in a decade, far outpacing population growth.

“We can and we must do better,” said Promise Resource Network CEO and founder Cherene Allen-Caraco.  “There is no conversation that starts with ‘shackles and restraints are healing.’ None.” 

Allen-Caraco is a trauma and suicide attempt survivor who is vocally opposed to any form of forced psychiatric treatment. For years, she has advocated for and created alternatives at PRN, now taking the form of this new peer-run respite center. 

“And today we will do better because of effective, less costly, less traumatizing alternatives that exist,” she said. 

At $111 per day per guest, a stay at the respite house costs a lot less than a stay at a state-run psychiatric hospital, which averages $1,300 per day according to the NC Department of Health and Human Services. A Kaiser Family Foundation 2018 estimate found an even higher average cost of inpatient psychiatric treatment across North Carolina at $2,234 per day.

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. 

Want to know more about respites? Afiya produced a video explaining the history and operating model of peer-run respites here

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.

YouTube video

“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.”

Community and state support

Several city, county, state and law enforcement officials voiced their support for Promise Resource Network and the new respite program at PRN’s ribbon-cutting celebration.

Mecklenburg County Sheriff Gary McFadden said he’d been having a tough week when he showed up to speak at the respite’s opening ceremony. He had just lost a childhood friend and two colleagues.

“It was kind of funny because everything I’m struggling with as a leader in this city and the complications of life, this is where I needed to come today,” McFadden told the crowd gathered outside the respite house. “I walked around in this fabulous, unbelievable home for people like me and others. Some of y’all don’t want to admit it but we all struggle.”

The sheriff said he was dedicated to PRN because “somebody finally got it right,” he said. “Somebody finally brought the people that can really tell the story. Those closest to the problem are often closest to the solution.”

A Black man in a PRN t-shirt speaks into a microphone in front of the mental health agency's new home
Mecklenburg County Sheriff Gary McFadden speaks about the need for alternatives for people experiencing mental health crisis at the ribbon-cutting for PRN’s peer-run respite, which would be one such alternative. Photo credit: Taylor Knopf

McFadden said he already called two other county sheriffs who will come to check out the respite model soon.

“There is so much right about what’s happening here today,” said Victor Armstrong, director of Mental Health at the NC Department of Health and Human Services. “You have a facility here designed by and for people with lived experience, who should be showing us the way of how to provide behavioral health services.” 

Armstrong added that there is a lot that is wrong with the state’s mental health system. 

“We don’t have a system that’s designed to protect and nurture the individual that’s having a mental health emergency. We have a system that’s designed to protect the rest of us from the person with mental illness,” Armstrong said. “That is wrong.”

The state’s mental health system isn’t designed to meet the needs of the people, but is “designed to squeeze these people into our funding streams, programs and into our progresses,” he explained. 

Several other local luminaries wrote letters of support, which PRN peer support specialist Cedric Dean read to the audience at the celebration. 

“One of the things I always say is I want to be treated as a colleague and not a convict,” said Dean, who was formerly incarcerated. 

A Black man in a PRN t-shirt speaks into a microphone in front of the mental health agency's new home
PRN peer support specialist Cedric Dean reads a letters from local officials in support on PRN’s new respite and peer support services. Photo credit: Taylor Knopf

“The first colleague is one that I would have never ever thought when I was sitting in a prison cell serving life plus five years would be a colleague of mine. But his name happens to be Spencer B. Merriweather, our district attorney. He drove right here today to hand-deliver this letter,” Dean said before continuing to read the letter from the district attorney who congratulated PRN on the opening of the respite house. 

Beating the odds

“In the work that I’ve done and what I’ve seen in the community, whether it’s through treatment courts or other alternative programming, when you get the right people in place, you really do see miracles,” said Bob Ward, Mecklenburg County Assistant Public Defender.

Ward is a familiar face to many PRN staff who greeted him with big hugs at the opening of the respite. Ward represents patients who have been involuntarily committed in court and sounded the alarm after he noticed his caseload increasing. He launched an effort to collect IVC data statewide and has been an advocate for alternatives to hospitalization and police involvement for people in mental health crises. 

“You see people overcoming some tremendous odds,” Ward said. “This is just so encouraging.”

PRN staff provide peer support in five different court diversion programs, such as mental health court. They help people find employment and housing and keep both. PRN is embedded in other community agencies to help meet people’s basic needs of food, shelter and clothes. 

“The foundation of PRN and everything we do is trauma-informed peer support. Without that, there is no Promise Resource Network,” said peer support specialist Aaron Wells. 

A large installation that looks like a windmill on the wall of a conference room inside the mental health agency. The rainbow pinwheel looking wall hanging lists the 8 dimensions of wellness: physical, intellectual, environmental, emotional, financial, social, spiritual, occupational
The programs at Promise Resource Network are designed around eight “dimensions of wellness”: environmental, emotional, financial, social, spiritual, occupational, physical and intellectual. This reminder hangs on the wall of one of the new classrooms at PRN. Photo credit: Taylor Knopf

“When people are struggling, they often have no hope and think there’s nothing out there for them,” Wells explained. “That’s not true. Charlotte is the 16th largest city in the country. There’s a lot of things out there. It’s just a lot of things that are disconnected out there.”

Peers at PRN come alongside and help navigate these systems for those seeking help, Wells said. 

Two peer support specialists, an older Black man and a younger white man, both wearing purple Promise Resource Network shirts and khaki pants, sit on a bench in front of a white board full of schedules at the mental health agency's respite center
PRN peer support specialists Aaron Wells (left) and Sam Cowden (right) explain Promise Resource Network’s 16 different initiatives during a tour of the new respite. Photo credit: Taylor Knopf

“The great thing about peer support is that the things that our life experience eliminates from other career fields, they qualify us for this,” said Wells who has experienced homelessness himself. 

Wells told the story of a man coming out of long-term incarceration who he met through recovery court. All he wanted to do was be a father to his children again, but he couldn’t find housing or a job due to his criminal record, Wells said. The man was driving out of the county — in violation of his parole — to work a minimum wage job at a chicken farm. After connecting with peer support and discussing his situation with the judge, the PRN team found him housing and a job paying a living wage in Mecklenburg County. The man was then able to regain custody of two of his children. 

“It took a whole team of people to get off their own agenda of what the program looked like and actually look at a person and look at their needs,” Wells said. “And that was a happy ending.”

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Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...