As we have been discussing this year in Invested, mental health is an integral aspect of overall well-being, and the need for comprehensive support systems has never been more apparent. Last month, we discussed crisis care in the mental health sector. In this issue, we are diving a little deeper into the first of the three areas of crisis care in which Viewpoint Foundation wishes to make headway: diverting patients away from emergency rooms and into community-based care.

Community-based care has emerged as a crucial component in providing assistance and relief to individuals grappling with mental health challenges. In this article, we will explore the significance of community-based respite care, its advantages, and how it contributes to the well-being of mental health patients.

Understanding Community-Based Respite Care

Community-based care refers to a supportive service designed to offer temporary relief and assistance to individuals experiencing mental health issues. Unlike traditional mental health care settings, community-based care is, as the name suggests, embedded within local communities. This creates a more familiar and less clinical environment for individuals in need. These programs are typically structured to provide short-term, non-clinical support with the goal of preventing the escalation of mental health crises, keeping more patients out of emergency rooms.

Elements of Care in Community-Based Respite Facilities[2][3]

1. Local Integration: Community-based care centres are strategically located within neighbourhoods to ensure easy accessibility for individuals in distress. The proximity to familiar surroundings fosters a sense of belonging and comfort, which is crucial for mental health recovery.
2. Peer Support: One of the distinguishing features of community-based care facilities is the emphasis on peer support. Trained peer support workers, who have firsthand experience with mental health challenges, play a pivotal role in providing understanding, empathy, and shared experiences that can be instrumental in the recovery process.
3. Supportive Space: The setting should offer a non-clinical calming, safe, non-judgmental, and caring environment. Initial conversations should not be formal assessments, but rather an engaging conversation to determine that the person is in the right place. There should also be both communal space for conversation and connection, as well as more private but non-isolated spaces. These are no barrier spaces with no appointment necessary and everyone is welcome.
4. Skill Development with a Resilience and Recovery Focus: This entails addressing various aspects of an individual's life. This may include counseling, social activities, skill-building workshops, and educational resources to empower individuals to manage their mental health more effectively in the long term. This can include goal setting, progress monitoring, and helping the person regain a sense of control and hope.

Advantages of Community-Based Respite Care[2][3]

1. Preventing Hospitalization: By offering timely and community-integrated support, these facilities can help prevent the need for hospitalization. This is especially important in managing mental health crises effectively and reducing the strain on psychiatric emergency services.
2. Reducing Stigma: This type of care helps destigmatize mental health challenges by providing care in non-clinical settings. This normalizes the idea that seeking help for mental health is a natural and essential part of our overall well-being.
3. Promoting Social Inclusion: Participation in community-based care activities encourages social interaction and a sense of belonging. This promotes social inclusion and helps individuals build a supportive network within their community.
4. Empowering Individuals: The peer support model employed in these facilities empowers individuals to take an active role in their recovery. By connecting with others who have faced similar challenges, individuals gain a sense of hope, resilience, and self-efficacy.

Recovery Café’s vs Respite Houses

There are two models of community-based respite care that Viewpoint Foundation has been exploring: Respite Houses and Recovery Cafés. Both share the same elements of care; however, Respite Houses are 24/7, as they also incorporate temporary residential spaces where individuals can stay for a brief period to receive support and treatment.

While Respite Houses need to be in their own dedicated location, Recovery Café’s have the benefit of being able to utilize already established public spaces such as coffee shops, bookstores, museums, community centres, or other businesses with a cozier atmosphere. These spaces are then turned into a Recovery Café when they close and are operational until typically 1:00AM. This is based on public transportation hours, and the fact that research has shown that after 1:00AM crises are on average more emergent and better suited to emergency responders or a hospital setting. (Frayme & Habitus, 2023)

Habitus Collective is an organization in the U.K. that is working with Canadian organization Frayme towards establishing Recovery Café’s in Canada, the first step of which was a feasibility study in 2022 that found a clear need for out-of-hours, community-based support. Cafés in the U.K. have seen between 20 and 25 people per evening, or 6,800-9,100 people per year, but they would be cost effective if they were only serving one person per evening! They have also found that 85% of people who utilize the cafés would have gone to the emergency department if the café wasn’t available, and there was a 33% drop in psychotic hospital admissions in the first six months of the cafés opening. (Frayme & Habitus Collective, 2023)

In a study from 2013 on Respite Houses that came out of New York City, it was found that in the months that the pilot respite centre was in operation, Medicaid expenditures were $2,138 lower on average and there were 2.9 fewer hospitalizations per crisis respite client than would have been expected without respite care being available. It was also found that peer support services helped to reduce client depression, increase hope in clients when compared with typical clinical care, and increase rates of client engagement in their care. The authors concluded that these findings suggested that crisis respite facilities can achieve impact at the system level. (Bouchery et al., 2018)

At Viewpoint Foundation, we feel hopeful that community-based mental health care will become common place, as it plays a vital role in transforming the landscape of mental health support by offering a localized, peer-driven, and holistic approach. As communities continue to recognize the importance of mental health and well-being, investing in and expanding these community-based initiatives can contribute significantly to fostering healing and resilience among individuals facing mental health challenges, as well as lowering the financial and resource burden on hospitals and emergency departments.

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