Community Access is not a bed-and-breakfast, although it feels like one when you walk through its unmarked door off Second Avenue on Manhattan's Lower East Side. Also known as Parachute NYC, this quiet, seven-bedroom facility is one of four publicly funded mental health centers in the city for people on the verge of a mental health crisis.
These respite centers have no medical staff, no medications, no locks or curfews and no mandatory activities. They are secure, welcoming places where people go to escape pressure in their lives and talk to trained "peer professionals" who are recovering from mental illness themselves.
Aside from places like this, New Yorkers battling serious mental illness have little choice but to check in to a hospital or a hospital-like crisis center when their lives spin out of control. Some need to be hospitalized for severe psychosis and depression, but many others end up in the hospital because they have no other options.
Relatively rare in the United States, respite centers like this one cost a fraction of the price of a hospital stay and can be far more effective at helping people avoid a psychotic break, severe mood swing or suicidal episode.
Community-based mental health services are particularly vital at a time when the number of beds in state psychiatric hospitals has shrunk sharply, said Sita Diehl, director of state policy at the National Alliance on Mental Illness. Nationwide, state psychiatric beds decreased from roughly 51,000 in 2005 to 43,000 in 2010 and the number continues to dwindle, Diehl said. According to a 2013 report by the Substance Abuse and Mental Health Services Administration, 55 percent of U.S. counties had no practicing behavioral health workers and 77 percent had unmet behavioral health needs.
Launched in 2013, Parachute NYC includes mobile treatment units and a phone counseling system in addition to the four bricks-and-mortar respite centers. A collaboration of city and state mental health agencies, the project received a $17.6 million innovation grant from the U.S. Department of Health and Human Services. Its financial goal is to save nearly $52 million in hospital expenses in its first three years.
— — —
"A hospital is the last place you want to be if your life is unraveling," said Community Access's chief executive, Steve Coe. "They put you in a room, check your blood pressure and walk away and leave you for hours. You need to put your life back together, not be held in a place where you can't do anything or talk to anyone," he said.
Nevertheless, there is broad agreement that nonmedical services such as Parachute's respite centers are not for everyone.
"The caution is that while this approach is good for some people, others really need medication and structure, so it has to be a good match for the person who is coming into it," Diehl said. "The advantage is that you get an expert listener working with you, really delving into who you are, rather than someone slapping a diagnosis on you and handing you a prescription."
Community Access and Parachute NYC's other respite centers provide a non-threatening environment where people who are coming undone can take a break and think through their problems before they reach a crisis point. Many who shun hospitals and crisis stabilization units will voluntarily seek help at respite centers, Coe said.
Community Access insists that all prospective guests check in on their own, without coercion from a doctor, friend or family member. They also screen applicants to ensure that respite is their best option. Some may need medication and more intensive treatment.
"We're not against medication," explained Keith Aguiar, assistant director of the Manhattan respite center. "If they come in with their own medications and they want to take them, that's fine. But we do not tell them they have to."
Many guests have full-time jobs and continue working and seeing friends during their stay. They can come and go any time of day or night. Unlike a hospital, Coe stressed, respite centers allow people to maintain their lives and relationships instead of putting everything on hold. Guests can also continue seeing their regular mental health providers during their stay.
The maximum length of stay is 10 days, soon to be shortened to one week. But guests can return up to three times per year. They also can visit as "alumni" and take part in group activities and talk to staff. The service is free and includes meals. Some rooms are private, others semi-private, with a dividing wall. There are periodic waiting lists, but usually for only a few days.
To qualify for Parachute's respite centers, guests must be city residents who are 18 or older. They must also have a clinical evaluation (within the last 48 hours) and a referral from a mental health provider stating they are not an imminent risk to themselves or others and would benefit from respite care. Guests also must have stable housing to go back to.
"We have a wide diversity of guests, from a Columbia University professor and an art critic to people who have been chronically homeless much of their lives," Aguiar said. "We see men and women of all ages and all walks of life."
In the last month, the guest list at Community Access included a 28-year-old woman who was living in mental health support housing and believed her roommates were practicing witchcraft on her. She was referred by her housing counselor. Another 24-year-old woman with a diagnosis of schizoaffective disorder needed to escape mounting conflicts at home with her brother, who had a diagnosis of schizophrenia. She was referred by a community psychiatric team.
A 70-year-old jazz musician with drug and alcohol addiction came to get away from his chaotic living situation. He talked to peers about his struggle with addiction, played his trumpet and napped a lot during his stay. "It was the best sleep I've had in years," he told the center's director, Lauren D'Isselt, who is a psychologist.
Another guest, age 25, spoke calmly about her history of mental illness while sitting on a bench in the center's sunny courtyard.
"I wanted to finish college," she said, "but I kept ending up on the tops of buildings." Diagnosed with depression at age 7, she has been in psychiatric care most of her life. She had spent the better part of the past six months in hospitals.
Five days into her stay, she said it had been good for her and she had been able to make plans for future treatment. "At a typical hospital, they take depressed people and lock them up and away from everyone and expect them to get better," she said. "Here you can go out and have coffee with a friend and no one has to go through double-locked doors to see you.
"When I feel really anxious or sad, I can talk to a peer."
— — —
One adult in four, about 62 million Americans, experience mental illness each year. Of those, about 14 million live with a serious mental illness such as schizophrenia, major depression or bipolar disorder, according to data from the National Alliance on Mental Illness. More than half of them do not seek treatment, in many cases because they don't know where to find help.
For those who do seek treatment, the direct medical costs total more than $100 billion per year, according to estimates from the National Institute of Mental Health. Community mental health services such as respite centers may make it possible to reduce those costs and relieve the demand for psychiatric hospital beds, which are in short supply in most communities.
Parachute NYC has served about 700 people at its respite centers, 600 through its mobile treatment teams and more than 20,000 through its peer-operated telephone support service. The city's health department intends to analyze the program to determine whether it has resulted in a reduction in the city's 100,000 annual visits to psychiatric emergency rooms.
"We don't perform miracles here," D'Isselt said. Most guests forge new friendships and leave with a new life plan, she said. "A lot can happen in a week."
This article was produced by Stateline, an initiative of the Pew Charitable Trusts.
