A colleague at the Sally and Howard Levin Clubhouse and Supported Living Program copies the clubhouse standards for an upcoming training program he plans on attending, while working the front desk on Wednesday, Sept. 17, 2025, in Squirrel Hill South. The Clubhouse is a voluntary, peer-led mental health support option. (Photo by Stephanie Strasburg/Pittsburgh’s Public Source)
There is as yet no site identified for county-funded peer respite facilities to address behavioral health crises, despite a contract executed in February 2024. In some cases, peer services can be an alternative to compulsory care.
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Content warning: This story includes descriptions of suicidal thoughts and behavior.
Adam H. said he had “all the clinical help in the world” when he was sleeping in a hallway in his family home, surrounded by trash bags full of his belongings. He’d been living this way for months after he was released last year from a state-run psychiatric hospital on Long Island, New York.
Adam’s family members had taken over his room while he spent the summer at the facility. They tossed his mattress and things into that hallway, where he stayed because he was too depressed to figure out a solution.
“I came home to the most traumatic thing I’ve ever experienced,” said Adam, 33, who is neurodivergent and has multiple mental health conditions. To talk about sensitive psychiatric and family issues, he asked to be identified by his first name and last initial. Adam described being abused by his parents, witnessing his father’s suicide at 21, his own suicidality and nightmarish involuntary hospitalizations. Being displaced from his room seemed even worse, he said from his native Suffolk County.
Once a top-performing financial advisor for a national bank, he now had no income, no independent living arrangement and no car. Medication and weekly therapy didn’t keep him from feeling “like a dog in a cage” as trash piled up around him and his depression and isolation worsened.
Adam is now enrolled in New York state’s pilot for a non-clinical, peer-led engagement program. Called Intensive and Sustained Engagement Teams [INSET], it’s designed to support the recoveries of people with serious mental illness who’ve been underserved by the traditional mental health system. It’s completely voluntary.
INSET is one of several peer-led models — including peer respites and Clubhouses — that advocates have held up in recent years as ways to help those who are distrustful of the behavioral health system due to negative experiences. They argue that peer support is more likely than coercion to engage those who are hardest to reach.
Some local policymakers are listening. After a July research paper found that some involuntary hospitalizations in Allegheny County nearly double a person’s risk of facing violent crime charges or dying by suicide or overdose, the county announced a list of policies and programs it’s implementing or considering to reduce the harm. One is peer-led, overnight respite for people in mental health crisis.
For Adam, INSET has involved twice-weekly visits from certified peer specialist James Mileto, who helped him clear out the trash and set up a bedroom in the basement. Mileto drives him to a grocery store and food pantry. And the two “spend a lot of time talking,” which Adam said is a balm for his loneliness.
“I allowed my peer advocate to do his job and to actually help me,” Adam said, noting the program is voluntary and he trusts Mileto. “If I’m forced [to receive services], it’s just not happening.”
While Allegheny County aims to bring peer respite services for those like Adam here, progress is slow.
The county awarded a contract to Unity Recovery, a Philadelphia-based, peer-led recovery community organization, to open and operate two respite houses for people experiencing mental health crises. It was executed in February 2024, but the program has yet to get off the ground.
“That’s a long time to open a peer respite,” said Cherene Caraco, the CEO and chief global strategist of Promise Resource Network, a peer-run agency that operates respites in North Carolina. It would ideally take a year, she said.
“The program launch has taken much longer than anticipated,” wrote a spokesperson for the county’s Department of Human Services, attributing the delay to contract negotiations between Unity and Community Care Behavioral Health Organization [CCBH] — a managed care organization that’s part of the UPMC Insurance Services Division. The deal would unlock funding for buying the properties, they said, noting the delay will likely be “resolved in the near future.”
A CCBH spokesperson said the organization is committed to finalizing the complex, ongoing negotiations “and implementing the plan to benefit eligible county residents.”
Experts said a contract with an insurer is an uncommon way to finance respites — typically funded by state dollars or private foundations — and speaks to the challenging funding environment.
Peer respites to open in Allegheny County
Peer respites support people through their mental health crises with the goal of avoiding hospitalization. They don’t provide medical treatment, but rather a home-like environment staffed by trained peers who draw on their lived experience to support others. Respites are voluntary and can include recovery planning, warmlines, support groups and connections to health care providers.
Research shows they can deliver equal or better outcomes than hospitals at a lower cost.
“They are a viable alternative to going to the ER or going to the psychiatric hospital and they have tremendous results,” said Travis Atkinson, the chief experience officer at TBD Solutions, a Michigan-based crisis services research group.
There are more than 80 peer respites across the country, but Atkinson said the model is relatively new in Pennsylvania. The two respites in development will be the first in Allegheny County. The county’s Department of Human Services invited him in 2023 to review proposals for the program, including Unity’s successful one. His involvement ended after the group was selected to run the program.
Officials at both Unity and the county’s Department of Human Services declined to be interviewed about the program. They collaborated to answer detailed questions about its progress.
Unity hasn’t identified locations for respites. Once contract negotiations are over, Unity will receive funds to buy two properties with three to five bedrooms.
Unity will also become a contracted provider in the CCBH network, allowing it to bill Medicaid for its services. Atkinson said most respites don’t do this because it could introduce clinical requirements that aren’t in sync with peer respite values. CCBH officials acknowledged the program would need to “follow Medicaid requirements and billing rules,” but that “shouldn’t be a barrier to implementation.”
Long-term funding stability is the “biggest financial challenge” for peer respites, with 70% reporting they didn’t know how long their current funding would last or expected it for fewer than five years, according to a 2024 study. The department spokesperson said Allegheny County hopes to expand peer-led services, but “there are tough funding decisions in our future.”
“We still have not evolved where we need to be when it comes to humane forms of treatment.”
Travis atkinson
Caraco pointed out that Unity is known for serving people recovering from substance use disorders, not mental health crises, though the two often co-occur. It provides services at a drop-in community center on the South Side and receives referrals from the county jail as people test positive for opioids during booking. It’s never operated a peer respite.
A department spokesperson wrote that the peer respite model focuses on “emotional distress causing interruptions to a person’s life,” and the county is “confident that Unity Recovery has a wealth of experience” in that space.
Caraco said respite spaces should foster guests’ sense of safety and trust. “Think water features. Think plants and flowers. Think fire pits” instead of “locked doors, hard surfaces, plastic, plexiglass, seclusion and restraint.”
Unity Recovery didn’t provide many details about the environment it will create. Executive Director Robert Ashford wrote that it will “not resemble an institution or traditional crisis setting” and be “home-like, inviting” and “therapeutic.”
Respites can face neighborhood resistance. Unity’s proposal to the county promised town halls and community listening sessions about the program, which Ashford said will start after locations are identified.
‘Divergent philosophies’ in the county’s approach
As the county develops a peer respite program, it’s also considering assisted outpatient treatment [AOT].
AOT is a controversial legal mechanism for involuntary mental health treatment in the community, instead of a hospital. The county told the state last year that it would implement Pennsylvania’s AOT statute by Sept. 1, though it hasn’t done so yet. The county’s top human services official, Erin Dalton, has since told Pittsburgh’s Public Source that the decision to implement hasn’t been made. If the county successfully develops an AOT program, it would be the first in Pennsylvania to do so since the tool became state law in 2018.
Atkinson pointed out the “divergent philosophies” of AOT and peer respite. The former, he said, takes away people’s agency and choices and is part of a system where “we still have not evolved where we need to be when it comes to humane forms of treatment.”
“Why would you go down both roads?” Caraco asked, speculating that the county wants to use “as many tools” as possible to help people in crisis. While she agrees that “we need to have a buffet,” she worries that “the bias toward clinical and forced spaces is very, very real” — especially “in this political climate.”
The Trump administration, in a July executive order, threw its weight behind involuntary mental health care for “individuals with mental illness who pose risks to themselves or the public or are living on the streets.” It’s also scrutinizing funding to mental health programs.
“I don’t know … anybody on AOT right now who’s really happy, … living a life of purpose and having supportive relationships,” said Melissa Wettengel, the CEO of Hands Across Long Island, one of four peer-led agencies that received funding from New York state to pilot INSET. Adam is enrolled in the agency’s program.
Clubhouses as ‘places of refuge’
Some other peer-led models — such as Clubhouses — have already been established here. An advocate described them as “places of refuge” from the isolation and social stigma people with mental illness often experience.
The one Clubhouse in Allegheny County is the Sally and Howard Levin Clubhouse. It’s a program of The Branch, a nonprofit formerly known as Jewish Residential Services.
It has about 140 members who actively participate in Clubhouse activities. About 35 of them spend time each day at its Squirrel Hill community center, which offers computers for member use, a communal kitchen and a free thrift shop stocked with donated clothes and shoes for job interviews. Membership is free.
On a recent afternoon, about 10 members gathered for a discussion with this reporter about their experiences in the county’s public mental system. Several described negative experiences during crisis responses and involuntary hospitalization, including at UPMC Western Psychiatric Hospital.
One said she was standing outside a restaurant about five days after she was evicted this year when police officers arrived and took her to the facility in handcuffs under a 302 commitment. “I lost some rights right there and then,” she said, noting she believes she was targeted for involuntary hospitalization and treated poorly by hospital staff because she is Black. Others discussed how a 302 can permanently impact the lives of people who’ve experienced a mental health crisis, preventing them from legally owning a gun and limiting their choices in the job market.
The Clubhouse movement was founded in the 1940s by psychiatric patients who began meeting on the steps of the New York Public Library’s main branch in Manhattan to help each other find work, housing and social belonging after being institutionalized. They exist all over the world and are governed by international standards.
The Sally and Howard Levin Clubhouse receives referrals from Western Psych and other clinical facilities, but membership is voluntary. The model involves members and staff working side by side to run the Clubhouse and make decisions. Research shows this helps members believe they matter and perceive themselves as more capable and less stigmatized. “I like to challenge people to tell me who the staff are and who the members are,” said Program Director Chrissy Whiting-Madison said. “They’re almost always wrong, and I love that.”
The Clubhouse also offers transitional employment, placing members in short-term jobs through its partnerships with local employers. It even has a scholarship fund for education opportunities members want to pursue — from singing lessons to college degrees.
Caraco has worked with Clubhouses and said “they can be very powerful if done well.” But she believes the model has strayed from its mutual aid roots and become part of the system, noting many Clubhouses have participation requirements for being an active member. “I love that members run the Clubhouse [with staff] — except they’re the ones that aren’t being paid,” she added, noting many live in group homes and other institutional settings, and “to just expect that you would be a volunteer is problematic to me.”
Despite being the only one left in the county, Whiting-Madison said the Sally and Howard Levin Clubhouse isn’t financially at risk. It’s largely funded by Medicaid payments, but “wealthy benefactors” are willing to step up.
‘The most validating’ experience of my life
INSET was borne out of years of advocacy in New York to curb the institutionalization of people with serious mental illness. The program helps participants work toward their life goals and connect with their community.
An enrollee with agoraphobia hoped to fix up their RV to move out of state, said Alex Frisina, senior director of empowerment services at Hands Across Long Island. Working with the agency’s INSET team, they realized they’d need to manage their anxiety to feel comfortable stopping at rest areas and being around crowds.
“And that was all through them self-identifying what they would need to reach their goal, not us coming in and saying, ‘Well, I think you need to look at this’” Frisina added.
That kind of “self-directed motivation” is often undermined by involuntary treatment, said Nev Jones, an associate professor in the School of Social Work at the University of Pittsburgh who was awarded a contract by New York state to co-lead an evaluation of AOT there. Jones advocates “doing everything possible to build supportive, trusting relationships, because that’s where deeper change is going to come from.”
They build trust over time by offering people what they need, be it food, clean clothes or a place to relax after being kicked out of other spaces, said Modupe Mujota, chief strategy officer at Baltic Street Wellness Solutions in Brooklyn, another INSET agency. The Hands Across Long Island team even refers people who use its mobile shower units to the program, winning them over by offering people without stable housing a service they need.
“We tend to hang around people until they fall in love with us,” Wettengel said.
Adam was recently under an AOT order as a condition of his plea deal for the felony DWI he was charged with the week he experienced his worst mental health crisis — an example of how civil AOT can be intertwined with the criminal legal system. The court order “crushed [his] sense of self-worth” because he had always adhered to treatment and felt he was being told he “didn’t do a good-enough job.”
He identifies as “a deeply mistrusting person” due to the abuse he’s experienced at home and in care settings, and didn’t initially trust his peer advocate, Mileto. But Adam opened up to Mileto after learning about his own recovery story.
It was “the most validating and amazing experience of my life. To have somebody who understood — and not just in theory [but] somebody who had lived it — was deeply rewarding and encouraging,” Adam said. “Because this guy is doing it, so maybe I can, too.”
Venuri Siriwardane is the health and mental health reporter at Pittsburgh’s Public Source. She can be reached at venuri@publicsource.org or on Bluesky @venuri.bsky.social.
This story was fact-checked by Ayla Saeed.
The Jewish Healthcare Foundation has contributed funding to Public Source’s health care reporting.
This article first appeared on Pittsburgh’s Public Source and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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