In the face of a shortage of mental health services, the Living Room approach addresses gaps

Updated 2 years ago on October 17, 2022

If you or someone you know is thinking about suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (Spanish: 1-888-628-9454; for the deaf and hard of hearing: 1-800-799-4889) or with the Crisis Text Line by texting HOME to 741741. Beginning July 16, emergency services will be available by dialing 988.

After a bad breakup, 19-year-old Benjamin Kowalczyk said he felt like everything around him was falling apart. He dropped out of college and felt he was starting to get angry with his family.

"I fell into a severe depression," said Kowalczyk, who lives outside of Chicago. "So, you know, at that point I realized I needed to go back to therapy. And I need to do something about my mental health because it's deteriorating very quickly."

He was worried that seeing a former therapist would take too long. Kowalczyk's mother called around and was told about Forever Hope, a "Living Room" in Chicago run by Thresholds, a community mental health organization.

Kowalczyk had never heard of Living Rooms, places created as alternatives to emergency rooms where people with suicidal or homicidal thoughts, panic attacks, severe depression or struggling substance use can easily find help. There are about two dozen Living Rooms scattered throughout Illinois, and at least a dozen other states have similar models that aim to provide a safe and comfortable place for people in crisis.

Kowalczyk and his mother made a half-hour trip and spent about 30 minutes with one of Forever Hope's counselors. At subsequent meetings, the counselor helped him find a therapist and psychiatrist.

"It was such a learning experience to be there for the first time. I felt like I really had a safe place to go," says Kowalczyk, who says he feels much better today. He still visits Hope Forever once or twice a week, in addition to therapy.

In Illinois, providers hope the "living room" model will help fill a gap in mental health services as a new crisis number, 988, is introduced this month. The three-digit version of the National Suicide Prevention Lifeline begins July 16 and is designed to make it easier for people in crisis to connect with qualified counselors.

While most calls to 988 are expected to be resolved by phone, there will be people who need in-person help. And for those in crisis, there are still few options for appropriate places to go.

Now some states are trying to fill these gaps. Part of the solution may be facilities such as Living Rooms, which offer an alternative to the emergency room and prisons, which often become the main providers of mental health emergencies.

The best option for mental health care

Emergency rooms are not ideal places to get mental health care. They are noisy, overcrowded, and staff are not always trained in mental health. It is not uncommon to have to wait hours or, on rare occasions, more than a full day for help.

Living rooms are designed to provide a home-like atmosphere. They are usually grant-funded and staffed primarily by recovery support professionals with at least a year of training in mental health and personal experience with mental illness or addiction.

It's important to understand that mental health crises look different for different people, says Ann Rainey, CEO of The Living Room at Turning Point in Skokie, Ill.

"We've never turned anyone away because of the definition of a crisis," Rainey said. "It could be someone who has had an accident, it could be someone who has . mental health issues. It could be someone who lost their job."

UnityPlace, a living room run by UnityPoint Health in Peoria, Illinois, has a large room with upholstered chairs, a Nintendo Wii, and a TV. In the corner is a coffee maker and snacks.

As with all "Living Rooms" in the state, guests can just walk in - no doctor's note or payment required.

"We've had clients come to us who were really struggling ... and they said, 'It saved my life to come here, to be able to talk to someone,'" said Christina Gerlach, crisis services manager at UnityPlace.

Limited but promising evidence

One disadvantage of lounges in Illinois is that they are not open 24 hours a day due to insufficient funding. Nevertheless, the data on these establishments are promising, though limited.

In one small study, researchers found that out of more than 200 visits to the Living Room around Chicago, 93% of patients did not need further treatment in the ER. Lead researcher Michelle Heiland says it saves money for both health care providers and patients.

An emergency room visit can cost thousands of dollars, while a single "living room" visit costs $269, according to the same study.

According to Heiland, an assistant professor at Rush University in Chicago, two-thirds of the study participants said that learning coping skills was the most helpful aspect of their Living Room experience.

"Eighty percent said the most helpful thing was being able to discuss the situation and solve the problem," she said.

One of the goals of the Living Room approach is to connect people with outside resources and prevent future crises.

In Illinois, Living Rooms executives are not sure that the rollout of 988 will mean a sudden influx of visitors, especially if it takes time to raise public awareness about both 988 and Living Rooms.

People know what ERs are, they know what therapists are... but the lounge still doesn't resonate with the general public," says Patricia Johnston, director of the lounge at Trinity Services in New Lenox, Ill.

Meanwhile, Living Room executives say they're keeping a close eye on the influx of visitors.

"To me, there's no better feeling than when someone comes in and they're in the most difficult moment of their life," says Matthew Tassinari, who oversees counseling at Forever Hope in Chicago. "They're in trouble. They're crying. And when they walk away with a smile on their face, knowing that they have a safe place to go back to ... it's truly amazing."

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