Clubhouse Model of Psychosocial Rehabilitation
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The Clubhouse Model of Psychosocial Rehabilitation is a comprehensive and dynamic program of support and opportunities for people with severe and persistent mental illnesses. In contrast to traditional day-treatment and other day program models, Clubhouse participants are called "members" (as opposed to "patients" or "clients") and restorative activities focus on their strengths and abilities, not their illness. The Clubhouse is unique in that it is not a clinical program, meaning there are no therapists or psychiatrists on staff. All clinical aspects of the program have been removed so as to focus on the strengths of the individual, rather than their illness. Additionally, all participation in a clubhouse is strictly on a voluntary basis.
Clubhouse International, formerly International Center for Clubhouse Development (ICCD), lays out four guaranteed Rights of membership, which are at the core of the Clubhouse Model:
- A right to a place to come;
- A right to meaningful relationships;
- A right to meaningful work; and
- A right to a place to return.
The members and staff of a Clubhouse work side-by-side to manage all the operations of the Clubhouse, providing an opportunity for members to contribute in significant and meaningful ways; therefore, a Clubhouse is operated in a partnership model with members and staff working side-by-side as colleagues. Through this environment of support, acceptance, and commitment to the potential contribution and success of each individual, Clubhouses are places where people can belong as contributing adults, rather than passing their time as patients who need to be treated. The Clubhouse Model seeks to demonstrate that people with mental illness can successfully live productive lives and work in the community, regardless of the nature or severity of their mental illness. Currently, there are over 325 clubhouses in 28 countries around the world.
In 1948, a small group of people who recently had been discharged from a New York state psychiatric hospital united to create a group known as "We Are Not Alone (WANA)." Initially started as a self-help organization, WANA later evolved into a highly successful and innovative community based program to assist people with mental illness to reclaim the lives and aspirations they had lost during the time of their illness. With the help of dedicated volunteers, WANA officially purchased a building in the early 1950s and renamed their organization "Fountain House." The Fountain House program became the template for the Clubhouse Model of Rehabilitation, with over 325 other programs eventually adopting the recovery model in 28 countries around the world. Given its longstanding history and status within the clubhouse community, Fountain House was and continues to be closely affiliated with the governing ICCD body.
The Typical Clubhouse
Clubhouse Units: Clubhouses are divided into various work units designed to manage the everyday tasks associated with the operation of the clubhouse. Typical work units may include Clerical, Food Services, Facilities/Environmental, Reach Out (contacting and supporting members who have not attended the Clubhouse in a while), Membership, Education, Advocacy, Social Recreation, and Employment. The work of each unit is further divided into specific, manageable tasks. When a member joins the clubhouse, he or she selects a "home unit", according to his or her interests and abilities. The member can then sign up to perform the unit tasks, giving him or her an opportunity to work side-by-side with the clubhouse staff in a unique partnership and to contribute in meaningful ways to the overall operation of the clubhouse. All member contribution inside the clubhouse is done so on a voluntary basis; payment of a member to work in the clubhouse is considered unethical, regardless of work performed or hours put in.
Community Employment: Clubhouses offer a tiered employment program designed to integrate interested members back into meaningful and gainful employment in the community. The first step of the program is Transitional Employment (TE), in which members can work in meaningful part-time jobs outside the clubhouse procured through partnerships with community entities and businesses. The member selected by the clubhouse community for these position(s) are trained by a clubhouse staff and/or member who are in charge of that particular placement. As an incentive to the employer, job attendance and performance are guaranteed, as a staff and/or member will support or even fill-in for the clubhouse member if he or she needs to be absent for any reason. Each member contribution at a Transitional Employment position is designed to be transitional and temporary, lasting for six to nine months, as these positions belong to the clubhouse, and are designed in such a way so that ideally all members will have an opportunity to work. Each member of a clubhouse who participates in a Transitional Employment position is guaranteed to earn minimum wage or above. Additionally, all clubhouse TE positions are entry level so that all members have the opportunity to work in all positions. The single most important factor in placing members in TE positions is the individual's desire to work.
The second step is supported employment, in which the clubhouse community helps an interested member obtain his or her own employment and serves as a resource and support for résumé makeup, interviewing skills, transportation, and employer liaisons.
The third step is independent employment, in which the member is meaningfully and gainfully employed without the intervention (but always with the support) of the clubhouse community.
Other Aspects of the Clubhouse Model
In addition to in-house and community based work opportunities, clubhouses generally offer a wide array of other member services, including housing support and placement, benefit advocacy, case management, financial planning, evening and weekend social programs, continuing education support, and regional and international conferences. As with all aspects of clubhouse operations, these services and programs are administered through the joint efforts of both clubhouse members and staff.
The Mosaic Clubhouse is based in the London Borough of Lambeth, UK and is a member of Clubhouse International. Since its inception in 1994, the number of members of Mosaic Clubhouse has grown to over 800, of which, approximately 50 visit the Clubhouse daily.
Mosaic Clubhouse is one of the 11 Clubhouses worldwide which are designated as training bases for assisting in communicating the Clubhouse Model of Psychosocial Rehabilitation. Therefore, members and staff travel to Mosaic for three-week training sessions up to four times a year.
Mosaic Clubhouse runs four main work units:
- Business and Administration Department
- Employment, Education and Information Department
- Hospitality, Horticulture and Facilities Department
- Recreational and Leisure Programme
The first of these, the Business and Administration Department ensures that all of the administrative requirements of the Clubhouse are met. Members are encouraged to learn computer skills through tasks such as data entry, typing and handling statistics. Furthermore, this department also offers the opportunity for members to work on the reception desk.
One of the main aims of the Employment, Education and Information Department is to support members in obtaining TE placements generally lasting from six to nine months. The placements are designed as part of a goal plan which may lead to the attainment of future employment goals. Subsequent to TE placements, members may move on to Supported or Independent Employment, or college courses.
The third unit, the Hospitality,Horticulture and Facilities Department organizes weekly workshops providing advice on many aspects of housing support, for example, how to bid for properties on the Home Connections website. In addition to this support, this department is also responsible for the general cleaning, laundering, shopping and banking of Mosaic. Clubhouse members may also assist in running Café Effra Mosaic, the in-house café and snack bar.
Lastly, the Recreational and Leisure Programme provides information and support to members encompassing a range of lifestyle topics. For example, regular healthy eating sessions and smoking cessation meetings are coordinated by this department.
Clubhouse International, Clubhouse Standards, and Accreditation
As more treatment programs began adopting and implementing the principles of the Clubhouse Model, the need for some sort of central organization and defining criteria of what a clubhouse comprises became apparent. In March 1994, the International Center for Clubhouse Development, now Clubhouse International, was created to serve and represent the rapidly growing clubhouse community. Through Clubhouse International, a set of International Standards for Clubhouse Programs were developed and consensually agreed upon by the worldwide clubhouse community, giving the first working definition of the Clubhouse Model of Rehabilitation. Every two years, the worldwide clubhouse community reviews the Standards, and amends them as deemed necessary. The process is coordinated by the Clubhouse International Standards Review Committee, which made up of members and staff of Clubhouse International-certified clubhouses from around the world. The Standards serve as a "bill of rights" for members and a code of ethics for staff, oversight boards, and administrators. The Standards consistently emphasize choice, respect, and opportunity for all clubhouse members. Currently, there are 36 standards.
These standards also provide the basis for assessing clubhouse quality, which is evaluated through the Clubhouse International certification process. Programs wishing to officially adopt the Clubhouse Model can request a visit from Clubhouse International Faculty Members (consisting of members and staff from various clubhouses around the world), who pay a three-day visit to the program, assessing its adherence to Clubhouse International Standards, giving feedback regarding the quality of the program, and, ultimately, deciding whether the official status of the program should be given the title of "Clubhouse."
Critique and Assessment
Given the relative recency of the Clubhouse Model as a growing, viable alternative to traditional day-treatment programs, the literature regarding its effectiveness in treating mental illness as compared to other models is in the beginning stages.
- Cowell, Alexander J.; et al., "Deriving Service Costs for a Clubhouse Psychosocial Rehabilitation Program", Journal Administration and Policy in Mental Health and Mental Health Services Research, Springer Netherlands, Volume 30, Number 4, March 2003, pages 323-340
- Farrell SP, Deeds ES. "The clubhouse model as exemplar. Merging psychiatric nursing and psychosocial rehabilitation", J Psychosoc Nurs Ment Health Serv. 1997 Jan;35(1):27-34.
- McReynolds, C. (2002) "Psychiatric Rehabilitation: The Need for a Specialized Approach". International Journal of Psychosocial Rehabilitation. 7, 61-69.
- "APA Achievement Awards: Gold Award: The Wellspring of the Clubhouse Model for Social and Vocational Adjustment of Persons With Serious Mental Illness", Psychiatric Services, 50:1473-1476, November 1999
- A complete list of Clubhouses around the world
- Fountain House, the original Clubhouse
- Independence Center, Clubhouse International Training Base, and 2nd Largest Clubhouse in the World
- The Clubhouse International Standards
- Official web site of "West 47th Street," award-winning film documentary which follows members of a Clubhouse over three years.
- Official Website of The Carriage House, a Clubhouse International Accredited Clubhouse in Fort Wayne, IN.
- Official web site of Breakthrough Club, a Clubhouse in Wichita, KS.
- Official Web Site of Hedwig House, a comprehensive Psychiatric Rehabilitation program offering Housing Support, Vocational Rehabilitation, and Clubhouse services in PA.
- Official Web Site of Mosaic Clubhouse in Lambeth, London.
- Official Web Site of Stepping Stone Clubhouse in Brisbane, Australia.
- Pioneer House, Peabody, MA.
- Official Website of Canefields Clubhouse in Logan City, Australia.
- Official Web Site of Toowoomba Clubhouse in Toowoomba, Australia.