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Join the Club: The Hottest Trend in Recovery

Reprinted with permission from  Schizophrenia Digest, Spring 2007

“Once you become a member, you’re always a member with a sense of belonging. We call ourselves family.”

Mattie King, of Staten Island, New York, is talking about “her” Clubhouse— SkyLight Center, a member of the International Center for Clubhouse Development (ICCD)—and she can’t say enough good things about it.

For King, 55, who was diag­nosed with schizoaffective disorder in 2001 (and who also is a regular panelist for Christina Bruni's Recovering Together column in Schizophrenia Digest), the "nudge" pro­vided by SkyLight Center was just the ticket for her recovery: a springboard to greater responsibility and a more meaningful life.

And she is not alone. There are hundreds of formally established psy­chosocial clubhouses around the world, many sanctioned by the ICCD and others that function independ­ently and are driven more by the unique needs of their local communi­ty. All share an emphasis on peer sup­port, with varying degrees of profes­sional involvement.

So if you're looking for a place to belong and also thrive, why not reach out to a Clubhouse near you? Membership is open to anyone who has a history of mental illness, and many proponents believe this is "it"— the hottest trend and the future of treating mental illness.

Empowerment through involvement

"When I was diagnosed, I was devas­tated," says King. "I felt like I didn't belong anywhere anymore, didn't fit into mainstream society anymore, and couldn't work in corporate America."

King says she felt her fear, moved through it and then past it, and began exploring each of the work units set up at her Clubhouse. The work units are designed to provide members with a sense of responsibili­ty while providing skills training in various areas.

"Getting engaged in meaningful work helps self-esteem go through the roof," she says excitedly. "It broadens your horizon. It's very empowering."

And aside from the work units, King notes that her Clubhouse offers wellness programs, a dental van, an exercise program, and even a thrift shop—amenities that make the place feel like "home."

King's first Clubhouse job was as a receptionist; then she moved into col­lecting attendance data (critical for funding) and helping produce the monthly newsletter. It was all volun­tary, "but you get so much more than money can give you," she says. "It's about the inner person: feeling self-worth soar and being useful."

So inspired was she that she's now on SkyLight Center's board of direc­tors and was recently named acting division director at the Baltic Street Mental Health Board.

Thousands of miles away, Laura Miyashiro, 55, of Kauai, Hawaii, shares King's enthusiasm. She, too, has had a positive experience with her Clubhouse, called Friendship House.

"I know there are some folks who feel like because they have a mental illness, the world owes them some­thing," Miyashiro says. "I don't like having a mental illness any more than anyone else does, and I fought and denied it for a long time. However, I think I have the right attitude in thinking it is me who owes the world a living, not the other way around. I have something to offer, and now I feel alive again."

Miyashiro has been attending Friendship House for 10 years and transitioned into full-time employment in 1999; she now works full time at a local dry cleaning business and thanks her Clubhouse for "their support, [which] included job preparation, job training, helping me with reporting my benefits to the government, and giving me rides to work when our bus system is closed on holidays."

Jamal Ali, formerly of Trinidad, West Indies, and now a resident of Calgary, Alberta, is an expressive writer, researcher, and mental health advocate who was diagnosed with schizophrenia at 25. He has been active in his local Clubhouse, Potential Place, since 2002.

"It has transformed my life for the better … [and] continues to do me wonders," he says. "Every day at this Clubhouse is a vibrant day for me."

Ali volunteers at the Clubhouse and also contributes to its newsletter.

He says it has "given me courage to become a bridge to other organiza­tions." He works part time for the Schizophrenia Society of Alberta– Calgary chapter, where he talks open­ly with other family members about his experience with the disorder, and he's spoken to psychology classes "to help erode the stigma and edu­cate young minds."

At 51, Ali says he is taking small but measurable steps "managing my illness" and getting the necessary structure he needs in his life through his Clubhouse involvement.

Clubhouse with a capital "C"

So how did these nonmedical, community-based Clubhouses (note that official capital letter "C", denot­ing ICCD affiliation)—or psychiatric rehabilitation programs—come to be, and how does ICCD assure they'll continue their good works?

"Clubhouses are founded on the realization that recovery from serious mental illness must involve the whole person in a vital and culturally sensi­tive community," ICCD's mission statement reads. "A Clubhouse com­munity offers respect, hope, mutuali­ty, and unlimited opportunity to access the same worlds of friendship, housing, education, and employment as the rest of society."

ICCD's mandate is to promote the development and strengthening of Clubhouses; oversee the creation and evolution of standards; facilitate and assure the quality of training, consul­tation, certification, research, and advocacy; and provide effective com­munication and dissemination of information.

The very first Clubhouse, Fountain House, was opened in New York City in 1948 by a group called We Are Not Alone, or WANA. It was an "intentional" community— a residential community for men and women who had histories of psychiatric illness. ICCD's Web site (www.iccd.org) describes this ground­breaking institution as "unique in the world of mental health in many important ways."

Unlike other programs for people with mental illness, Fountain House was founded on the premise that its members could work productively and have socially satisfying lives. Fountain House was also the first to create a Clubhouse in which mem­bers and staff work together side by side, as colleagues, to ensure the smooth operation of the Clubhouse.

Members and staff as partners in a symbiotic relationship? How could such a union even be suggested?

Bravely, and with conviction, that's how. According to ICCD's Web site, "for nearly 30 years, Fountain House was alone in this way of working. It was considered a naive, if not radical notion that people with mental illness could benefit by a program based on rehabilitation, community, and mutu­ally reciprocal relationships with staff."

Coworkers, neighbors, friends

Clubhouse members worldwide applaud the Fountain House model, which alone has served more than 16,000 people since its inception. Its basis for programs and partnerships originates in work units that bring members and staff together to devel­op and operate a particular activity. Members facilitate intake and orienta­tion of new members, housing place­ments, hiring of new staff, building maintenance, policy setting, advocacy initiatives, meal preparation, and serv­ice and program development.

The influence of Fountain House's wide-ranging curriculum has made it possible for members there and at other Clubhouses that fol­lowed suit to be respected as coworkers, neighbors, and friends—as they should be.

The concept has widespread appeal. Jack Yatsko, ICCD direc­tor of training, reports that some 20 to 25 Clubhouses open annu­ally, and all adhere to a set of internationally reviewed and accepted Clubhouse standards. More than 400 Clubhouses are now established in 29 countries, with 225 functioning in North America alone. Approximately 150 have gone through a rigor­ous accreditation process to become ICCD certified. Yatsko estimates he receives approxi­mately 50 emails a week inquiring about how to start a new clubhouse; he expects the first Clubhouse in Mainland China to open this year.

To get a sense of the value of Clubhouses, he says, just take a tour. The food service work unit, for exam­ple, is only one necessary function and involves many categories: shop­ping, budgeting, menu planning, meal preparation, and clean-up. 

"When members volunteer for a job, it fosters a degree of respect and expectation," Yatsko says. "Members ­and staff rely upon each other throughout the day in an atmosphere of collegial mutuality in carrying out the important work of the Clubhouse."

The paid staff's role, he adds, is to "reach out and engage members in all aspects of Clubhouse operations. Members have strong leadership roles in decision-making aspects of the operation that constitute a 'work­ ordered day.'"

What you won't find at a Clubhouse are contracts or rules to enforce member participation; med­ication clinics; day treatment or thera­py programs; or work for outside indi­viduals or agencies. A Clubhouse enables its members to return to paid work through transitional employ­ment, supported employment, and independent employment, but it does not provide employment per se to members through in-house business­es, segregated Clubhouse enterprises, or sheltered workshops. All of these work opportunities are integrated into the community as Clubhouse mem­bers work in real jobs, for real wages.

But personal needs aren't ignored; members do receive help in securing housing, advancing their education, and obtaining good psy­chiatric and medical care.

More than mingling

Brad Turner, 44, of Midland, Ontario, was diagnosed with schizo­phrenia in 1985 and is now a part-time paid peer support worker at Our Place in his hometown, north of Toronto. Although Our Place is not accredited by or affiliated with the ICCD, it does incorporate valuable peer and professional support—and it has been so successful that a move to expanded headquarters is planned for the near future.

"It's not just a place to come and drink coffee," Turner says. "It's a relaxed, comfortable setting where people can come together and talk and, without even knowing it, develop social and communication skills—and I'm sorry, but without social and com­munication skills, you can't be inte­grated back into society, and you cer­tainly can't get or hold down a job."

The role that interaction plays can't be discounted, he adds. "I have come a long way with the help of mental health professionals, but I have come even farther due to the sharing of experience and support of my peers. This is where that sharing and support occurs, among all of our peers. The professionals talk and the­orize about mental health issues. We live them."

At Our Place, peer support work­ers like Turner attend training semi­nars. "We do have professionals super­vising the clubhouse," he explains, "[but] the peer support workers run it." Recreational therapists from the Mental Health Centre Pentenguishene (MHCP) oversee programs, and many members access the care of a psychia­trist or social worker and a career counselor.

Our Place wasn't modeled after any other particular clubhouse, but Grace Parker, manager of rehabilita­tion services for MHCP, doesn't think Our Place "needs to be implemented exactly the same way as every other club in the world." It's rural, for example, and she's happy—as are members—with what she calls the "mutant" concept: "a club that doesn't fit the same kind of formal, credentialed model.

"We prefer to tailor our club to fit the community, and we're fortunate in this area to have a pretty good rela­tionship between consumers and providers," Parker says. "It's our own entity that can grow in a way we want and need it to grow."

The need to belong

Wayne E. Baker, a professor at the University of Michigan's Ross School of Business, once wrote: "The need to belong is a potent human force that finds expression in personal rela­tionships, work relationships, com­munity involvement, participation in voluntary associations, national pride, patriotism, tribal loyalties, and reli­gious allegiances. The need to belong is hard-wired … Belonging has measurable positive effects on subjective well-being, mental and physical health, and the body's bio­chemistry." Simply put, to belong— to be a member of the club—makes us feel good.

Although Baker is a business expert, his observations are just as rel­evant to this business we call life.

Stephanie Stephens is a freelance print and broadcast journalist based in Laguna Niguel, California, and Auckland, New Zealand.

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