Scaling the Clubhouse Model
Overview of the Problem
There are several devastating impacts that stem from living with a serious mental illness. The social and vocational disability that so often accompanies the illness creates, and often maintains, isolation and separation from others in society. Psychiatric disability contributes to poor functioning in the demanding roles and tasks that are required of us all in day to day community living. As a result, people with schizophrenia and other serious mental illnesses often experience their community lives as increasingly stressful and stress heightens their vulnerability to symptoms. The tragic results often include unnecessary hospitalizations, homelessness, encounters with law enforcement, the courts and/or incarceration.
Psychiatric rehabilitation grew out of the failures of the community mental health system in the era of deinstitutionalization in the 1960s and recognized that, by better attending to psychiatric disability in the areas of living, learning, working and socializing, people with schizophrenia and other serious mental illnesses would achieve better functioning in the community and reduce the likelihood of hospitalization. A mix of skills and supports is the heart and soul of the psychiatric rehabilitation approach and this mix is abundantly available at Clubhouses worldwide.
What is now known as the Clubhouse Model of Psychiatric Rehabilitation began at Fountain House in New York City the late 1940s. It is an internationally recognized and evidence-based program that provides an intentional community that guarantees a place to come, meaningful work, meaningful relationships and a place to return for program participants, known as members. (Family perspectives of how their relatives with mental illness benefit from Clubhouse participation: a qualitative inquiry, Chia-Ling Chung et al. Journal of Mental Health, 2016, 25(4):372-378)
At an accredited Clubhouse, members find a community of support from both other members and staff, have opportunities to participate in the actual running of the Clubhouse; pursue employment, education, social/recreational opportunities; access needed community resources such as housing, medical, dental and substance abuse care; achieve greater self-reliance and become productive members of society. (A Systematic Review of Evidence for the Clubhouse Model of Psychosocial Rehabilitation, Colleen McKay, et al. Administration Policy Mental Health (2018) 45:28-47)
Research on Clubhouses has clearly established that members benefit from higher employment rates, a decrease in hospitalization, reduced incarceration, improved well-being, and reduced cost of services in comparison to other programs. (Analysis of the Association of Clubhouse Membership with Overall Costs of Care for Mental Health Treatment, Swungyoung Hwang, et al. Community Mental Health Journal, June, 2016) In 2017, over 3500 people were involuntarily detained for psychiatric reasons in King County and placed on single bed certifications in emergency departments and medical units. If only 10% of these detentions had been avoided due to that right mix of skills and support being provided in the community by a Clubhouse, the recovery of people diverted would have been greatly enhanced and the savings to the system would have been enormous. This makes Clubhouse a good deed and a good deal and deserving of support for both reasons.
There are 330 Clubhouses worldwide, across 32 countries, serving over 100,000 members each year—but this resource is not available to WA State residents, as there are only two accredited Clubhouses in WA State.
“We would love to see a Clubhouse in every community on this planet. Clubhouse offers a radical new vision for the psychiatric approach.” Vikram Patel, MD, Harvard Medical School
The Washington State Clubhouse Coalition, including HERO House in Bellevue, Evergreen Clubhouse in Spokane, and the newly formed Seattle Clubhouse, has come together to work on bringing Clubhouse to every community in Washington State. The plan is to build three or four very strong, accredited Clubhouses that will act as hubs for expanding into new communities around the state. This will provide a strong base for growth using better economies of scale, shared services, diversity of sustainable funding sources, and a large voice for advocacy at the state level.
1. A diversity of funding is essential to build and sustain a network of Clubhouses in Washington state. Current support for the two accredited Clubhouses in the state comes from a mix of funds from county and regional support and private support. There may be a creative solution to increase funding from other sources including the WA state legislature.
2. Many communities will need to identify a building for the Clubhouse and space for activities.
3. Employment is a top priority, and a “work-ordered day” is central to the Clubhouse model. New clubhouses will need new employment opportunities for their members and will seek partners to provide jobs and supported employment opportunities.
4. Volunteers are needed to build and sustain these community centers.
5. Advocacy. Everyone can advocate for this resource for his/her community’s most vulnerable members.
Please contact Larry Clum (firstname.lastname@example.org; 253-350-8014) for information on how to get involved in creating clubhouses for Washington State residents with serious mental illness.
Jonathan Beard, LICSW, CPRP
as of October, 2019
Opened the doors to another Clubhouse under the HERO House NW auspice, called Everett Clubhouse.
Hired a Program Director for the Everett Clubhouse who is a current faculty member for Clubhouse International, the accrediting body for clubhouse model programs worldwide.
Provided guidance and consultation to start-up groups in Tacoma, Chehalis, Bellingham and Bremerton.
Placed and supported 73 Clubhouse members with serious mental illness into evidence based supported employment jobs in the last year.