Clubhouse model of psychosocial rehabilitation

Last updated

The Clubhouse model of psychosocial rehabilitation is a community mental health service model that helps people with a history of serious mental illness rejoin society and maintain their place in it; it builds on people's strengths and provides mutual support, along with professional staff support, for people to receive prevocational work training, educational opportunities, and social support. The model was created by Fountain House, one of the prime settings for what would, in the space of forty years, become the type specimen of the clubhouse model. [1] Its validity is moderated and approved by Clubhouse International. [2] [3]

Contents

The model, which is non-residential, [4] has its roots in a support group formed in 1943 inside Rockland Psychiatric Center in New York; when people were discharged they met in New York City, and eventually formalized their group in a house in Manhattan that was called "Fountain House". [5] [6] It was "the first psychiatric rehabilitation center of its kind in the United States." [7] The group hired professional staff for the first time in 1955; [8] together staff and members created a set of day programs that, along with the member-centered approach, became the model for other clubhouses. [9] : 215 

There is an international clubhouse network, to which member clubs pay dues and which provides accreditation; standards were developed in 1989 and accreditation began in 1992. [2]

History

Fountain House was the first program of its kind. [10] The model was spread across the US and eventually internationally starting in the 1950s, led largely by the National Council of Jewish Women. [9] : 220  The model spread further with funding from the National Institute of Mental Health in 1977 for the National Clubhouse Training Program. [2] In the mid-1990s New York City added "16 new clubhouses" that were funded, in part by "savings from the closing of several state mental hospitals into community programs." [11]

Model

Membership in a club is open to anyone with a serious mental illness, is voluntary, and never expires. [2] 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. [2] Clubhouses are community-based, and strive to help members join and remain part of society, with educational, prevocational, health, and mental health support. [2] Members and staff work together to run structured day programs that follow the workday of the community where a given club is located. [2] Programs are based on assumption that people have individual strengths that can be built on and that meaningful relationships and work are essential; members have the right to choose staff to work with and the kind of work they do. [2]

Evening programs facilitate having a place to go after work hours. One such program collects people's of-the-moment writing, before they can edit and self-censor. [12]

There is an international clubhouse network, to which member clubs pay dues and which provides accreditation; standards were developed in 1989 and accreditation began in 1992. [2]

Effectiveness

A review of research on the effectiveness of the clubhouse model in helping people found that evidence was limited by lack of randomized controlled trials, wide differences in the kinds of outcomes that were studied, and lack of long-term follow-up; these limitations make it difficult to generalize the results. [2] Outcomes that have been measured include time to find full-time employment, earnings, and workplace integration; life satisfaction; psychiatric hospitalization; social integration; educational attainments; and physical health. [2] It appears that clubhouse participation helps people avoid psychiatric hospitalization, improves quality of life, and may improve social integration. [2] A 2016 review came to similar conclusions. [13] A systematic review of the literature in 2018 found that the clubhouse model is a promising practice and calls for more rigorous studies. [14]

Related Research Articles

Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work practice draws from liberal arts, social science, and interdisciplinary areas such as psychology, sociology, health, political science, community development, law, and economics to engage with systems and policies, conduct assessments, develop interventions, and enhance social functioning and responsibility. The ultimate goals of social work include the improvement of people's lives, alleviation of biopsychosocial concerns, empowerment of individuals and communities, and the achievement of social justice.

<span class="mw-page-title-main">Mental health</span> Level of human psychological well-being

Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to the World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community". It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others.

Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives, and is an active "community services and funding" stream across the United States. It was developed by different professional academics and US governmental departments that supported housing. Supportive housing is widely believed to work well for those who face the most complex challenges—individuals and families confronted with homelessness and who also have very low incomes and/or serious, persistent issues that may include substance use disorders, mental health, HIV/AIDS, chronic illness, diverse disabilities or other serious challenges to stable housing.

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, reflective listening, or counseling. Peer support is also used to refer to initiatives where colleagues, members of self-help organizations and others meet, in person or online, as equals to give each other connection and support on a reciprocal basis.

A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment, individual and family psychoeducation, adult day care, foster care, family services and mental health counseling.

Assertive community treatment (ACT) is an intensive and highly integrated approach for community mental health service delivery. ACT teams serve individuals who have been diagnosed with serious and persistent forms of mental illness, predominantly but not exclusively the schizophrenia spectrum disorders. ACT service recipients may also have diagnostic profiles that include features typically found in other DSM-5 categories. Many have histories of frequent psychiatric hospitalization, substance abuse, victimization and trauma, arrests and incarceration, homelessness, and additional significant challenges. The symptoms and complications of their mental illnesses have led to serious functioning difficulties in several areas of life, often including work, social relationships, residential independence, money management, and physical health and wellness. By the time they start receiving ACT services, they are likely to have experienced failure, discrimination, and stigmatization, and their hope for the future is likely to be quite low.

The psychiatric survivors movement is a diverse association of individuals who either currently access mental health services, or who have experienced interventions by psychiatry that were unhelpful, harmful, abusive, or illegal.

Psychiatric rehabilitation, also known as psychosocial rehabilitation, and sometimes simplified to psych rehab by providers, is the process of restoration of community functioning and well-being of an individual diagnosed in mental health or emotional disorder and who may be considered to have a psychiatric disability.

The recovery model, recovery approach or psychological recovery is an approach to mental disorder or substance dependence that emphasizes and supports a person's potential for recovery. Recovery is generally seen in this model as a personal journey rather than a set outcome, and one that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. Recovery sees symptoms as a continuum of the norm rather than an aberration and rejects sane-insane dichotomy.

Independence Center is a rehabilitation center for people with psychiatric disorders in St. Louis, Missouri. It uses the Clubhouse Model of Psychosocial Rehabilitation and is modeled after New York City's Fountain House. It was founded in 1980 by Robert B. "Bob" Harvey. IC also participates in the Transitional Employment Program (TEP), and colleague training.

Dual diagnosis is the condition of having a mental illness and a comorbid substance use disorder. There is considerable debate surrounding the appropriateness of using a single category for a heterogeneous group of individuals with complex needs and a varied range of problems. The concept can be used broadly, for example depression and alcohol use disorder, or it can be restricted to specify severe mental illness and substance use disorder, or a person who has a milder mental illness and a drug dependency, such as panic disorder or generalized anxiety disorder and is dependent on opioids. Diagnosing a primary psychiatric illness in people who use substances is challenging as substance use disorder itself often induces psychiatric symptoms, thus making it necessary to differentiate between substance induced and pre-existing mental illness.

Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing. Despite the different approaches, many of the psychosocial processes in the groups are the same. Self-help groups have had varying relationships with mental health professionals. Due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population.

Virginia Gonzalez Torres is a female human rights activist in Mexico who provides support and resources for the mentally ill. She is often referred to as the Dorothea Dix of Mexico.

<span class="mw-page-title-main">Judi Chamberlin</span> American psychiatric survivors movement activist

Judi Chamberlin was an American activist, leader, organizer, public speaker and educator in the psychiatric survivors movement. Her political activism followed her involuntary confinement in a psychiatric facility in the 1960s. She was the author of On Our Own: Patient-Controlled Alternatives to the Mental Health System, which is a foundational text in the Mad Pride movement.

Supported employment refers to service provisions wherein people with disabilities, including intellectual disabilities, mental health, and traumatic brain injury, among others, are assisted with obtaining and maintaining employment. Supported employment is considered to be one form of employment in which wages are expected, together with benefits from an employer in a competitive workplace, though some versions refer to disability agency paid employment. Companies such as Skilcraft in the United States are an example of "supported employment" which is defined in law for state and federal reimbursements.

Community mental health services (CMHS), also known as community mental health teams (CMHT) in the United Kingdom, support or treat people with mental disorders in a domiciliary setting, instead of a psychiatric hospital (asylum). The array of community mental health services vary depending on the country in which the services are provided. It refers to a system of care in which the patient's community, not a specific facility such as a hospital, is the primary provider of care for people with a mental illness. The goal of community mental health services often includes much more than simply providing outpatient psychiatric treatment.

Services for mental health disorders provide treatment, support, or advocacy to people who have psychiatric illnesses. These may include medical, behavioral, social, and legal services.

<span class="mw-page-title-main">Patricia Deegan</span>

Patricia E. Deegan is an American disability-rights advocate, psychologist and researcher. She has been described as a "national spokesperson for the mental health consumer/survivor movement in the United States." Deegan is known as an advocate of the mental health recovery movement and is an international speaker and trainer in the field of mental health.

Case management is the coordination of community-based services by a professional or team to provide quality mental health care customized accordingly to individual patients' setbacks or persistent challenges and aid them to their recovery. Case management seeks to reduce hospitalizations and support individuals' recovery through an approach that considers each person's overall biopsychosocial needs without making disadvantageous economic costs. As a result, care coordination includes traditional mental health services but may also encompass primary healthcare, housing, transportation, employment, social relationships, and community participation. In the 1940s, this was known as social counseling. It is the link between the client and care delivery system.

Fountain House is a national mental health nonprofit organization focused on supporting people with serious and persistent mental illness. Founded in 1948, Fountain House originated the Clubhouse Model of Psychosocial Rehabilitation. The organization's stated mission is "to create the community, innovation, and social change needed for people most impacted by mental illness to lead connected and healthy lives."

References

  1. ↑ "Fountain House".
  2. 1 2 3 4 5 6 7 8 9 10 11 12 McKay, Colleen; Nugent, Katie L.; Johnsen, Matthew; Eaton, William W.; Lidz, Charles W. (31 August 2016). "A Systematic Review of Evidence for the Clubhouse Model of Psychosocial Rehabilitation". Administration and Policy in Mental Health and Mental Health Services Research. 45 (1): 28–47. doi:10.1007/s10488-016-0760-3. PMC   5756274 . PMID   27580614.
  3. ↑ "Clubhouse International".
  4. ↑ Karen Demasters (October 15, 2000). "ON THE MAP: Raising Crops, and Self-Esteem, on a Special Farm". The New York Times .
  5. ↑ Fountain House, New York City (November 1999). "Gold Award: The Wellspring of the Clubhouse Model for Social and Vocational Adjustment of Persons With Serious Mental Illness". Psychiatric Services. 50 (11): 1473–1476. doi:10.1176/ps.50.11.1473. PMID   10543858. Open Access logo PLoS transparent.svg
  6. ↑ Farrell, SP; Deeds, ES (January 1997). "The clubhouse model as exemplar. Merging psychiatric nursing and psychosocial rehabilitation" . Journal of Psychosocial Nursing and Mental Health Services. 35 (1): 27–34. doi:10.3928/0279-3695-19970101-15. PMID   8994933.
  7. ↑ Howard A. Rusk, M.D. (February 4, 1968). "Mental Rehabilitation; Fountain House on 47th St. Is Mecca To Many Former Patients in the State". The New York Times .
  8. ↑ "John H. Beard Is Dead at 59; Director of Fountain House". The New York Times . December 12, 1982. became executive director of Fountain House, at 425 West 47th Street, in 1955
  9. 1 2 Ikkaku, Takayuki; Hosaka, Arisa; Kawabata, Toshihiro (2013). "Chaoter 7: Psychiatric Day Programming". In Pratt, Carlos W.; Gill, Kenneth J.; Barrett, Nora M.; Roberts, Melissa M. (eds.). Psychiatric Rehabilitation. Academic Press. p. 215. ISBN   9780123870087.
  10. ↑ Goertzel, Victor; Beard, John H.; Pilnick, Saul (April 1960). "Fountain House Foundation: Case Study Of An Expatient's Club". Journal of Social Issues. 16 (2): 54–61. doi:10.1111/j.1540-4560.1960.tb00949.x.
  11. ↑ Lisa W. Foderaro (November 8, 1994). "'Clubhouse' Helps Mentally Ill Find the Way Back; At Fountain House, the Emphasis Is on Jobs, Education and Friendship". The New York Times .
  12. ↑ Devi Lockwood (September 3, 2019). "Anonymous Stories for the Instagram Age". The New York Times .
  13. ↑ Battin, C; Bouvet, C; Hatala, C (December 2016). "A systematic review of the effectiveness of the clubhouse model". Psychiatric Rehabilitation Journal. 39 (4): 305–312. doi:10.1037/prj0000227. PMID   27786524.
  14. ↑ McKay, C.; Nugent, K. L.; Johnsen, M.; Eaton, W. W.; Lidz, C. W. (2018). "Systematic Review of Evidence for the Clubhouse Model". Administration and Policy in Mental Health. 45 (1): 28–47. doi:10.1007/s10488-016-0760-3. PMC   5756274 . PMID   27580614.

Further reading


This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.