Clubhouse Model of Psychosocial Rehabilitation

The Clubhouse Model of Psychosocial Rehabilitation is a comprehensive and dynamic program of 'treatment' for people with severe and persistent mental illness. In contrast to traditional day-treatment models, clubhouse participants are called "members" (as opposed to "patients" or "clients") and treatment focuses on their strengths and abilities, not their illness. The clubhouse is unique in such 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 independence of the individual, rather than their illness. Additionally, all participation in a clubhouse is strictly on a voluntary basis.

As a summary of its philosophy, the Clubhouse Model has adopted the Four Guaranteed Rights of Membership:

1.) A right to a place to come; 2.) A right to meaningful relationships; 3.) A right to meaningful work; and 4.) 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 run 'by the members, for the members.' 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 300 clubhouses in 24 countries around the world.

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 ICCD, 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 (ICCD) was created to serve and represent the rapidly growing clubhouse community. Through the ICCD, 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 ICCD Standards Review Committee, made up of members and staff of ICCD-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, through the ICCD certification process. Programs wishing to officially adopt the Clubhouse Model can request a visit from ICCD 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 the ICCD 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."

History
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 300 other programs eventually adopting the treatment model in 24 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.

Critique and Assessment
Given the relative recency of the Clubhouse Model as a growing, viable option to traditional day-treatment programs, the literature regarding its effectiveness in treating mental illness as compared to other models is in the beginning stages.

As mental health service delivery systems face new administrative and programmatic challenges, the ICCD and the Clubhouse Model will continue to insist on the promotion and protection of the rights, opportunities, abilities, and future of psychiatrically disabled men and women who are members of the clubhouse community.