Community-based rehabilitation and the Clubhouse Model as means to recovery and mental health services reform.

Abstract

Se examinan las tendencias de rehabilitación basada en la comunidad (CBR) y el modelo de rehabilitación psicosocial denominado Clubhouse (CH) como instrumentos de políticas de reforma de la Salud Mental (MH). El trabajo se basa en documentación del proyecto transnacional “Empoderamiento de adultos con enfermedad mental para aprendizaje e inclusión social en 2010-2012” además de otras fuentes. La colección de datos y subsecuentes análisis se prepararon en el contexto de cerca de 30 recomendaciones internacionales de políticas de salud mental desde los años 90 hasta el 2012. Los documentos fueron analizados y comparados con diferentes enfoques orientados a la recuperación, tales como el modelo CH, y con conceptos clave de la ciencia de Rehabilitación, vinculados con tendencias recientes de la rehabilitación psicosocial. Algunas de las más importantes recomendaciones intergubernamentales de políticas de salud mental son las Guías conjuntas de Trabajo de la Organización Mundial de la Salud (OMS) y UNESCO y varias asociaciones internacionales tales como la Asociación Mundial de Rehabilitación Psiquiátrica (WAPR) y el Marco Piramidal de la OMS para la óptima combinación de servicios de Salud Mental, complementados con el Plan Integral de Acción en Salud Mental 2013-2020 aprobado por la OMS este año. Todas estas fuentes incluyen el espectro total de trastornos mentales. Factores de combinación son los derechos humanos, basados en una comprensión más holística de las discapacidades en lugar de un enfoque meramente médico. Todas estas recomendaciones están orientadas a su utilización a nivel global.

How Young Adults in London Experience the Clubhouse Model of Mental Health Recovery: A Thematic Analysis

“…Each individual also had goals, skills, an interest in those around them, and an appreciation for services which treated them as capable adults. As Hanninen et al explain, empowering individuals to make their own decisions and continuing to focus on their abilities even during difficult periods is hugely beneficial, and this was clear throughout the interviews (27). Overall, the experience of being a young adult in the clubhouse was highly valuable; with meaningful relationships, social inclusion, learning new skills and helping others all clear contributors to perceived improvement in overall wellbeing.…”

“…Members generally regarded clubhouse staff as "normal", non-judgemental, and genuinely interested in their opinions and skills. This tied in with empowerment concepts, where it is recognised that everyone has strengths on which they can build up their lives, even during difficult periods (27). A benefit of the clubhouse service was that members described feeling included in decisions made about them and about the service at large.…”

Interaction, Ideology, and Practice in Mental Health Rehabilitation

“…The model originated in the early 1940s and was inspired by the recovery ideology of AA meetings [26]. It provides community-based programmes whose goal is to support mental rehabilitants (henceforth referred to as ''members'') to live a self-directed life and to reach their full potential [27,28]. Clubhouse documents in its Clubhouse Standards [29] operational principles and guidelines including a strengths-based philosophy and the right to self-determination.…”

“…Recent Clubhouse literature has begun to reclaim the recovery ideology embodied in the model [27,[30][31][32][33][34][35][36]. Raeburn et al [32], for instance, reviewed samples of key programme documents within an Australian Clubhouse to assess how they reflect recovery ideology.…”

“…In addition to the recovery ideology, the Clubhouse model is also inspired by the communal approaches described above. In the Clubhouse model, the workordered day is central [27,29]. Unlike business workplaces or conventional prevocational programmes, the work-ordered day involves members and their support workers mutually helping each other to run the community.…”