Conceptualizing participation in the community mental health context: Beginning with the Clubhouse model

Abstract

Purpose: Although participation is key to community mental health, the concept remains elusive. The study explored a conceptualization of participation in the community-based mental health agencies context from a first-person perspective, using the Clubhouse model as an example. Methods: Qualitative data, collected from 21 Clubhouse service users through three focus groups (1 UK and 2 US) for primary analysis and secondary data from 104 individual interviews, were analysed using a grounded theory approach. Results: Focus group narratives revealed three main domains of what may be named everyday participation process, Making Decisions, Doing Work, and Locating Oneself in Community, blended with each other rather than forming clear-cut stages. Sixty-six extracted primary codes, with two underlying interrelated core categories identified, named Autonomy and Egalitarian Connection, were organized by domain and by category. Conclusions: The findings suggest a 3 × 2 axial model of participation that participation signifies a behaviour, comprised of three blended activity domains, entailing actions and interactions that concern Autonomy and Egalitarian Connection, which, dynamically interacting with each other, appear to condition meaningful participation the next day. Egalitarian relationship skills development appears critical for training practitioners to help promote service users' quality everyday participation and getting-a-life-back experiences towards wellbeing, or meaningful life.

A conceptual model of how mental health clubhouses impact health and quality of life among individuals with serious mental illness.

“…The emphasis on reciprocity is also unique to Clubhouses and is particularly important given that PWSMI tend to have fewer reciprocal relationships than the general population. Our findings on social support align with Tanaka et al’s (2021) conceptual model on participation and Coniglio et al’s (2012) conceptual model on peer support. Although these studies examined different processes, they both highlight the importance of reciprocity.…”

“…They posited four layers of peer support that began with social inclusion and belonging and progressively deepened to the levels of shared achievement through doing, interdependency, and intimacy . Tanaka et al (2021) developed a conceptual model of participation within Clubhouses. They conceptualized participation as the relationship between autonomy (e.g., empowerment, being free to be oneself, confidence to achieve) and egalitarian connection (e.g., mutual respect, trust, sense of belonging), which contribute to continued meaningful participation in the future.…”

Mental health rehabilitees’ agency construction and promotion in community-based transitional work programme

“…The analysis demonstrates that staff members exercise considerable power over the rehabilitees’ agency—both in terms of the type of agency and in terms of whose agency in the TE programme is promoted in the first place. This is important, considering that Clubhouse activities should be based on equality and equal opportunities (Fekete et al, 2020 ; Tanaka et al, 2021 ; Valkeapää et al, 2019 ).…”

“…Their main concept involves the “work-ordered day” in which rehabilitees, also called Clubhouse members, participate in daily activities to maintain and develop the Clubhouse community, such as grocery shopping, staff recruitment and administration (Hänninen, 2016 ; McKay et al, 2018 ; Pirttimaa & Saloviita, 2009 ). In and through all this the Clubhouse organization promotes mental health rehabilitee’s initiative and activity (Fekete et al, 2020 , 2021 ), participation (Tanaka et al, 2021 ) or agency (Valkeapää et al, 2019 ), that is, their state of acting and exerting power over their lives.…”

Identifying barriers affecting citizen participation in community‐driven development projects in Afghanistan: A case study of Herat city

“…A high volume of theoretical research has been conducted on public participation in the fields of political science, urban planning, governance etc. (Arnstein 1969;Delwiche and Henderson 2013;Kelty et al 2015;Tanaka et al 2021). Mccarthy et al (2017) uncover that "participation" can have different levels, from "involvement" to "control", which aims to enhance citizens' empowerment (see also, Hickey and Mohan 2005).…”