Staff views on member participation in a mental health clubhouse

Abstract

The clubhouse model is a community psychiatric rehabilitation program aiming to provide a restorative environment for people with severe mental health problems. These clubhouses provide their members with opportunities for friendship, employment, and education, which help them on their paths towards mental health recovery. Towards that end, the model features clubhouse members and staff working side by side to execute clubhouse activities. That is, unlike most of the community mental health programs where staff provide services to their clients, clubhouse staff are required to partner with members in their work. The aim of this qualitative study was to understand how the clubhouse staff elicited member participation and facilitate recovery. The research was conducted between Year 2013 and Year 2014 at the world's first clubhouse: Fountain House in New York City. The first author conducted 262 hr of active participant observation in 41 visits to Fountain House, and in‐depth interviews with 38 staff members who had worked at Fountain House for at least 1 month during the study period. The dimensional analysis procedure was used to analyse the observation notes and interview transcripts. Results showed that participation was a key to rebuilding members’ self‐confidence, which further encouraged members to seek more opportunities for self‐enhancement and personal growth. Specific organisational policies, programming, practical considerations, and other strategies shaped a positive environment for members to exercise autonomy, experience self‐efficacy, and model behaviours after others who have succeeded. Findings of this research support the egalitarian staff–member relationships and the maintenance of an open and transparent atmosphere of the clubhouse, as observational learning enables members to move forward with their journeys to recovery. Findings also may inform efforts to shift traditional psychiatric services towards recovery‐oriented care.

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

“…P. Chen & Oh, 2019;Pardi & Willis, 2018;Raeburn et al, 2013Raeburn et al, , 2015Rice et al, 2020;Schiff et al, 2008;Tan et al, 2018;Tanaka et al, 2015;Tanaka & Davidson, 2015a, 2015b. Our study focus being service users' perspectives, it is notable that the Autonomy and Egalitarian Connection themes we found corroborate staff views on what fosters member participation (F. P. Chen & Oh, 2019).…”

“…In the CMH context, Salzer and his associates (Salzer et al, 2014(Salzer et al, , 2015Wong et al, 2007) have advanced a domain-specific conceptualization that is fairly reduced to objective indicators of participation. A few qualitative studies have focused on the subjective experiences of participation in activities occurring in community life, which are either descriptive (Schiff et al, 2008;Yilmaz et al, 2008Yilmaz et al, , 2009 or based on staff views (F. P. Chen & Oh, 2019).…”

Supported Housing as a recovery option for long-stay patients with severe mental illness in a psychiatric hospital in South India: Learning from an innovative de-hospitalization process

“…The HCWs played a key role here in building trust and bridging the gap during the transition period, and being sensitive to the residents' needs for confirmation and connection. Supporting residents in their transition, also through linking them with the community, is described by Chen [50] as a core element of community-based support programmes. It is important to emphasize these shifts in roles for staff, as supporting links with people in the community is not always considered part of mental health [51].…”

“…In the current project, we saw that the more hands-on responsibility of interacting with the community lies largely with the HCWs, as well as the managing team. As explained also by Chen [50], it means that for the development of sufficient insight into the residents' status to facilitate community integration, HCWs are required to be close to the residents, and ideally to live with them most of the time.…”

“Finally, I belong somewhere I can be proud of” – Experiences of being a Clubhouse member in Norway

“…Moreover, qualitative studies have revealed that members find participation in the Clubhouse community to be a stepping-stone to vocational recovery (Roth, 2017;Tanaka & Davidson, 2015a). For example, participation in the work-ordered day has been found to increase members' self-confidence (Norman, 2006;Tanaka & Davidson, 2015a), apparently resulting in increased faith in their ability to (re)enter the labour market (Chen & Oh, 2019). Consistent with these findings, a recent metasynthesis (Kinn, Tanaka, Bellamy, & Davidson, 2018) explored the Clubhouse participation experiences of Clubhouse staff and members and their families.…”