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A mental health model that works

By Taylor Sisk

To be diagnosed with a severe and persistent mental illness is, quite often, to be labeled an “other.” It’s an isolating experience. For many, simply having a place to go, where a sense of belonging is nurtured, can make all the difference in the world.

This premise is the foundation of a model of mental health care called clubhouse, introduced 64 years ago with the opening of Fountain House in New York City.

There are now more than 300 clubhouses around the world, eight in North Carolina, which follow standards set by the International Center for Clubhouse Development.
These clubhouses are founded on the belief that “recovery from serious mental illness must involve the whole person in a vital and culturally sensitive community,” with the individual as a partner in that recovery.

Essentially, clubhouses are community centers, offering hope and opportunity.

My first-hand experience with clubhouses is as a board member of Club Nova in Carrboro. Club Nova operates under a Community Bill of Rights comprising four guarantees: a place to come, meaningful work, meaningful relationships and a place to return.

Club members participate in the management and upkeep of Club Nova, and the club offers an employment program in collaboration with the local business community.

Transitional employment helps bridge the gap between work within the clubhouse and independent employment. Members are often then placed in permanent jobs, with ongoing support.

“Before Club Nova,” said Jim Huegerich, director of Crisis and Human Services for the Chapel Hill Police Department, “like clockwork, those with chronic and persistent mental illness would cycle in and out of state mental hospitals every six months, initially surfacing with law enforcement in a crisis. For those who are members of Club Nova, this cycle has essentially been broken.”

“Throughout my career as a police officer, I’ve met many people associated with Club Nova, and I’ve grown both professionally and personally through those contacts,”

Carrboro Police Chief Carolyn Hutchison said. “I value the collaborative relationship that exists between the Carrboro Police Department and Club Nova.”

Why not more?

Clubhouses are “the most cost-effective treatment for the persistently mentally ill,” said state Sen. Ellie Kinnaird, a longtime supporter.

Threshold Clubhouse in Durham compiled some statistics in 2010 that help define the cost-effectiveness of the model. Based on its Medicaid reimbursement rate, six months of care at Threshold costs $10,412, less than the price of eight days of psychiatric care at Central Regional Hospital. (That reimbursement rate has since been reduced.)

Studies have shown the rehospitalization rate for people with severe and persistent mental illness to be as high as 40 percent after six months and 75 percent after five years. For 2011, Threshold had a rehospitalization rate of 7 percent after one year, a number consistent with past years and with other clubhouses in the state.

Places of employment for Club Nova members have included Staples, the YMCA, Carolina Fitness, the UNC School of Social Work, Open Eye Cafe and the Mental Health Association.

“Club Nova members gain real work experience and renewed self-confidence,” state Rep. Verla Insko said, “and the business people gain insights into the strengths and abilities of people with mental illness, as well as some very good workers.”

Clubhouse members aren’t just good workers, they’re good teachers.

“Club Nova has been a place of learning for me and for my students that is penetrating and constantly renewing,” said Sue Estroff, a professor in UNC’s School of Social Medicine. Club members have been guest lecturers in her classroom for years, and she sometimes moves that classroom to the clubhouse.

“The visit is indelible for the students,” she said.


These are all compelling arguments for the funding of clubhouses. But the importance of that simple guarantee of a place to go shouldn’t be downplayed. In a fundamental regard, the clubhouse structure itself is salvation.

Susan Coppola is a clinical associate professor in UNC’s division of occupational science. We build ramps for wheelchairs and make other adaptations for conditions like vision or hearing loss, she points out.

But “invisible conditions, like mental illness, require more subtle environmental adaptations that are difficult to understand,” she said. “Because of the complexity, and, let’s face it, the stigma of mental illness, we are reluctant to invest in environmental situations that reasonably accommodate and support these conditions.

“Individuals with mental illness and their families have had to work outside the system to create these environments, and do so at a very low cost.”

Clubhouses, Coppola said, are such efforts in action.
Recent research into the phenomenon of resiliency finds that people recover from illness – both physical and psychological – better when they have social support.

“Clubhouse member” may just sound like pretty words, said Jacquie Gist, a member of the Carrboro Board of Aldermen. “But that’s what it’s about, and it really makes a difference. Not ‘patient’; not ‘client.’ ‘Clubhouse member.’ It’s a sense of belonging, and an indication of how members are valued.”

Some years ago, Jonah Pierce, a nurse now working with HIV/AIDS patients, was receiving treatment after two suicide attempts, and was progressing well. But, he said, “I desperately needed to be needed in some way.”
The desire to belong is universal, Pierce said, but it’s especially true for those with a stigmatizing illness. “Immediately upon coming to Club Nova, I felt this incredible sense of welcome.”

“I’ve known some members for 30 years now,” Gist said, “and I’ve seen how they’ve been given the resources to get by, the support tools they need to live and thrive.”
And, she adds, “Most importantly, it’s done with dignity.”

The clubhouse experience can help people with mental health disabilities overcome not only their symptoms but the feelings of despair that can develop when their lives are turned upside down by mental illness.

“These are the things that can disable you,” said Larry Fricks, a national advocate for peer support in mental health treatment, “your symptoms, the stigma and the way your self-image changes when you experience mental illness.”

“I have no desire to go back to my former days before Club Nova,” said member Charlene Lee. “I have a strong desire to move forward,” and she has.

Insko said that among her priorities as a member of the House Appropriations Subcommittee on Health and Human Services is protecting funding for clubhouses across the state.

As we continue to defund and dismantle mental health care services in North Carolina, please ask your representatives to advocate for this critical, cost-effective and proven model of care. You’ll be serving your community well.

“Club Nova is something our community can be straight-up proud about,” Gist said. “It’s something we’ve done right as a community. … It saves lives.”

  1. Gordon Marx

    I think that the article is a very good discription of how a clubhouse is supposed to operate. Our clubhouse is no longer viable for the members & has completely abandoned their mandate. If you send me an e-mail address where I can send you some documents, I will tell you more. Do you happen to have an e-mail address where I can contact ICCD? I haven’t been able to find it.
    Gordon Marx member # 1471 of POTENTIAL PLACE Calgary