By Taylor Sisk
To be diagnosed with a severe and persistent mental illness is, quite often, to be labeled an â€œother.â€ Itâ€™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 â€œrecovery from serious mental illness must involve the whole person in a vital and culturally sensitive community,â€ 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.
â€œBefore Club Nova,â€ said Jim Huegerich, director of Crisis and Human Services for the Chapel Hill Police Department, â€œlike 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.â€
â€œThroughout my career as a police officer, Iâ€™ve met many people associated with Club Nova, and Iâ€™ve grown both professionally and personally through those contacts,â€
Carrboro Police Chief Carolyn Hutchison said. â€œI value the collaborative relationship that exists between the Carrboro Police Department and Club Nova.â€
Why not more?
Clubhouses are â€œthe most cost-effective treatment for the persistently mentally ill,â€ 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.
â€œClub Nova members gain real work experience and renewed self-confidence,â€ state Rep. Verla Insko said, â€œand the business people gain insights into the strengths and abilities of people with mental illness, as well as some very good workers.â€
Clubhouse members arenâ€™t just good workers, theyâ€™re good teachers.
â€œClub Nova has been a place of learning for me and for my students that is penetrating and constantly renewing,â€ said Sue Estroff, a professor in UNCâ€™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.
â€œThe visit is indelible for the students,â€ she said.
These are all compelling arguments for the funding of clubhouses. But the importance of that simple guarantee of a place to go shouldnâ€™t be downplayed. In a fundamental regard, the clubhouse structure itself is salvation.
Susan Coppola is a clinical associate professor in UNCâ€™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 â€œinvisible conditions, like mental illness, require more subtle environmental adaptations that are difficult to understand,â€ she said. â€œBecause of the complexity, and, letâ€™s face it, the stigma of mental illness, we are reluctant to invest in environmental situations that reasonably accommodate and support these conditions.
â€œIndividuals 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.â€
Clubhouses, Coppola said, are such efforts in action.
Recent research into the phenomenon of resiliency finds that people recover from illness â€“ both physical and psychological â€“ better when they have social support.
â€œClubhouse memberâ€ may just sound like pretty words, said Jacquie Gist, a member of the Carrboro Board of Aldermen. â€œBut thatâ€™s what itâ€™s about, and it really makes a difference. Not â€˜patientâ€™; not â€˜client.â€™ â€˜Clubhouse member.â€™ Itâ€™s a sense of belonging, and an indication of how members are valued.â€
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, â€œI desperately needed to be needed in some way.â€
The desire to belong is universal, Pierce said, but itâ€™s especially true for those with a stigmatizing illness. â€œImmediately upon coming to Club Nova, I felt this incredible sense of welcome.â€
â€œIâ€™ve known some members for 30 years now,â€ Gist said, â€œand Iâ€™ve seen how theyâ€™ve been given the resources to get by, the support tools they need to live and thrive.â€
And, she adds, â€œMost importantly, itâ€™s done with dignity.â€
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.
â€œThese are the things that can disable you,â€ said Larry Fricks, a national advocate for peer support in mental health treatment, â€œyour symptoms, the stigma and the way your self-image changes when you experience mental illness.â€
â€œI have no desire to go back to my former days before Club Nova,â€ said member Charlene Lee. â€œI have a strong desire to move forward,â€ 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. Youâ€™ll be serving your community well.
â€œClub Nova is something our community can be straight-up proud about,â€ Gist said. â€œItâ€™s something weâ€™ve done right as a community. â€¦ It saves lives.â€