Clubhouse Members Design Their Road to Recovery

One constant in the 50-year history of Horizon House, a multiservice mental health center headquartered in Philadelphia, is the struggle to find ways of meeting the needs of each individual who comes for services.

Efforts to translate that core concept into practice are highly visible at Providence House, a clubhouse in Chester, Pa., that is one of the agency's many programs.

“Many people don't understand the clubhouse model,” said Courtney Smith, the director. “They think it's just a drop-in center, where people come to sit around.”

To receive certification from the International Center for Clubhouse Development (ICCD), however, a clubhouse must meet standards set by a committee made up of members and staff of ICCD-certified clubhouses from around the world.

Those standards promote self-determination and respect for the capabilities of members as a means of promoting their recovery.

Membership is voluntary and open to anyone with a history of mental illness, unless the person poses a significant and current threat to the general safety of the clubhouse community. There are no agreements, contracts, schedules, or rules intended to enforce participation of members.

Members and staff work side by side and are involved in all aspects of clubhouse operation. All meetings are open to both groups. The clubhouse offers transitional, supported, and independent employment outside the clubhouse.

“You don't just `do clubhouse,'” said Smith. “It's a whole culture in which everyone is valued. We don't focus on the illness.”

Creating that culture is a daily enterprise that requires a constant emphasis on promoting empowerment of clubhouse members (Original article: see box).

How, for example, does staff approach the issue of medication compliance?“ We would help a member advocate for him- or herself with the doctor about side effects or other problems,” said Smith. “But no one would be barred from clubhouse for noncompliance unless it is an issue of danger.”

No staff member is hired without member approval, and staff evaluations soon will include member comments.

Smith has traveled a long road to get to Providence House. Beginning in 1979, he worked for 15 years as a case manager in a joint effort between Columbia University medical school and Harlem Hospital to provide community-based treatment.

He remembers that period as a time when a patient released from the psychiatric ward of the hospital often had no place to live and was offered medication and little else in terms of treatment or support

“We were telling people what to do,” he said. “We weren't helping them find a way to get better.”

Smith moved to Philadelphia and worked in another capacity at Horizon House until he earned a master's degree in human services.

Richard Ziegler, director of Delaware and Chester County Services for Horizon House, can trace his professional involvement with the mental health system back nearly three decades.

Two decades of that experience took place as a Horizon House employee. He now has overall supervisory responsibility for Providence House, as well as various housing programs in both counties and a mobile psychiatric service that provides services to consumers in a setting of their choice.

Ziegler can recount a long list of efforts to involve recipients of mental health services in the decisions that affect them.

Recently, staff convened separate focus groups of consumers and family members as part of their preparation for a response to a Request for Proposal from the Delaware County Office of Behavioral Health. That agency undertook a competitive process to select an organization to operate a Program of Assertive Community Treatment (PACT).

“It's the same approach we use when developing an individual service plan,” Ziegler said. We ask, `What will work for you?'”

He said common themes emerged from the two groups. Family members and recipients of mental health services emphasized the importance of“ caring, competent staff” and of continuity of PACT team members. They worried about “staff burnout” and low pay. And they urged flexibility in providing services and supports.

Horizon House, which ultimately received the contract, includes a peer specialist as part of its PACT team. Peer specialists are or have been recipients of mental health services.

Their involvement in the provision of mental health services raises issues about roles, said Ziegler, but they bring an important perspective to treatment.

He was also part of an earlier effort to provide community-based support for people who were discharged from Haverford State Hospital when it closed in 1998.

“We went to the hospital and talked with them about what they wanted,” Ziegler said. “Many of them wanted to be in single-person apartments, rather than group homes.” They recognized their need for privacy and the problems that can result when another resident regresses.

Horizon House offers a variety of living arrangements in Chester and Delaware counties that include varying degrees of staff supervision in supported and permanent housing. Approximately 100 individuals are served in those programs.

Section 8 vouchers, which are funded through the U.S. Department of Housing and Urban Development (HUD) and authorized by the U.S. Housing Act of 1937, are key to the provision of many of those opportunities for low-income people with mental illness. A recipient of a Section 8 voucher pays 30 percent of his or her income as rent, with public funds paying the remainder.

Ziegler said, “There is not nearly enough adequate and affordable housing now. It's difficult for anyone to remain healthy who is living in an unsafe environment. Any cuts to the program would hamper our ability to serve people with serious mental illness.”

Like Horizon House CEO Jeffrey Wilush, however, Ziegler believes that resources must be flexible, as well as adequate.

“We need the ability to use resources in ways that work for the consumer,” he said.

Information about Horizon House is posted at<www.hhinc.org>.▪