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 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
"You don't just `do clubhouse,'" said Smith. "It's a
whole culture in which everyone is valued. We don't focus on the
Creating that culture is a daily enterprise that requires a constant
emphasis on promoting empowerment of clubhouse members
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
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
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
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
"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
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>.▪