Innovation summary

Clubhouse programs are designed for individuals living with serious and persistent mental illnesses, offering them hope and opportunities to achieve their full potential. A Clubhouse is a community created in a specified locality and is run by people affected by mental health problems, in collaboration with professional staff. There are currently 330 Clubhouses operating in 33 countries on six continents, receiving 90% of their funding from government funding sources.

Clubhouse is based on the belief that work and normal social and recreational opportunities are restorative and play an important part in a person’s path to recovery. The basic components of successful Clubhouses are: a work-ordered day; employment programs; evening, weekend and holiday activities; community support; out-reach services; supported education; housing support; and decision-making and governance.

Impact summary

  • Each year, Clubhouses are accessed by about 100,000 people with mental health problems
  • Clubhouse members are more likely than non-members to report being in recovery and having a higher quality of life1
  • Number of working days and average earnings are significantly higher among members2
  • Frequency and duration of hospitalizations are significantly reduced3

"I don’t know what I would have been today without Fountain House and the Clubhouse. Would I have been locked in somewhere? Would I have been sleeping in a basement with a couple of pills? I don’t know. Now I have a life. So Fountain House and the Clubhouse have given me a real life."
- Lasse, once a member of Fountain House in Stockholm

Innovation details

A Clubhouse is first and foremost a local community centre that offers people living with mental illnesses hope and opportunities to achieve their full potential. Much more than simply a programme or a social service, a Clubhouse is a community of people working together to achieve a common goal.

A Clubhouse is organised to support people living with mental illness. During the course of their participation in a Clubhouse, members gain access to opportunities to rejoin the worlds of friendships, family, employment and education, and to the services and support they may individually need to continue their recovery. A Clubhouse provides a restorative environment for people whose lives have been severely disrupted because of their mental illness, and who need the support of others who are in recovery and who believe that mental illness is treatable.

The average Clubhouse serves 150 members monthly and 65 each day, but daily numbers range from 10 to 325. Start-up Clubhouses typically have one or two staff for the first year until funding can be organised for more. The role of the staff in a Clubhouse is not to educate or treat the members. The staff are there to engage with members as colleagues in important work and to be encouraging and engaging with people who might not yet believe in themselves. Clubhouse staff are charged with being colleagues, workers, talent scouts and cheerleaders.

Clubhouses offer people living with mental illness hope and opportunities to reach their full potential. They operate on proven standards which have been developed by Clubhouse International over two and a half decades, and which are effective in over 330 Clubhouses worldwide. The Clubhouse model is replicable in any location because it relies on the concepts of community, local cultural norms and the available resources.

The basic components of successful Clubhouses are:

  • A Work-Ordered Day: An eight-hour period, typically Monday through Friday, which parallels the typical business hours of the Clubhouse’s local community
  • Employment Programs: Opportunities to return to paid employment in integrated work settings through both Transitional Employment and Independent Employment programmes
  • Evening, Weekend and Holiday Activities: Structured and non-structured social activities scheduled outside the work-ordered day
  • Community Support: Help in accessing the best quality social and medical services available in their community; such as affordable and dignified housing, psychiatric and general medical services, and government disability benefits
  • Reach-Out: Keeping in contact with all active members when they do not attend the Clubhouse, through telephone calls and visits, reminding them that they are missed, welcome and needed
  • Education: Educational opportunities for members to complete or start certificate and degree programmes at academic institutions and adult education providers. Members’ talents and skills are used to provide educational opportunities to others, particularly in literacy
  • Housing: Help in accessing safe, decent and dignified housing. Where none is available, the Clubhouse seeks funding and establishes its own housing programme
  • Decision-Making and Governance: Members and staff meet in open forums to discuss policy issues and future planning

Key drivers

Comprehensive Training Opportunities

  • A formal training program offered at 9 authorized Training Bases
  • Basic and advanced training for members, staff and board members
  • A two-day workshop for new Clubhouse start-ups followed by one year of individualised coaching
  • Details of Clubhouse training programs can be found here.

Best Practice Standards

  • A set of 36 international standards available here and used by all replicated Clubhouses

Formal Accreditation Program

  • Based on self-study, objective peer review and fidelity to the International Standards for Clubhouse Programmes

Coordinated Information Dissemination

  • Extensive sharing of information through the Clubhouse web page, social media, e-mail support groups, telephone consultations, newsletters and “Download and Discuss” training articles

Challenges

  • Scarcity of local funding for Clubhouses
  • Societal stigma against people with mental illness
  • Lack of education about recovery as a real possibility
  • Resistive traditional mental health providers

Continuation

Acquired Brain Injury service providers have begun to adopt the model with success.

E.g. Cornerstone Clubhouse, Canada

Partners

  • Clubhouse members
  • Government mental health administrations
  • Local businesses (members’ employers)
  • Local mental health advocates
  • Local mental health service providers
  • Philanthropists
  • Private foundations and individual donors
  • Social ministries
  • Volunteer board of directors (trustees)

Funders:

  • Clubhouses on average receive about 90% of their funding from government, county, city, state and other municipal funding sources ( e.g. Departments of Mental Health, Social Ministries, vocational rehabilitation agencies, healthcare and social services administrations, etc.)
  • 75% of Clubhouse programmes are programmes of a parent organisation operating multiple social service programs
  • 25% are stand-alone NGOs solely providing Clubhouse services
  • Stand-alone Clubhouses typically have multiple funding sources and receive about 20-30% of their funding from private contributions

Evaluation methods

ClubhouseAccreditation (TM) is Clubhouse International’s quality assurance programme, designed to determine whether an organisation is providing a full range of Clubhouse opportunities to its members. Clubhouse Accreditation involves the entire Clubhouse community in an interactive process of self-evaluation and strategic planning.

Cost of implementation

Clubhouse costs vary enormously relative to economy and culture, as the program is fairly adaptable. The average Clubhouse has an annual budget of approximately $550,000 (USD) per year, Clubhouses in low-resource settings operate with significantly smaller budgets. A Clubhouse in Kampala, Uganda began with no funding and met under a tree or in a large tent for more than a year until a building could be arranged.

Clubhouses cost much less than other models of community based care; such as supported-employment, Community Mental Health Centres, and Assertive Community Treatment. The cost of Clubhouses is estimated to be one-third of  the cost of the IPS mode, about one-half the annual costs of Community Mental Health Centres, and substantially less than the ACT model.4

Impact details

  • Each year, Clubhouses are accessed by about 100,000 people with mental health problems
  • About 60,000 people are active members using a Clubhouse regularly
  • Clubhouse members are more likely to report being in recovery and having a higher quality of life compared with a group of participants from consumer-run drop-in centers1
  • Membership in a Clubhouse program resulted in a significant decrease in the number of hospitalizations3
  • Clubhouse members worked significantly longer (median of 199 days vs. 98 days) and earned more (median of $3,456 vs. $1,252 total earnings) compared with assertive community treatment (ACT) participants2
  • Researchers in China found that, among the people diagnosed with schizophrenia, Clubhouse members showed significant improvements in their symptoms, self-esteem, quality of life and employment rates after being at the Clubhouse for 6 months5
  • The most successful impact of the programme is that people who are typically excluded and pushed into the margins of society find a place to belong and opportunities to develop full citizenship through healthy lifestyles, education, employment and social networks

References

1. Mowbray C et al. (2009) Characteristics of users of consumer-run drop-in centers versus clubhouses. Journal of Behavioral Health Services Research, 36(3): 361-71.

2. Macias C et al. (2006) Supported employment outcomes of a randomized controlled trial of ACT and clubhouse models. Psychiatric Services, 57(10): 1406-15.

3. Di Masso J et al. (2001) The clubhouse model: An outcome study on attendance, work attainment and status, and hospitalization recidivism. Work, 17(1): 23-30.

4. McKay C et al. (2007) Costs of Clubhouses: An International Perspective. Administration and Policy in Mental Health and Mental Health Services Research, 34(1): 62-72.

5. Tsang AWK et al. (2010) A six-month prospective case-controlled study of the effects of the clubhouse rehabilitation model on Chinese patients with chronic schizophrenia. East Asian Archives of Psychiatry, 20(1): 23-30.

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