The Development of Clubhouse Programs

During the late 1940s a group of ex-patients from Rockland Psychiatric Center in New York State formed a support group, which met on the steps of the New York City Public Library in Manhattan. The support group members called themselves "WANA" (We Are Not Alone). A private social welfare group, the National Council of Jewish Women, became aware of the WANA group and began supporting their cause. In 1948, with the help of Elizabeth Schermerhorn, a building on West 47th Street in New York City was purchased as a clubhouse for WANA (Dincin, 1975; Flannery & Glickman, 1996; Propst, 1992a). Because it had a small fountain in the backyard the group named it Fountain House. Fountain House, initially staffed and operated solely by its members and volunteers, was designed to provide social supports and serve as a meeting place for ex-patients. People who joined Fountain House were called members rather than patients and, like a club, they could remain members for as long as they wished.

As Fountain House grew, the members decided to hire professional, non-consumer staff to operate the program. The first professional, non-consumer mental health staff were recruited in 1955. Even with the addition of professionally trained staff, Fountain House retained its clubhouse atmosphere and philosophy. After trying out several directors with unsatisfactory results a social worker named John Beard was hired. Beard helped to change Fountain House (Beard, Propst, & Malamud, 1982) from what was essentially a social club into a truly comprehensive psychiatric rehabilitation facility, which became the model for the clubhouse movement (see Box 6.2).

The National Council of Jewish Women played a major role in the development of the clubhouse movement and psychiatric rehabilitation nationwide. During the 1950s this philanthropic group focused its attention on the plight of ex-mental patients. Capitalizing on the success of their efforts at Fountain House, they supported and encouraged the development of clubhouse model programs nationwide including Thresholds (Chicago, Illinois), Hill House (Cleveland, Ohio), Council House (Pittsburgh, Pennsylvania), and Bridge Haven (Louisville, Kentucky) (Dincin, 1975).

As awareness of the benefits of clubhouses grew, other centers were developed around the country, including Horizon House (Philadelphia, Pennsylvania), Fellowship House (Miami, Florida), Center Club (Boston, Massachusetts), and the Social Rehabilitation Center (Fairfax, Virginia), to name but a few. Most importantly, using a strategy similar to the mythical Johnny Appleseed, Fountain House and programs like it vigorously trained their staff and then sent them out to develop new clubhouses around the country and the world (Propst, 1992a; Vorspan, 1992). Today, literally hundreds of clubhouse programs worldwide can trace their roots back to either Fountain House or one of the other early clubhouse programs.

BOX 6.2 John H. Beard

John Beard was the father of the worldwide clubhouse movement. Beard, who earned his master's degree in social work from Wayne State University in Detroit, Michigan, had worked at Wayne County General Hospital in Michigan as a social worker. In 1955, Elizabeth Schermerhorn and the board of directors of Fountain House hired Beard as their executive director. He led Fountain House until his death in 1982.

Beard focused on the members' strengths rather than on their illnesses. An excerpt from a video made in 1978 captures his attitude about working with members.

I had no interest in why he was sick. That was not my job ... I wasn't interested in trying to review his . . . psychopathology. I had no interest in it at all. I was terribly interested in how normal we might get him to function. (Flannery & Glickman, 1996, p. 28)

Almost single-handedly at first, Beard's vision and efforts were the guiding force behind the creation of the clubhouse movement. Today there are over 300 clubhouses worldwide and the number is growing. Each of these programs is, in some small way, a symbol of Beard's caring and efforts. In 1982 he recieved the Extraordinary Service Award for Exceptional Commitment and Dedication in Serving the Mentally Ill of New York. The award reads as follows:

His leadership has provided:

Dignity where there was shame,

Belonging where there was alienation, Empowerment where there was helpessness, Self-respect where there was self-denigration, Hope and opportunity where once there was only despair.

The clubhouse exists primarily to improve the quality of life of its members. Clubhouses began as places where members gathered to socialize and to give and receive support. As such, nothing designated as medical "treatment" took place there. Members were accepted without regard to their symptoms and did not have to "improve" in order to continue their member status. This focus on quality-of-life issues led to an emphasis on members' basic needs: housing, work, socialization, and recreation. Length of stay, the time an individual is in a program, is a good example of the difference in how a clubhouse operates in contrast to a partial hospitalization program. Clubhouse members can stay as long as they wish regardless of their clinical state; they are considered members for life. By contrast, many partial hospitalization programs have prescribed lengths of stay and clients are discharged if their clinical state improves.

Probably the most important difference between clubhouses and early partial hospital-ization was the clubhouse's emphasis on work (Jackson, 1992; Vorspan, 1992). Clubhouse philosophy, embodied in the "work-ordered day," stresses the importance of work for providing a sense of meaning in life and a sense of belonging to a community. Performing meaningful work endows the worker with purpose. For clubhouse members, work begins with the day-to-day operation of the clubhouse itself, from custodial tasks and record keeping to paying bills and hiring new staff. The clubhouse emphasis on work leads to several other important outcomes such as member empowerment and the development of a sense of self-efficacy and self-esteem. Perhaps most importantly, it is intended to lead to competitive employment outside the clubhouse. Clubhouse members and staff emphasize many ways in which their programs differ from other types of psychiatric rehabilitation services. The following section about clubhouse standards highlights some of the most important ideas behind these programs and some of the ideas that make them different.

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