Facilitating Member Participation in a Clubhouse for People with Severe Mental Illness

Background and Purpose:

The clubhouse model is an evidence-based program that provides a working community where people with severe mental illness can pursue mental health recovery and continuous growth. Hallmarks of the model include members and staff “working side-by-side” as partners to perform clubhouse operations. This egalitarian dynamic is crucial to promoting a sense of empowerment and competence among members of the clubhouse. This study aimed to investigate how staff materialized this principle, taking into account of influences at the individual and programmatic levels.

Methods:

This grounded theory study was conducted at Fountain House in New York City, the world’s original clubhouse. In addition to in-depth interviews with 28 staff members, 10 supervisors, and 15 members, the researcher conducted 262 hours of participant observation in 41 visits to all 7 program units over a five-month period. All interviews, ranging from 30 to 60 minutes in length, were verbatim transcribed. Notes were taken on participant observation, focusing on unit characteristics, activity flow during the observed period, specific practice episodes, and reflective memos for theoretical and methodological considerations and the researcher’s reflexivity. The multiple sources (staff, members, and supervisors) and types of data (interviews and observation) provided the basis for comparative analysis. Authors applied the dimensional analysis procedures and identified a practice framework of encouraging participation while respecting member autonomy. Authors categorized 5 members’ conditions that altered staff practices on engaging members, and analyzed qualities of the overall context that supported member participation.

Results:

Member participation was a primary objective of staff practice. Strategies to encourage member participation varied, depending on members’ (a) levels of motivation/willingness, (b) health and mental health state, (c) interests, (d) capabilities, and (e) readiness to advance to new tasks. To address these various conditions, participants found that developing a strong staff-member relationship was fundamental. The relationship helped to motivate members’ involvement; adjust participation according to members’ health status and preferences; and encourage members to venture out of their comfort zone. Additionally, to provide all members with opportunities to contribute to the House, staff intentionally identified simple, but meaningful tasks (e.g., sorting documents) to accommodate members’ different levels of capacities, and created tools (e.g., instruction manuals) to facilitate participation. When members rejected invitations to participate, staff stressed the importance of not taking offense, using humor to release tension, offering different options, repeating invitations at different times and occasions. Finally, member participation was fostered by structural designs, such as unit meetings for friendly invitations and task delegation, and working in an open space where members could easily observe other members modeling participation.   

Conclusions and Implications:

The study identified a relationship-based practice framework that addressed individualities when facilitating member participation in a clubhouse. Results not only echoed psychological constructs of self-agency and self-efficacy and their relations to mental health recovery, but also demonstrated the significance of staff’s deliberate relational and practical approaches that fostered a supportive environment and nurtured members’ experiences with self-agency and self-efficacy. Findings have important implications for mental health agencies and professionals in providing recovery-oriented services.