Occupational therapy’s distinct value in mental health lies in the emphasis on engagement in everyday activities, with the ultimate goal “to enable participation in personally and socially meaningful occupations that support health and well-being (Krupa, Fossey, Anthony, Brown, & Pitts, 2009, p.156). There are many settings within the community-based mental health service system through which occupational therapy has the potential support individuals labeled with serious mental illness (SMI), and a setting that stands out as an excellent fit is the Clubhouse.
“Clubhouses are intentionally formed, non-clinical, integrated therapeutic working communities composed of adults and young adults diagnosed with SMI (members) and staff who are active in all Clubhouse activities. Clubhouse membership is open to anyone who has a history of mental illness. Membership is voluntary and without time limits. Being a member means that an individual is a critical part of the community and has both shared ownership and shared responsibility for the success of the Clubhouse” (McKay, Nugent, Johnsen, Eaton, & Lidz, 2018, p.29). A key feature of the clubhouse model is the work-ordered day, which refers to the expectation that staff and members work side-by-side, and the temporal flow of the clubhouse paralleling typical business activities and hours of operation of the working community where the clubhouse is located (Stoffel, 2011).
The clubhouse model implements several basic principles which emphasize individual strengths and potential, teamwork, the belief that work and work-mediated relationships support recovery, and empowerment through choice of activity (McKay et al., 2018, p.29). Clubhouses also provide support for gaining employment in the greater community through transitional employment, supported employment, or independent employment; participating in formal education; and connecting to resources in the community for health, finances, and housing. Also, 193 clubhouses responding to a survey regarding available activities reported offering some type of health promotion programming, including education on health, nutrition, and smoking sessions, and opportunities for exercise (McKay et al., 2018).
Research has found many benefits to clubhouse participation. A study that compared clubhouse participants to participants in a program for assertive community treatment (PACT) found that “Clubhouse participants were employed more calendar days than PACT participants, worked significantly more hours, earned more during the study, and earned more per hour each week” (McKay et al., 2018, p.36). This same study also found that clubhouse participants reported greater quality of life related to social and financial aspects, and greater self-esteem and service satisfaction than PACT participants (McKay et al., 2018).
Benefits of clubhouse participation are also found in the areas of physical health, rehospitalization rates, and social participation. A study on a 16-week structured exercise program implemented in a clubhouse called Genesis found that participants had significant improvements in aerobic capacity and perceived mental health, as well as positive changes in the domains of social and physical functioning, physical and emotional roles, vitality, and general health (Pelletier, Nguyen, Bradley, Johnsen, & McKay, 2005). A systematic review found results from 10 published studies that suggest clubhouse participants have lower rehospitalization rates, and the authors reasoned that evidence supported by at least 6 of the included studies suggest that Clubhouse participation may be beneficial in promoting social relationships by increasing social integration and supporting social competence (McKay et al., 2018).
The first clubhouse, established in New York City in 1948, was known as Fountain House, and offered its members supportive experiences in job training, arts and crafts, and recreational activities; occupational therapists were involved in Fountain House by leading workshops in fabricating small items (Stoffel, 2011). The clubhouse environment presents an ideal setting for occupational therapists to support the recovery of individuals labeled with serious mental illness due to the shared principles between the clubhouse model of psychosocial rehabilitation and the foundational theories of occupational therapy. Occupational therapy is founded on the principle that engagement in meaningful activities provides structure to an individual’s day and purpose to an individual’s life, resulting in improved physical and mental wellbeing, while the clubhouse model implements principles that emphasize structuring participation around the work-ordered day and supporting recovery through engagement in work and work-mediated relationships.
The clubhouse model of psychosocial rehabilitation offers an environment in which individuals labeled with SMI can enter the community and be viewed as having individual strengths and potential to lead personally satisfying lives. Clubhouse participation has been found to be beneficial for individuals labeled with SMI through bolstering employment and educational opportunities, enhancing social participation, and connecting individuals to resources for health promotion. The clubhouse goals of helping individuals engage in meaningful work, supporting the pursuit of employment and formal education, and engaging in culturally relevant social and recreational activities are consistent with the occupational therapy domain of engagement in occupation to support overall health and well-being (Stoffel, 2011). Through innovation and client-centered practice occupational therapists can implement services in clubhouse settings to support the recovery of individuals labeled with serious mental illness and facilitate the realization that all people can be positively contributing members of society.
Sharon Vincuilla, OTR/L
Occupational Therapy Doctoral Resident
Krupa, T., Fossey, E., Anthony, W. A., Brown, C. & Pitts, D. B. (2009). Doing daily life: How occupational therapy can inform psychiatric rehabilitation practice. Psychiatric Rehabilitation Journal, 32(3): 155-161. Doi: 10.2975/32.3.2009.155.161
McKay, C., Nugent, K. L., Johnsen, M., Eaton, W. W., & Lidz, C. W. (2018). A systematic review of evidence for the clubhouse model of psychosocial rehabilitation. Administrative Policy in Mental Health, 45: 28-47. https://doi.org/10.1007/s10488-016-0760-3
Pelletier, J. R., Nguyen, M., Bradley, K., Johnsen, M., & McKay, C. (2005). A study of a structured exercise program with members of an ICCD certified clubhouse: Program design, benefits, and implications for feasibility. Psychiatric Rehabilitation Journal, 29(2), 89-96. http://dx.doi.org.libproxy1.usc.edu/10.2975/29.2005.89.96
Stoffel, V. C. (2011). Psychosocial Clubhouses. In C. Brown & V. C. Stoffel (Eds.), Occupational therapy in mental health: A vision for participation (Chapter 39, pp. 559–570). Philadelphia, PA: F. A. Davis Company.