Skip to main content

Advertisement

SpringerLink
Log in

Why We Come: Clubhouse Members Seek Connection, Purpose and Meaning

  • Original Paper
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Approximately 4.5% of U.S. adults live with a serious mental illness (SMI) (Substance Abuse and Mental Health Services Administration, 2018). Creating a place for people seeking structure, connection, and purpose following psychiatric hospitalization or for mental health recovery is difficult given several factors associated with illness trajectories, lack of community-based support programs, and reliance on traditional models of care. Using semi-structured interviews, the current study examined the reasons people attend community programs referred to as psychosocial "clubhouses." Interviews with 140 people across 10 clubhouse programs in one state were conducted. Qualitative analyses revealed that social connections and the need to reduce social isolation were driving forces for attending. Further, individuals noted that the “structure” of engaging in meaningful activities and roles was a main reason for participating. Authors discuss the continued need for community models that provide a “place” for all people to successfully engage and recover from psychiatric illnesses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Appelbaum, P. S., & Hoge, S. K. (1986). The right to refuse treatment: What the research reveals. Behavioral Sciences & the Law, 4(3), 279–292.

    Google Scholar 

  • Appleby, L., Dennehy, J. A., Thomas, C. S., Faragher, E. B., & Lewis, G. (1999). Aftercare and clinical characteristics of people with mental illness who commit suicide: A case-control study. The Lancet, 353(9162), 1397–1400.

    CAS  Google Scholar 

  • Aquila, R., Malamud, T. J., Sweet, T., & Kelleher, J. D. (2006). The store front, fountain house, and the rehabilitation alliance. Medscape General Medicine, 8(3), 67.

    PubMed  PubMed Central  Google Scholar 

  • Badcock, J. C., Shah, S., Mackinnon, A., Stain, H. J., Galletly, C., Jablensky, A., et al. (2015). Loneliness in psychotic disorders and its association with cognitive function and symptom profile. Schizophrenia Research, 169(1–3), 268–273.

    PubMed  Google Scholar 

  • Barut, J., Dietrich, M., Zanoni, P., & Ridner, S. (2016). Sense of belonging and hope in the lives of persons with schizophrenia. Archives of Psychiatric Nursing, 30(2), 178–184.

    PubMed  Google Scholar 

  • Beller, J., & Wagner, A. (2018). Loneliness, social isolation, their synergistic interaction, and mortality. Health Psychology, 37(9), 808–813.

    PubMed  Google Scholar 

  • Beutel, M. E., Klein, E. M., Brahler, E., Reiner, I., Junger, C., Michal, M., et al. (2017). Loneliness in the general population: Prevalence, determinants and relations to mental health. BMC Psychiatry. https://doi.org/10.1186/s12888-017-1262-x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cacioppo, S., Capitanio, J. P., & Cacioppo, J. T. (2014). Toward a neurology of loneliness. Psychological Bulletin, 140(6), 1464–1504.

    PubMed  PubMed Central  Google Scholar 

  • Carolan, M., Onaga, E., Pernice-Duca, F., & Jimenez, T. (2011). A place to be: The role of clubhouses in facilitating social support. Journal of Psychiatric Rehabilitation, 35(2), 125–132.

    Google Scholar 

  • Chang, C. W., Chung, C. L., Biegel, D. E., Pernice-Duca, F., Min, M. O., & D’Angelo, L. (2014). Predictors of loneliness of clubhouse members. Psychiatric Rehabilitation Journal, 37, 51–54.

    PubMed  Google Scholar 

  • Chen, F. (2017). Building a working community: Staff practices in a clubhouse for people with severe mental illness. Administration and Policy in Mental Health, 44, 651–663. https://doi.org/10.1007/s10488-016-0757-y.

    Article  PubMed  Google Scholar 

  • Clubhouse International. (2020a). Quality Standards. Retrieved October 11, 2019, from https://clubhouse-intl.org/resources/quality-standards/.

  • Clubhouse International. (2020b). Accreditation. Retrieved June 5, 2020, from https://clubhouse-intl.org/resources/accreditation.

  • Clubhouse International. (2020c). Clubhouse Directory. Retrieved June 18, 2020, from https://clubhouse-intl.org/what-we-do/international-directory/.

  • Corrigan, P. W., & Phelan, S. M. (2004). Social support and recovery in people with serious mental illness. Journal of Community Mental Health, 40(6), 513–523.

    Google Scholar 

  • Dilk, M. N., & Bond, G. R. (1996). Meta-analytic evaluation of skills training research for individuals with severe mental illness. Journal of Consulting and Clinical Psychology, 64(6), 1337–1346.

    CAS  PubMed  Google Scholar 

  • Dixon, L., Weiden, P., Torres, M., & Lehman, A. (1997). Assertive community treatment and medication compliance in the homeless mentally ill. The American Journal of Psychiatry, 154(9), 1302–1304.

    CAS  PubMed  Google Scholar 

  • Doyle, A., Lanoil, J., & Dudek, K. (2013). Fountain House: Creating community in mental health practice. New York: Columbia University Press.

    Google Scholar 

  • Dunbar-Jacob, J., & Schlenk, E. A. (1996). Treatment adherence and clinical outcome. Can we make a difference? In R. J. Resnick & R. H. Rozensky (Eds.), Health psychology through the lifespan: Practice and research opportunities (pp. 323–343). Washington, DC: American Psychological Association.

    Google Scholar 

  • Eglit, G., Palmer, B. W., Martin, A. S., Tu, X., & Jeste, D. V. (2018). Loneliness in schizophrenia: Construct clarification, measurement, and clinical relevance. PLoS ONE, 13(3), e0194021. https://doi.org/10.1371/journal.pone.0194021.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Goertzel, V., Beard, J. H., & Pilnick, S. (1960). Fountain House Foundation: Case study of an expatient’s club. Journal of Social Issues, 16(2), 54–61. https://doi.org/10.1111/j.1540-4560.1960.tb00949.x.

    Article  Google Scholar 

  • Gold, P. B., Macias, C., & Rodican, C. F. (2016). Does competitive work improve quality of life for adults with severe mental illness? Evidence from a randomized trial of supported employment. The Journal of Behavioral Health Services & Research, 43(2), 155–171.

    Google Scholar 

  • Gumber, S., & Stein, C. H. (2018). Beyond these walls: Can psychosocial clubhouses promote the social integration of adults with serious mental illness in the community? Journal of Psychiatric Rehabilitation, 41(1), 29–38.

    Google Scholar 

  • Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine, 40(2), 218–227.

    PubMed  Google Scholar 

  • Hendryx, M., Green, C. A., & Perrin, N. A. (2009). Social support, activities, and recovery from serious mental illness: STARS study findings. The Journal of Behavioral Health Services & Research, 36(3), 320–329.

    Google Scholar 

  • Herman, S. E., Onaga, E., Pernice-Duca, F., Oh, S., & Ferguson, C. (2005). Sense of community in clubhouse programs: Members and staff concepts. American Journal of Community Psychology, 36(3–4), 343–356.

    PubMed  Google Scholar 

  • Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. Journal of PLoS Medicine, 7(7), 2–20.

    Google Scholar 

  • Hwang, S., Woody, J., & Eaton, W. W. (2017). Analysis of the association of clubhouse membership with overall costs of care for mental health treatment. Community Mental Health Journal, 53(1), 102–106.

    PubMed  Google Scholar 

  • Johnsen, M., McKay, C., Henry, A., & Manning, T. D. (2004). What does competitive employment mean? A secondary analysis of employment approaches in the Massachusetts employment intervention demonstration project. Research on employment for persons with severe mental illness (13th ed., pp. 43–62). Bingley: Emerald Group Publishing Limited.

    Google Scholar 

  • Kelly, S. M., O’Grady, K. E., Schwartz, R. P., Peterson, J. A., Wilson, M. E., & Brown, B. S. (2010). The relationship of social support to treatment entry and engagement: The community assessment inventory. Journal of Substance Abuse, 31(1), 43–52.

    Google Scholar 

  • Kessler, R. C., Berglund, P. A., Bruce, M. L., Koch, J. R., Laska, E. M., Leaf, P. J., et al. (2001). The prevalence and correlates of untreated serious mental illness. Journal of Health Services Research, 305(1), 27.

    Google Scholar 

  • Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., Walters, E. E., et al. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine, 352(24), 2515–2523.

    CAS  Google Scholar 

  • Kinn, L. G., Tanaka, K., Bellamy, C., & Davidson, L. (2018). “Pushing the boat out”: A meta-synthesis of how members, staff and family experience the clubhouse model. Journal of Community Mental Health, 54(8), 1199–1211.

    Google Scholar 

  • Lehner, R. K., Dopke, C. A., Cohen, K., Edstrom, K., Maslar, M., Slagg, N. B., et al. (2007). Outpatient treatment adherence and serious mental illness: A review of interventions. American Journal of Psychiatric Rehabilitation, 10(4), 245–274.

    Google Scholar 

  • McCabe, M. P., & Leas, L. (2008). A qualitative study of primary health care access, barriers and satisfaction among people with mental illness. Psychology, Health and Medicine, 13(3), 303–312.

    PubMed  Google Scholar 

  • 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. Administration and Policy in Mental Health, 45(1), 28–47.

    PubMed  Google Scholar 

  • Mowbray, C. T., Megivern, D., & Holter, M. C. (2003). Supported education programming for adults with psychiatric disabilities: Results from a national survey. Psychiatric Rehabilitation Journal, 27, 159–167.

    PubMed  Google Scholar 

  • Mueser, K. T., Penn, D. L., Addington, J., Brunette, M. F., Gingerich, S., Glynn, S. M., et al. (2015). The NAVIGATE program for first-episode psychosis: Rationale, overview, and description of psychosocial components. Psychiatric Services, 66(7), 680–690. https://doi.org/10.1176/appi.ps.201400413.

    Article  PubMed  Google Scholar 

  • Murphy, R., McGuinness, D., Bainbridge, E., Brosnan, L., Felzmann, H., Keys, M., et al. (2017). Service users’ experiences of involuntary hospital admission under the mental health act 2001 in the republic of Ireland. Psychiatric Services, 68(11), 1127–1135.

    PubMed  Google Scholar 

  • Nersesian, P. V., Han, H. R., Yenokyan, G., Blumenthal, R. S., Nolan, M. T., Hladek, M. D., et al. (2018). Loneliness in middle age and biomarkers of systematic inflammation: Findings from midlife in the United States. Journal of Social Science & Medicine, 209, 174–181.

    Google Scholar 

  • Norman, C. (2006). The fountain house movement, an alternative rehabilitation model for people with mental health problems, members’ descriptions of what works. Scandinavian Journal of Caring Sciences, 20(2), 184–192. https://doi.org/10.1111/j.1471-6712.2006.00398.x.

    Article  PubMed  Google Scholar 

  • Noyes, S., Sokolow, H., & Arbesman, M. (2018). Evidence for occupational therapy intervention with employment and education for adults with serious mental illness: A systematic review. The American Journal of Occupational Therapy, 72(5), 1–10.

    Google Scholar 

  • Onaga, E., Kemp, A., & Sankar, S. (2015). Michigan Clubhouse Survey. A report prepared for the Michigan Health and Human Services, October, 2015.

  • Perese, E., & Wolf, M. (2005). Combating loneliness among persons with severe mental illness: Social network interventions’ characteristics, effectiveness, and applicability. Issues in Mental Health Nursing, 26(6), 591–609.

    PubMed  Google Scholar 

  • Pernice-Duca, F. M., Biegel, D. E., Hess, H. R., Chung, C., & Chang, C. W. (2015). Family members' perceptions of how they benefit when relatives living with serious mental illness participate in clubhouse community programs. Family Relations, 64(3), 446–459.

    Google Scholar 

  • Petterson, H., Ruud, T., Ravndal, E., Havnes, I., & Landheim, A. (2014). Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use. International Journal of Mental Health Systems, 8(1), 40.

    Google Scholar 

  • Prince, J. D., Oyo, A., Wyka, K., & Schonebaum, A. D. (2018). Loneliness among persons with severe mental illness. Journal of Nervous and Mental Disease, 206(2), 136–141.

    Google Scholar 

  • Qualter, P., Vanhalst, J., Harris, R., Van Roekel, E., Lodder, G., Bangee, M., et al. (2015). Loneliness across the life span. Perspectives on Psychological Science, 10(2), 250–264.

    PubMed  Google Scholar 

  • Sanchez, J., Chan, F., Yaghmaian, R., Johnson, E. T., Pfaller, J. S., & Umucu, E. (2016a). Assessing community functioning and independent living skills of individuals with severe mental illness. Journal of Applied Rehabilitation Counseling, 47(3), 6–14.

    Google Scholar 

  • Sanchez, J., Rosenthal, D. A., Chan, F., Brooks, J., & Bezyak, J. L. (2016b). Relationships between world health organization international classification of functioning, disability, and health constructs and participation in adults with severe mental illness. Rehabilitation Research, Policy, and Education, 30(3), 286–304.

    Google Scholar 

  • Schonebaum, A., & Boyd, J. (2012). Work-ordered day as a catalyst of competitive employment success. Psychiatric Rehabilitation Journal, 35(5), 391–395. https://doi.org/10.1037/h0094499.

    Article  PubMed  Google Scholar 

  • Shiovitz-Ezra, S., & Ayalon, L. (2010). Situational versus chronic loneliness as risk factors for all-cause mortality. Journal of International Psychogeriatrics, 22(3), 455–462.

    PubMed  Google Scholar 

  • Smith, S. G., Jackson, S. E., Kobayashi, L. C., & Steptoe, A. (2018). Social isolation, health literacy, and mortality risk: Findings from the English longitudinal study of ageing. Journal of Health Psychology, 37(2), 160–169.

    Google Scholar 

  • Solis-Roman, C., & Knickman, J. (2016). Project to evaluate the impact of fountain house programs on Medicaid utilization and expenditures. New York: Health Evaluation and Analytics Lab.

    Google Scholar 

  • Stain, H. J., Galletly, C. A., Clark, S., Wilson, J., Killen, E. A., Anthes, L., et al. (2012). Understanding the social costs of psychosis: The experience of adults affected by psychosis identified within the second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry, 46(9), 879–889.

    Google Scholar 

  • Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSUDH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved April 10, 2020, from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHFFR2017/NSDUHFFR2017.pdf.

  • Swanson, J., Estroff, S., Swartz, M., Borum, R., Lachicotte, W., Zimmer, C., et al. (1997). Violence and severe mental disorder in clinical and community populations: The effects of psychotic symptoms, comorbidity, and lack of treatment. Psychiatry, 60(1), 1–22.

    CAS  PubMed  Google Scholar 

  • Swartz, M. S., Swanson, J. W., Hiday, V. A., Borum, R., Wagner, H. R., & Burns, B. J. (1998). Violence and severe mental illness: The effects of substance abuse and nonadherence to medication. American Journal of Psychiatry, 155(2), 226–231.

    CAS  Google Scholar 

  • Tanaka, K., & Davidson, L. (2014). Meanings associated with the core component of clubhouse life: The work-ordered day. Psychiatry Quarterly, 86, 269–283. https://doi.org/10.1007/s11126-014-9330-6.

    Article  Google Scholar 

  • Tanaka, K., Davidson, L., & Craig, T. J. (2018). Sense of clubhouse community belonging and empowerment. International Journal of Social Psychiatry, 64(3), 276–285.

    Google Scholar 

  • Torras, M. C., & Tomas, E. P. (2018). Interventions to improve therapeutic adherence in subjects with schizophrenia. The Journal of Psychologist Papers, 39(1), 31–39.

    Google Scholar 

  • Tsang, H. W., Fung, K. M., Leung, A. Y., Li, S. M., & Cheung, W. M. (2010). Three year follow-up study of an integrated supported employment for individuals with severe mental illness. Australian and New Zealand Journal of Psychiatry, 44(1), 49–58.

    Google Scholar 

  • Warner, R., Huxley, P., & Berg, T. (1999). An evaluation of the impact of clubhouse membership on quality of life and treatment utilization. International Journal of Social Psychiatry, 45(4), 310–320.

    CAS  Google Scholar 

  • Weiner, A., Roe, D., Mashiach-Eizenberg, M., Baloush-Kleinman, V., Maoz, H., & Yanos, P. (2010). Housing model for persons with serious mental illness moderates the relation between loneliness and quality of life. Journal of Community Mental Health, 46(4), 389–397.

    Google Scholar 

  • Whiteford, H. A., Ferrari, A. J., Degenhardt, L., Feigin, V., & Vos, T. (2015). The global burden of mental, neurological and substance use disorders: An analysis from the Global Burden of Disease Study 2010. PLoS ONE, 10(2), e0116820.

    PubMed  PubMed Central  Google Scholar 

  • World Health Organization. (2018). Management of physical health conditions in adults with severe mental disorders: WHO guidelines. Geneva: World Health Organization.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Wayne State University, 351 College of Education, Detroit, MI, 48202, USA

    Francesca M. Pernice

  2. Wayne State University, 333 College of Education, Detroit, MI, 48202, USA

    Megan H. Price

  3. Fountain House New York, 425 West 47th Street, New York, NY, 10036, USA

    Kevin Rice

Authors
  1. Francesca M. Pernice
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Megan H. Price
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kevin Rice
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesca M. Pernice.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pernice, F.M., Price, M.H. & Rice, K. Why We Come: Clubhouse Members Seek Connection, Purpose and Meaning. Community Ment Health J 57, 446–456 (2021). https://doi.org/10.1007/s10597-020-00685-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-020-00685-6

Keywords

Search

Navigation