Recent Research - Clubhouse International

If you have any questions regarding Clubhouse research, please contact

Colleen McKay, Assistant Professor & Director

Program for Clubhouse Research
Systems and Psychosocial Advances Research Center
University of Massachusetts Medical School
222 Maple Avenue
Shrewsbury, MA 01545
(508) 856-8471
colleen.mckay@umassmed.edu

Clubhouses and Recent Clubhouse Research

The Clubhouse Model was accepted for inclusion on the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence Based Practices and Programs (NREPP) in 2011. The review indicates that the ICCD Clubhouse Model surpassed the minimum levels of research required for inclusion. There is evidence that supports clubhouse outcomes from studies with experimental or quasi-experimental designs. The review highlights the need for more research on ICCD Clubhouses.

Clubhouse information and outcomes are also available in two SAMHSA publications:

The United States Substance Abuse and Mental Health Services Administration (SAMHSA)’s Behavioral Health United States 2012. Clubhouse content is available on pages 148, 236, 324, 362, & 369:

Page 148, Table 67. Demographic and diagnostic characteristics for members of clubhouses, by certification status: number and percentage, United States
Page 236, Table 114. Clubhouses providing specific services and activities: percentage, United States
Page 324, Table 161. Funding sources and management structure for clubhouses, by certification status: percentage, United States

Recommended Citation:
Substance Abuse and Mental Health Services Administration. (2013). Behavioral Health, United States, 2012. HHS Publication No. (SMA) 13-4797. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Additional information regarding Clubhouse research is available in the following articles. Click on the Author Name(s) to view the Abstract for each article:

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 and Mental Health Services Research, 1-20. https://doi.org/10.1007/s10488-016-0760-3 PMID: 27580614
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. https://doi.org/10.1007/s10597-016-0041-3 PMID:27380210
Gorman, J.A., McKay, C.E., Yates, B.T., & Fisher, W.H. (2018). Keeping clubhouses open: Toward a roadmap for sustainability. Administration and Policy in Mental Health and Mental Health Services Research, 1-10. https://doi.org/10.1007/s10488-016-0766-x PMID: 27631611
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. https://doi.org/10.1007/s11414-014-9392-0 PMID:24504832
Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2016). The use of social environment in a psychosocial clubhouse to facilitate recovery-oriented practice. British Journal of Psychiatry Open, 2(2), 173–178. https://doi.org/10.1192/bjpo.bp.115.002642 PMID:27703771
Bonsaksen, T., Fouad, M., Skarpaas, L., Nordli, H., Fekete, O., Stimo, T., et al. (2016). Characteristics of Norwegian clubhouse members and factors associated with their participation in work and education. British Journal of Occupational Therapy, 79(11), 669-676. https://doi.org/10.1177/0308022616639977
Hultqvist, J., Markström, U., Tjörnstrand, C., & Eklund, M. (2017). Programme characteristics and everyday occupations in day centres and clubhouses in Sweden. Scandinavian Journal of Occupational Therapy, 24(3), 197-207. DOI: https://doi.org10.1080/11038128.2016.1200669 PMID:27347874
Chung, C-L., Pernice-Duca, F., Biegel, D.E., Norden, M. & Chang, C-W. (2016). Family perspectives of how their relatives with mental illness benefit from clubhouse participation: A qualitative inquiry. Journal of Mental Health, 25(4), 372-378. https://doi.org/10.3109/09638237.2016.1149805 PMID:26942501
Mandiberg, J.M. & Edwards, M. (2016). Business incubation for people with severe mental illness histories: The experience of one model. Journal of Policy Practice, 15(1-2), 82-101. https://doi.org/10.1080/15588742.2016.1109964
Prince, J.D., Ansbrow, J., Bennedict, A., DiCostanzo, J., Mora, O., & Schonebaum, A.D. (2016). Making connections: Severe mental illness and closeness with other people. Social Work in Mental Health, 15(1), 1-13. https://doi.org/10.1080/15332985.2016.1148095
Virkki, T. (2016). Working experiences of members of the Sörnäinen Clubhouse and their visions for improving the employment of mental health rehabilitators. Bachelor’s Thesis. Laurea University of Applied Sciences. Retrieved from: http://publications.theseus.fi/bitstream/handle/10024/114040/Virkki_Taina.pdf?sequence=1
Raeburn, T., Markstrom, U., Tjornstrand, C., & Eklundet, M. (2017). Autonomy support and recovery practice at a psychosocial clubhouse. Perspectives in Psychiatric Care, 53, 175-182. https://doi.org/10.1111/ppc.12149 PMID:26813736
Fitzgerald, S., Deiches, J., Umucu, E., Brooks, J., Veronica, M., Wu, J-R., & Chan, F. (2016). Psychometric properties of the Vocational Rehabilitation Engagement Scale when used with people with mental illness in clubhouse settings. Rehabilitation Research, Policy, and Education, 30(3), 276-285. https://doi.org/10.1891/2168-6653.30.3.276
Akiba, C.F. & Estroff. S.E. (2016). The business of staying in business: North Carolina Clubhouse programs. American Journal of Psychiatric Rehabilitation, 19(2), 97-102. https://doi.org/10.1080/15487768.2016.1162756
Battin, C., et al. (2016). A systematic review of the effectiveness of the clubhouse model. Psychiatric Rehabilitation Journal, 39(4), 305-312. https://doi.org/10.1037/prj0000227 PMID:27786524
Raab, P.A., Claypoole, K.H., Rhoads Merriam, K., Subica, A.M., Larsen, J.D., Chow, M,, & Golis, K. (2015). Indicators of success: academic research partnerships to implement performance indicator systems in clubhouses. Psychiatric Rehabilitation Journal, 37(7), 55-57. DOI: https://doi.org/10.1037/prj0000023 PMID: 24274063
Farmer, S. (2015). Spotlight on the safety net: Traumatic brain injury clubhouses in North Carolina. North Carolina Medical Journal, 76(2), 123-124. https://doi.org/10.18043/ncm.76.2.123 PMID:25856361
Grinspan, Z. (2015). Brief research report: Fountain House and use of healthcare resources. Click here to view and download article.
Gorman, J. (2015). Keeping the clubhouse open: Toward a road map for clubhouse sustainability (Doctoral dissertation), American University. Ph.D. Click here to view and download article.
Hancock, N., et al. (2015). Sources of meaning derived from occupational engagement for people recovering from mental illness. British Journal of Occupational Therapy, 78(8), 508-515. https://doi.org/10.1177/0308022614562789
Karnieli-Miller, O., et al. (2015). It’s in the cards: The contribution of illustrated metaphor cards to exploring values within narratives. Qualitative Health Research, 27(1), 138-151. https://doi.org/10.1177/1049732315609897 PMID:26489712
Pernice-Duca, F., et al. (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. https://doi.org/10.1111/fare.12127
Okon, S., et al. (2015). Health and wellness outcomes for members in a psychosocial rehabilitation clubhouse participating in a healthy lifestyle design program. Occupational Therapy in Mental Health 31(1), 62-81. https://doi.org/10.1080/0164212X.2014.1001012
Raeburn, T., et al. (2015). The contribution of case study design to supporting research on clubhouse psychosocial rehabilitation. BMC Research Notes, 8(1), 521. https://doi.org/10.1186/s13104-015-1521-1 PMID:26427943
Tanaka, K., et al. (2015). Clubhouse community support for life: Staff–member relationships and recovery. Journal of Psychosocial Rehabilitation and Mental Health, 2(2), 131-141. https://doi.org/10.1007/s40737-015-0038-1
Tanaka, K. & Davidson, L. (2015). Reciprocity in the clubhouse context. International Journal of Psychosocial Rehabilitation, 19(2), 21-33.
Raeburn, T., et al. (2015). Self-determination theory: A framework for clubhouse psychosocial rehabilitation research. Issues in Mental Health Nursing, 36(2), 145-151. https://doi.org/10.3109/01612840.2014.927544 PMID:25325308
Bouvet, C., et al. (2015). The Clubhouse model for people with severe mental illnesses: Literature review and French experiment. L’Encéphale, 41(6), 477-486. https://doi.org/10.1016/j.encep.2014.09.001 PMID:25438970
Swensen, A. (2014). Serious and Persistent Mental Illness (SPMI): The Impact of Clubhouse Participation on the Utilization of Mental Health Service Westminster College. https://www.westminstercollege.edu/docs/default-source/departments-and-offices-documents/mcnair-scholars-program/mcnair-research-journal/2008-and-2009/angela-swensen-paper.pdf?sfvrsn=2
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. https://doi.org/10.1037/prj0000052 PMID:24660951
Gorman, J. (2014). Cost-benefit and cost-effectiveness analysis of employment services offered by the clubhouse model. Master’s Thesis. American University. Retrieved from: http://hdl.handle.net/1961/14036
Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2014). Self-determination Theory: A Framework for Clubhouse Psychosocial Rehabilitation Research. Issues in Mental Health Nursing, 36(2), 145-151. https://doi.org/10.3109/01612840.2014.927544 PMID: 25325308
Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2014). Clubhouse model of psychiatric rehabilitation: How is recovery reflected in documentation? International Journal of Mental Health Nursing, 23(5), 389-97. https://doi.org/10.1111/inm.12068 PMID: 24698159
Tanaka, K. & Davidson, L. (2014). Meanings associated with the core component of clubhouse life: The Work-Ordered Day. Psychiatric Quarterly, 86(2), 269-83. https://doi.org/10.1007/s11126-014-9330-6 PMID:25417121
Tsoi, E., Lo, I., Chan, C., Siu, K., & Tse, S. (2014). How recovery oriented are mental health services in Hong Kong? Snapshots of service users’ perspectives. Asia Pacific Journal of Social Work and Development, 24, 82-93. https://doi.org/10.1080/02185385.2014.885211
Chen, F.P., Oh, H. (2019). Staff views on member participation in a mental health Clubhouse. Health & Social Care In The Community, 27, 788-796. https://doi.org/10.1111/hsc.12697
Li, L., Deng, M., Liu, Z., & Rohrbaugh, R. (2019). A Qualitative Study of Implementation Challenges of Mental Health Clubhouse Rehabilitation Services in China’s Hunan Province. Psychiatric Services, 1-7. https://doi.org/10.1176/appi.ps.201800549
Ritter, V.C., R. Fekete, O.R., Nordli, H. & Bonsaksen, T. (2019). Measuring perceived outcomes from participating at a clubhouse for persons with mental illness: Psychometric properties and associated factors, Scandinavian Journal of Occupational Therapy, 26:3, 219-225, DOI: 1080/11038128.2018.1508496
Valkeapää, T., Tanaka, K., Lindholm, C., Weiste, E., & Stevanovic, M. (2019). Interaction, Ideology, and Practice in Mental Health Rehabilitation. Journal of Psychosocial Rehabilitation and Mental Health, 6(1), 9-23. https://link.springer.com/article/10.1007/s40737-018-0131-3
Gola S.M., Burton L.J. (2018) The Thrive Programme at Toowoomba Clubhouse: Building Social Connections and Reducing Stigma Experiences for People with a Lived Experience of Mental Illness. Ní Shé É., Burton L., Danaher P. (eds) Social Capital and Enterprise in the Modern State. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-68115-3_12
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? Psychiatric Rehabilitation Journal, 41(1) 29-38. http://dx.doi.org/10.1037/prj0000262
Jones, N. & Jansson Selim, A. (2013). Education – the rainbow at the end of the tunnel. A study of a supported education program in a consumer-operated organization, with a focus on experiences of stigma. Bachelor’s thesis Ersta Skondal University College, Stockholm, Sweden. https://www.diva-portal.org/smash/get/diva2:665197/FULLTEXT01.pdf https://onlinelibrary.wiley.com/doi/abs/10.1111/scs.12587
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. Community Mental Health Journal, 54(8), 1199-1211. https://doi.org/10.1007/s10597-018-0257-5
Mutschler, C., Rouse, J., McShane, K., & Habal-Brosek, C. (2018). Developing a realist theory of psychosocial rehabilitation: The Clubhouse Model. BMC Health Services Research, 18:442, 1-12. https://doi.org/10.1186/s12913-018-3265-9
Pardi, J., Willis, M. (2018). How Young Adults in London Experience the Clubhouse Model of Mental Health Recovery: A Thematic Analysis. Journal of Psychiatric Rehabilitation and Mental Health, 5(2), 169-182. https://doi.org/10.1007/s40737-018-0124-2
Tan, Y.-X., Yan, H., Luo, Y.-H., Tang, H., Wu, H.-S., Chen, J.D. (2018). Mental rehabilitation in China: The Clubhouse Model. The Lancet Psychiatry, 386-387. https://doi.org/10.1016/S2215-0366(18)30047-6
Tanaka, K., Davidson, L., & Craig, T.J. (2018). Sense of clubhouse community belonging and empowerment. International Journal of Social Psychiatry 64(3), 276-285. https://doi.org/10.1177/0020764018759134
Torres Stone, R.A., Sabella, K., Lidz, C.W., McKay, C., & Smith, L.M. (2018). The Meaning of Work for Young Adults Diagnosed with Serious Mental Health Conditions. Psychiatric Rehabilitation Journal, 41(4), 290-298. http://dx.doi.org/10.1037/prj0000195
Chen, F., Oh. H. (2017). Building a working community: Staff practices in a clubhouse for people with severe mental illness. Administration and Policy in Mental Health and Mental Health Research, 44, 651-663. https://link.springer.com/article/10.1007/s10488-016-0757-y
Pernice, F.M., Biegel, D.E., Kim, J.-Y., & Conrad-Garrisi, D. (2017). The mediating role of mattering to others in recovery and stigma. Psychiatric Rehabilitation Journal, 40(4), 395-404. http://dx.doi.org/10.1037/prj0000269
Roth, G. (2017). Perspectives from Within the Clubhouse: A Qualitative Investigation into a Peer-to-Peer Vocational Support Program for Adults with Serious Mental Illness. Journal of Psychosocial Rehabilitation and Mental Health, 4(1), 5-17. https://doi.org/10.1007/s40737-016-0070-9
Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2016). Employment, community and recovery, lessons from a psychosocial Clubhouse. International Journal of Mental Health Nursing, pp. 46. ISSN 1445-8330.
Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2016). The use of social environment in a psychosocial clubhouse to facilitate recovery-oriented practice. BJPsych Open, 2(2), 173-178. DOI: https://doi.org/10.1192/bjpo.bp.115.002642

1. 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 and Mental Health Services Research, 45(1), 28-47. https://doi.org/10.1007/s10488-016-0760-3 PMid:27380210

The Clubhouse Model has been in existence for over sixty-five years; however, a review that synthesizes the literature on the model is needed. The current study makes use of the existing research to conduct a systematic review of articles providing a comprehensive understanding of what is known about the Clubhouse Model, to identify the best evidence available, as well as areas that would benefit from further study. Findings are summarized and evidence is classified by outcome domains. Fifty-two articles met the selection criteria of Randomized Clinical Trials (RCT’s), quasi-experimental studies, or observational studies for domains of employment (N = 29); quality of life/satisfaction (N = 10); reductions in psychiatric hospitalization(s) (N = 10); social relationships (N = 10); education (N = 3); and health promotion activities (N = 2). RCT results support the efficacy of the Clubhouse Model in promoting employment, reducing hospitalization(s), and improving quality of life. Quasi-experimental and observational studies offer support in education and social domains. The findings from this review indicate that Clubhouses are a promising practice but additional studies using rigorous methods that report the strength of the outcomes are needed to evaluate Clubhouse programs with fidelity to the Clubhouse Model.

2.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. https://doi.org/10.1007/s10597-016-0041-3 PMid:27380210

We examined whether frequency of attendance at the B’More Clubhouse was associated with lower mental health care costs in the Medicaid database, and whether members in the B’More Clubhouse (n = 30) would have lower mental health care costs compared with a set of matched controls from the same claims database (n = 150). Participants who attended the Clubhouse 3 days or more per week had mean 1-year mental health care costs of US $5697, compared to $14,765 for those who attended less often. B’More Clubhouse members had significantly lower annual total mental health care costs than the matched comparison group ($10,391 vs. $15,511; p < 0.0001). Membership in the B’More Clubhouse is associated with a substantial beneficial influence on health care costs.

3. Gorman, J.A., McKay, C.E., Yates, B.T., & Fisher, W.H. (2018). Keeping clubhouses open: Toward a roadmap for sustainability. Administration and Policy in Mental Health and Mental Health Services Research, 1-10. https://doi.org/10.1007/s10488-016-0766-x

Clubhouses are recovery centers that help persons with serious mental illness obtain and maintain community-based employment, education, housing, social integration, and other services. Key informants from U.S. clubhouses were interviewed to create a conceptual framework for clubhouse sustainability. Survival analyses tested this model for 261 clubhouses. Clubhouses stayed open significantly longer if they had received full accreditation, had more administrative autonomy, and received funding from multiple rather than sole sources. Cox regression analyses showed that freestanding clubhouses which were accredited endured the longest. Budget size, clubhouse size, and access to managed care did not contribute significantly to sustainability. https://link.springer.com/article/10.1007/s10488-016-0766-x

4. 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. https://doi.org/10.1007/s11414-014-9392-0 PMid:24504832

A randomized trial comparing a facility-based Clubhouse (N = 83) to a mobile Program of Assertive Community Treatment (PACT; N = 84) tested the widely held belief that competitive employment improves global quality of life for adults with severe mental illness. Random regression analyses showed that, over 24 months of study participation, competitively employed Clubhouse participants reported greater global quality of life improvement, particularly with the social and financial aspects of their lives, as well as greater self-esteem and service satisfaction, compared to competitively employed PACT participants. However, there was no overall association between global quality of life and competitive work, or work duration. Future research will determine whether these findings generalize to other certified Clubhouses or to other types of supported employment. Multi-site studies are needed to identify key mechanisms for quality of life improvement in certified Clubhouses, including the possibly essential role of Clubhouse employer consortiums for providing high-wage, socially integrated jobs.

5. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2016). The use of social environment in a psychosocial clubhouse to facilitate recovery-oriented practice. British Journal of Psychiatry Open 2(2), 173-178. http://doi.org/10.1192/bjpo.bp.115.002642 PMid:27703771

Background: Recovery-oriented language has been widely adopted in mental health policy; however, little is known about how recovery practices are implemented within individual services, such as psychosocial clubhouses. Aims: To explore how recovery practices are implemented in a psychosocial clubhouse. Method: Qualitative case study design informed by self-determination theory was utilized. This included 120 h of participant observation, interviews with 12 clubhouse members and 6 staff members. Field notes and interview transcripts were subject to theoretical thematic analysis. Results: Two overarching themes were identified, each comprising three sub-themes. In this paper, the overarching theme of ‘social environment’ is discussed. It was characterized by the sub-themes, ‘community and consistency’, ‘participation and opportunity’ and ‘respect and autonomy’. Conclusions: Social environment was used to facilitate recovery-oriented practice within the clubhouse. Whether recovery is experienced by clubhouse members in wider society, may well depend on supports and opportunities outside the clubhouse.

6. Bonsaksen, T., Fouad, M., Skarpaas, L., Nordli, H., Fekete, O., Stimo, T., et al. (2016). Characteristics of Norwegian clubhouse members and factors associated with their participation in work and education. British Journal of Occupational Therapy, 79(11), 669-676. https://doi.org/10.1177/0308022616639977

Abstract: Introduction: People with mental illness, in particular those with psychosis, have more problems related to getting and keeping a job than people in the general population. Clubhouses for people with mental illness are becoming increasingly common, but little is known about clubhouse members and their participation in work and education. The aim of this study was to explore these issues. Method: A member survey was conducted at one clubhouse in Oslo during February 2015. The data were analyzed with descriptive statistics and logistic regression analysis. Results: Eighty-nine clubhouse members completed the survey (response rate 55.6%). More than half of the sample had a desire to work, but only 14% participated in ordinary work. Sixty-seven percent of the participants were more than 50 years old, and they were frequent users and long-time members of the clubhouse. Higher age among the participants decreased their chances for participating in work and/or education. Conclusion: The study indicates that the clubhouse is of importance to its members, and that older members who have a desire to participate in work and/or education may be particularly challenged in their work towards such goals.

7. Hultqvist, J., Markström, U., Tjörnstrand, C., & Eklund, M. (2017). Programme characteristics and everyday occupations in day centres and clubhouses in Sweden. Scandinavian Journal of Occupational Therapy, 24(3), 197-207. https://doi.org/10.1177/0308022616639977

Abstract: Background: Meaningful everyday occupations are important for mental health and recovery and are provided by both community-based day centres (DCs) and clubhouses. It is unknown; however, if any of the two has more recovery-promoting features. Objective: This nine-month longitudinal study compared DC and clubhouses, concerning the users’ perceptions of unit and programme characteristics, and aspects of everyday occupations in terms of engagement and satisfaction. Stability over time in these respects, as well as motivation for participation and relationships with occupational engagement and satisfaction, were explored. Methods: Participants from 10 DCs (n=128) and 5 clubhouses (n=57) completed self-report instruments. Results: DC attendees rated lower levels on two organizational factors: choice and ability to influence decisions, and the unit’s social network. Motivation showed to be an important factor for perceived occupational engagement, which did not differ between the two groups. DC attendees were more satisfied with their everyday occupations at baseline, but that factor increased more in the clubhouse group and there was no group difference at follow-up. The unit and programme characteristics and occupational engagement showed stability over time. Discussion: Clubhouses seemed more advantageous and DC services may consider developing users’ opportunities for choice and decision-making, and peer support.

8. Chung, C-L., Pernice-Duca, F., Biegel, D.E., Norden, M. & Chang, C-W. (2016). Family perspectives of how their relatives with mental illness benefit from clubhouse participation: A qualitative inquiry. Journal of Mental Health, 25(4), 372-378. https://doi.org/10.3109/09638237.2016.1149805 PMid:26942501

Background: Although researchers have demonstrated the benefits of psychosocial Clubhouse participation on a number of clinical and psychosocial outcomes, few studies have investigated the consumer’s participation from the perspectives of others. Aim: This study aimed to investigate family members’ perspectives of how Clubhouse programming has affected consumers’ recovery. Method: Twenty-four relatives of Clubhouse members were interviewed using a semi-structured protocol. Relatives were nominated by their Clubhouse members as their family member who provided them with the most social support. All interviews were transcribed and underwent content analysis yielding multilevel coding. Results: Four main dimensions emerged from family interviews about how Clubhouses affected their relatives. These dimensions aligned with areas of clinical recovery and personal growth. Family members observed and noted changes in: (1) positive affective changes, (2) improved goal directed and challenging behaviors, (3) positive attitude changes and (4) greater social interactions. Conclusion: As one of the first studies to document the perspectives of the relatives of Clubhouse members, this exploratory study indicates that family members recognize positive changes in their Clubhouse family members and these changes align with areas of functional recovery. Implications for practice and future studies are discussed.

9. Mandiberg, J. M., & Edwards, M. (2016). Business incubation for people with severe mental illness histories: The experience of one model. Journal of Policy Practice 15(1-2): 82-101. http://dx.doi.org/10.1080/15588742.2016.1109964

ABSTRACT: The Enterprise People was a business incubator for people with serious mental health conditions that operated in Madison, Wisconsin, from 1998–2005. It supported entrepreneurs with learning basic business skills, start-up processes and expenses, back office supports, ongoing problem solving, and for some, with space to conduct their businesses. The original impetus was to discover whether people with SMI histories could successfully start and operate small businesses. Although this was confirmed, the experience also uncovered factors that will allow other projects of this sort to succeed, and some core infrastructural supports that need to be created. The experience demonstrates that self-employment supported by formal business incubation is a viable option in the range of mental health vocational rehabilitation models.

10. Prince, J. D., et al. (2016). Making connections: Severe mental illness and closeness with other people. Social Work in Mental Health, 15(1), 1-13. https://doi.org/10.1080/15332985.2016.1148095

Much has been written about social lives of people with severe mental illness (SMI). Before social lives can flourish, however, people with SMI must first get close to other people. We studied this closeness by holding three hour-long focus groups at Fountain House, a community mental health agency in New York City. We found that closeness between two people with SMI is challenging because someone with depression, for example, may have trouble understanding someone with a different disorder (e.g., schizophrenia). Romantically, closeness is also challenging—SMI is hard to explain to partners. In the workplace, closeness is difficult because SMI can alienate coworkers. It could push them away. In mental health programs, we found that closeness has more chance to develop: (1) in evening and weekend activities; (2) when activities are planned often enough to prevent isolation; and (3) when staff reach out to people before extended absence causes distance.

11. Virkki, T. (2016). Working experiences of members of the Sörnäinen Clubhouse and their visions for improving the employment of mental health rehabilitators. Laurea University of Applied Sciences. Bachelor’s Thesis.

http://www.theseus.fi/bitstream/handle/10024/114040/Virkki_Taina.pdf?sequence=1&isAllowed=y

12. Raeburn, T., Markstrom, U., Tjornstrand, C., & Eklundet, M. (2017). Autonomy support and recovery practice at a psychosocial clubhouse, Perspectives in Psychiatric Care, 53, 175-182.https://doi.org/10.1111/ppc.12149 PMid:26813736

Purpose: To explore how recovery practices are embodied in the behavior of staff and implemented by staff and members at a psychosocial clubhouse. Design and Methods: Case study design guided 120 hr of participation observation and 18 interviews at a psychosocial clubhouse. Data were subjected to thematic analysis guided by self-determination theory. Findings: “Autonomy support” emerged as an overarching theme, with three subthemes: “voice cultivating”, “talent scouting”, and “confidence coaching.” Practice Implications: Autonomy support is an important means of supporting the self-determination of clubhouse members. The findings of this study inform the ongoing development of the clubhouse involved and also provide insights for health services generally in relation to how to implement recovery-oriented practice.

13. Fitzgerald, S., Deiches, J., Umucu, E., Brooks, J., Veronica, M., Wu, J-R., & Chan, F. (2016). Psychometric properties of the Vocational Rehabilitation Engagement Scale when used with people with mental illness in clubhouse settings. Rehabilitation Research, Policy, and Education, 30(3), 276-285. https://doi.org/10.1891/2168-6653.30.3.276

Abstract: Purpose: The purpose of this study was to validate the Vocational Rehabilitation Engagement Scale (VRES) for use in the Clubhouse Model of Psychosocial Rehabilitation. Method: There were 124 individuals with serious mental illness recruited from 8 Clubhouse programs in Hawaii. Measurement structure of the VRES was evaluated using exploratory factor analysis. Results: Exploratory factor analysis of the Clubhouse version of the VRES yielded 2 reliable factors (cognitive-affective engagement and behavioral engagement). Both the cognitive-affective engagement and behavioral engagement factors were found to correlate with other self-determination theory constructs including autonomy support, relatedness, and outcome expectancy. Conclusions: The Clubhouse version of the VRES is a brief, reliable, and valid instrument for assessing vocational rehabilitation (VR) engagement and contributes to the use of self-determination as a paradigm for improving recovery outcomes in psychiatric rehabilitation.

14. Akiba, C.F. & Estroff. S.E. (2016). The business of staying in business: North Carolina Clubhouse programs. American Journal of Psychiatric Rehabilitation, 19(2), 97-102. https://doi.org/10.1080/15487768.2016.1162756

Clubhouse Model Programs in North Carolina are threatened by significant local and state reimbursement mechanisms. The goal of this study was to examine the impact of diminished state resources and administrative changes on the ground, from the perspective of Clubhouse members and staff at two Clubhouses in North Carolina. The lead author conducted participant observation for five weeks at each site engaging in various daily activities with members and staff, conducting conversational interviews, and reviewing program administrative data to corroborate findings. Income lost to decreased Psychosocial Rehabilitation (PSR) rates, decreased billable hours, and an increased delivery of non-reimbursed services represented a significant net cost to the Clubhouses’ operations and finances. The impact of these costs varied between the two organizations largely due to differing policies enacted by their Local Management Entities (LMEs). The costs of forced budgetary changes at the state level created varying degrees of hardship between clubhouses and their service missions.

15. Battin, C., et al. (2016). A systematic review of the effectiveness of the clubhouse model. Psychiatric Rehabilitation Journal, 39 (4), 305-312. https://doi.org/10.1037/prj0000227 PMid:27786524

Objective: The aim of the article is to synthesize studies that investigate the effectiveness of clubhouses, to summarize the strength of the evidence for this model, and to discuss methodological issues in the research. Methods: We collected 216 studies referencing clubhouses in the principal international scientific databases (PsycINFO, Psycarticles, Academic Search Premier, Medline, PubMed, and Science Direct). We then selected 77 studies that used experimental (randomized controlled trial) or quasi-experimental designs (with control group, without randomization and/or pre–post studies). As part of the 77 selected studies, we focused on 15 studies that specifically addressed the effectiveness of clubhouses. Results: There are few studies on the effectiveness of clubhouses, and the existing studies, because of their methodological design, allow us to affirm only moderate (quality of life, employment, rate of hospitalization) or low (symptomatology, social functioning) levels of evidence for the effectiveness of clubhouses. Most studies are limited by a lack of randomization, absence of a comparison group, or absence of a longitudinal design. Furthermore, the diversity of methodologies used makes a comparison of the results difficult. Conclusions and Implications for Practice: We offer several recommendations for future research to build the evidence base regarding this model and enhance comparability of studies.

16. Raab, P.A., Claypoole, K.H., Rhoads Merriam, K., Subica, A.M., Larsen, J.D., Chow, M,, & Golis, K. (2015). Indicators of success: academic research partnerships to implement performance indicator systems in clubhouses. Psychiatric Rehabilitation Journal, 37(7), 55-57. DOI:10.1037/prj0000023 PMID: 24274063

This article describes collaboration between academic researchers and Clubhouses to develop and implement a statewide Clubhouse performance indicator system. PURPOSE: Given the challenging funding climate, it is important that Clubhouses are able to gather service provision and performance data. However, establishing the necessary data structures can be a daunting task, and partnerships with academic researchers can aid in this process. We detail one such collaboration, utilizing a participatory research public-academic liaison framework, between researchers and Hawai’i’s Clubhouses. SOURCES USED: Sources used include published literature, personal communication, and personal observation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Lessons learned during the collaboration include the importance of face-to-face contact, technology training, duplicated and unduplicated variables, and tailoring data structures to the culture and work-ordered day of each Clubhouse. Experiences in this collaboration confirm that with support Clubhouse members are capable of fulfilling the rigorous responsibilities of contributing to a performance indicator system.

17. Farmer, S. (2015). Spotlight on the safety net: Traumatic brain injury clubhouses in North Carolina. North Carolina Medical Journal, 76, 123-124. https://doi.org/10.18043/ncm.76.2.123 PMid:25856361

Abstract: Traumatic brain injury (TBI) is a major and growing public health problem in North Carolina. Individuals who have experienced a moderate to severe TBI require a continuum of care involving acute hospitalization and post-acute rehabilitation; the latter should include community reintegration that, ideally, allows them to return home and to function as a productive member of the community. Specialized clubhouse/day programs are one model of community reintegration that has demonstrated some success.

A brain injury clubhouse is a community center for people living with the effects of TBI. The clubhouse is based on a model that has been recognized for more than 70 years. In 1948, Fountain House was founded on the premise that clubhouse members could work productively and have socially satisfying lives in spite of mental illness [1]. Over the years, the clubhouse model has been adapted to accommodate other disability groups, including people with brain injuries. A clubhouse offers a safe environment where people are treated with dignity and respect. Table 1 provides online resources related to TBI clubhouses.

18. Grinspan, Z. (2015). Brief research report: Fountain House and use of healthcare resources. Weill Cornell Medical College. Healthcare Policy & Research, 1-12.

Fountain House is a service organization dedicated to improving the lives of people with mental illness. In New York City, Fountain House provides residential rehabilitation for selected individuals. It is unclear how often these individuals use other health services, such as inpatient admissions emergency department (ED) visits, or outpatient care visits. It is also unclear how their use of these services compares to similar individuals who use residential rehabilitation services elsewhere in New York City. Click here to view and download article.

19. Gorman, J. (2015). Keeping the clubhouse open: Toward a road map for clubhouse sustainability (Doctoral dissertation), American University. Doctoral Disseration. UMI Dissertation # 3720527. Click here to view and download article.

Clubhouses are nonprofit human services organizations that provide a variety of programming including educational opportunities, housing, employment, and other supports to persons diagnosed with Serious Mental Illness (Glickman, 1992). Researchers conducted and analyzed interviews of key informants from U.S. clubhouses (N = 7) to create a basic conceptual framework for clubhouse sustainability. Retrospective multisite (N = 261) survey data were used to find the best predictors of sustainability using survival analyses. Key informants suggested immediate and long-term factors that influence clubhouse sustainability differed by circumstance. The Kaplan-Meier estimator showed that clubhouses with longer program sustainability had higher clubhouse accreditation levels (p < .001), clubhouse autonomy (p < .001), and multiple funding sources (p = .01). Cox regression analyses suggested clubhouses that were freestanding entities (p < .001) and were fully accredited (p = .025) were most likely to sustain programming over time. Future research could focus on aspects of model adherence and autonomy that increase the likelihood of program sustainability.

20. Hancock, N., et al. (2015). Sources of meaning derived from occupational engagement for people recovering from mental illness. British Journal of Occupational Therapy, 78(8), 508-515. https://doi.org/10.1177/0308022614562789

Introduction: Engagement in meaningful occupations is of central importance in mental health recovery. The purpose of this study was to gain a richer understanding of the relationships between occupations, sources of meaning and recovery for people living with mental illness. Method: People living with mental illness (n=78) attending an Australian Clubhouse completed the recovery assessment scale and socially valued role classification scale. Qualitative and quantitative data were analysed using mixed methods. Findings: The most meaningful occupations were those most likely to provide opportunities for social connection and being valued by others. The frequency with which these socially derived sources of meaning were identified far outweighed other sources: positive sense of self; skills/personal development; time use/routine; financial gain and fun/pleasure. Neither the occupations identified as most meaningful nor the source of meaning differed depending on level of recovery. Conclusion: Irrespective of stage of recovery, socially derived aspects of meaning are most frequently prioritized by people living with mental illness. In facilitating engagement in personally meaningful occupations, occupational therapists need to understand that, for many, meaningfulness centres around inter-dependence: being with others, belonging, giving, or contributing and being valued by others.

21. Karnieli-Miller, O., et al. (2015). “It’s in the cards”: The contribution of illustrated metaphor cards to exploring values within narratives. Qualitative Health Research, 27(1), 138-151. https://doi.org/10.1177/1049732315609897 PMid:26489712

In this article, we present the use of illustrated metaphorical cards as a technique to enrich the qualitative narrative interview. We examine the advantages of incorporating a projective tool to assist in constructing and understanding personal narratives of people living with severe mental illness. We interviewed 25 participants-staff and members of a clubhouse in Israel (an international community model of rehabilitation in mental health)-and sought to understand their stories focused on personal and organizational values. The findings revealed that, in most cases, the cards contributed to data collection by enhancing the interviewees’ ability for expression and by facilitating richer, more comprehensive stories and descriptions. This in turn enhanced the researcher’s ability to understand the messages and stories presented. The research conclusions discuss the cards’ potential contribution to improving data collection and analysis. The cards became an additional channel for expressing participants’ experiences, emotions, and unique voice.

22. Pernice-Duca, F., et al. (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. https://doi.org/10.1111/fare.12127

Family members provide a significant source of social support to relatives living with a serious mental health disorder, such as schizophrenia. Few public mental health programs offer families a supportive environment where their relatives can develop independence, life skills, and satisfying relationships that are not dependent on the family’s involvement. The Clubhouse is one such model. Although family members are not directly involved, they may experience indirect effects from their relative’s participation. Family members with relatives involved in Clubhouse (n=35) completed an in-depth semi-structured interview. Transcripts were analyzed to identify underlying themes. Five primary themes emerged ranging from less burden to greater positive family interaction. Specifically, family members attributed Clubhouses as providing a supportive external community for their loved ones, but also ameliorating negative aspects of family care and improving family interactions. Practical implications for family professionals are discussed.

23. Okon, S., et al. (2015). Health and wellness outcomes for members in a psychosocial rehabilitation clubhouse participating in a healthy lifestyle design program. Occupational Therapy in Mental Health, 31(1), 62-81. https://doi.org/10.1080/0164212X.2014.1001012

This study describes the development, execution, and outcomes of a health and wellness program at a certified clubhouse in Southwest Florida. Individuals with severe mental illnesses are at a higher risk of co-morbid health problems and lower quality of life. The Healthy Lifestyles Design Program consisted of 16 sessions and educated members about the topics of nutrition, physical activity, spirituality, and tobacco awareness through engagement in meaningful goal-directed occupations. The projected outcomes were to empower members to engage in healthy lifestyle activities and establish resources for members within the clubhouse and community for sustainable health and wellness.

24. Raeburn, T., et al. (2015). The contribution of case study design to supporting research on clubhouse psychosocial rehabilitation. BMC Research Notes, 8(1), 521. https://doi.org/10.1186/s13104-015-1521-1 PMid:26427943

Background: Psychosocial Clubhouses provide recovery-focused psychosocial rehabilitation to people with serious mental illness at over 300 sites in more than 30 countries worldwide. To deliver the services involved, Clubhouses employ a complex mix of theory, programs and relationships, with this complexity presenting a number of challenges to those undertaking Clubhouse research. This paper provides an overview of the usefulness of case study designs for Clubhouse researchers; and suggests ways in which the evaluation of Clubhouse models can be facilitated.

Results: The paper begins by providing a brief explanation of the Clubhouse model of psychosocial rehabilitation, and the need for ongoing evaluation of the services delivered. This explanation is followed by an introduction to case study design, with consideration given to the way in which case studies have been used in past Clubhouse research. It is posited that case study design provides a methodological framework that supports the analysis of either quantitative, qualitative or a mixture of both types of data to investigate complex phenomena in their everyday contexts, and thereby support the development of theory. As such, case study approaches to research are well suited to the Clubhouse environment. The paper concludes with recommendations for future Clubhouse researchers who choose to employ a case study design.

Conclusions: While the quality of case study research that explores Clubhouses has been variable in the past, if applied in a diligent manner, case study design has a valuable contribution to make in future Clubhouse research

25. Tanaka, K., et al. (2015). Clubhouse community support for life: Staff–member relationships and recovery. Journal of Psychosocial Rehabilitation and Mental Health, 2(2), 131-141. https://doi.org/10.1007/s40737-015-0038-1

With signs that early interventions for severe mental illness have at best only a modest impact on longer-term outcome, a need for a long-term care and support system that facilitates recovery is resurfacing. This article describes a well-established long-term support program, the clubhouse model, drawing on qualitative interview data from 105 users and 25 staff from 5 clubhouses in the U.S. and Finland, which was analyzed using a grounded theory approach. Recurrent patterns of transformative life changes emerged. Central to these processes was a sense of equality between staff and members that transcended social roles and mental health status and was experienced as embodying trust in human potential and respecting member’s choice. This staff–member relationship can be framed by the Aristotelian notion of friendship for life. The clubhouse, offering a home base to which members can return in times of need, may provide a viable safety net for recovery.

26. Tanaka, K. & Davidson, L. (2015). Reciprocity in the clubhouse context. International Journal of Psychosocial Rehabilitation, 19(2), 21-33. https://www.psychosocial.com/article/19-11/8150/

Albeit still limited, the literature has begun to document reciprocity, including service user-provider reciprocity, as key to psychiatric recovery. This article presents a thick description of reciprocity occurring in the mental health clubhouse context, drawing on qualitative interview data from 103 users and 25 staff at 5 clubhouses in the U.S. and Finland, which was analyzed using a grounded theory approach. We found that receiving and giving support appears to be a part of everyday life at the clubhouse. We also found that this seemed conducive to recovery in that it helped users, through what we identified as clubhouse ways, to experience personhood, thereby transforming their battered sense of existence into a sense of agency and, perhaps more importantly, a sense of self-worth and being part of society. The clubhouse model may represent a viable collective approach to complement current community-based mental health systems of care that emphasize individual support.

28. Bouvet, C., Battin, C., & Le Roy-Hatala, C. (2014). The Clubhouse model for people with severe mental illnesses: Literature review and French experiment. L’Encéphale, 41(6), 477-486. [Article in French]. https://doi.org/10.1016/j.encep.2014.09.001 PMid:25438970.

Abstract: AIM: The aim of this article is 1) to present the Clubhouse (CH) Model and the first French CH, and 2) study the empirical background on the efficiency of the CH concerning employment, quality of life, and hospitalization for people with mental illness. Historical, theoretical, and institutional background: The first Clubhouse was created sixty years ago in the U.S. The Clubhouse model of psychosocial rehabilitation is a program that offers to people with mental illness support and opportunities to find a job and return to a normal social life. The Clubhouse model has been built over the years thanks to the experiences of members and staff. It is based on “36 standards” (rules which each Clubhouse follows in order to attain its goals). Supported by associations and families of people with mental illness, health professionals, and the international federation of Clubhouses (Clubhouse International), the first Clubhouse in France has opened in November 2011. This non-medicalized association and its co-management by both members and staff are innovative in France. The aims of the Clubhouse are founded on the concept of empowerment and “peer-help”, and on the fight against isolation and stigmatization. Clubhouses offer day-programs which allow people with mental illness to have a sense of community and a useful purpose within the association. Indeed, the salaried management team is voluntarily understaffed so that the participation of members is necessary and so that they can benefit from the opportunities for useful activity within the Clubhouse, developing a real opportunity of empowerment. Method: In order to study the efficiency of CH, we conducted a systematic review of publications on CH, first in the database of Club House International (500 publications) and second, in the scientific data base (Psycinfo, Psycarticles, Academic Search Premier, Medline et Science Direct) (205 publications included in the 500). We identified 64 scientific studies. We have selected 28 of them that focused on the variable: employment, quality of life and hospitalisation. Results: Clubhouses have shown their effectiveness regarding employment, quality of life and hospitalization. Indeed, several studies compare Clubhouses with other programs of psychosocial rehabilitation. The results have demonstrated that Clubhouses’ members: find more salaried work, find jobs of higher quality, have a better quality of life and face fewer hospitalizations, than people in other psychosocial rehabilitation programs. Discussion: We discuss the interest of the CH in France using the experiment of the CH in Paris. This experiment in providing an innovative place of support, mutual aid, and autonomy is currently successful in France. Over 18 months, a team of 65 members and 3 staff members has come together. This enthusiasm is probably due to the fact that the Clubhouse in Paris is a place which helps people with mental illness establish a daily rhythm, social usefulness and affective links, all essential for recovery, in a context different from the usual medically supervised care in other settings: people are treated as individuals rather than as “sick persons” or “patients”. This article discusses the benefits of this new model of psychosocial rehabilitation in France, by presenting the originality and complimentarity of this concept, in comparison with other health structures.

29. Swensen, A. (2014). Serious and Persistent Mental Illness (SPMI): The Impact of Clubhouse Participation on the Utilization of Mental Health Service Westminster College.

Abstract: Persons with serious and persistent mental illness (SPMI are frequent users of mental health services. Such services may be delivered by mental health and/or other medical professionals in a hospital, emergency room or outpatient clinic setting. In addition, individuals with SPMI may participate in community based mental health care programs known as Clubhouses. Here they are considered members, and participate in the day-to-day business of running the Clubhouse. This business includes placement of members in supported employment opportunities, housing, educational assistance, and a variety of other activities that promote recovery and integration into the community. However, there is no direct delivery of mental health services, such as counseling or medication management. The current study seeks to measure the impact of Clubhouse participation on the use of other mental health services. Billing records for 37 individuals with SPMIs were analyzed to determine use of inpatient, outpatient, and emergency services for a three-year period before joining a local Clubhouse, as well as the three-year period following initial contact with the Clubhouse. It was hypothesized that usage of other mental health services would decrease after participation in Clubhouse. Statistical analysis indicated no significant difference in utilization of outpatient and emergency or crisis care before, as compared to after Clubhouse participation. However, there was a trend towards significance particular to the decrease in hospital readmission after Clubhouse participation.

Available: https://www.westminstercollege.edu/pdf/mcnair/Swensen,A_Sr.Paper_Final_Really.pdf

30. 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. https://doi.org/10.1037/prj0000052 PMid:24660951

Abstract: Objective: Loneliness can impede subjective experiences of recovery. This study examines the relationship between clubhouse participation and loneliness using standardized instruments while controlling for age, gender, living status, and social network characteristics. METHOD: A random sample of 126 members from one clubhouse was recruited for this cross-sectional investigation. A hierarchical multiple regression analysis was performed to examine the association between participation and loneliness. RESULTS: A greater number of clubhouse visits, greater perceived availability of social support and higher levels of overall satisfaction with social network relationships were significantly related to a lower level of loneliness after controlling for covariates. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Service providers may want to pay more attention to those members experiencing loneliness and help them connect with others. Future studies using longitudinal analyses are needed to further assess the causal relationship between clubhouse participation and loneliness. Multiple aspects of participation should be examined.

31. Gorman, J. (2014). Cost-benefit and cost-effectiveness analysis of employment services offered by the clubhouse model. Master’s Thesis. American University.

Abstract: Clubhouses are community-based mental health programs that offer participants (members) educational opportunities, housing, employment, and other services (Macias, Barreira, Alden, & Boyd, 2001). Currently, clubhouses dedicate many resources towards services to help members enter into community-based employment through Transitional Employment (TE), Supported Employment (SE), and Independent Employment (IE). Benefits from employment can assist in offsetting costs to mental health services. This study measured costs of member employment services in 43 US clubhouses. The present study found several relationships between how member earnings and employment may be affected by specific member and staff characteristics. Results demonstrated that for every hour a staff member dedicates to employment services members earn $38.73 and for every one dollar invested in employment services members earn $1.31. Further, clubhouses dedicated a median of 120.55 hours and $3,438 to employment services for every member employed for at least 6 months in a given year.

Available: http://hdl.handle.net/1961/14036

32. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2014). Self-determination Theory: A Framework for Clubhouse Psychosocial Rehabilitation Research. Issues in Mental Health Nursing, 36(2), 145-151. https://doi.org/10.3109/01612840.2014.927544 PMid:25325308

Abstract: The Clubhouse model is a widely used approach to psychosocial rehabilitation that has been a pioneer in supporting recovery-oriented programmes. Little consideration has been given however, to the theories that guide research of the recovery practices used by Clubhouses. In this paper, we provide a description of self-determination theory, including its philosophical background followed by explanation of its relevance to health care and Clubhouse contexts. We argue that self-determination theory provides a robust social constructionist theoretical framework that is well-suited to informing research related to psychosocial rehabilitation, recovery-oriented practices, and the Clubhouse Model.

33. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2014). Clubhouse model of psychiatric rehabilitation: How is recovery reflected in documentation? International Journal of Mental Health Nursing, 23(5), 389-397. http://dx.doi.org/10.1111/inm.12068

Abstract: Recovery-oriented models of psychiatric rehabilitation, such as the Clubhouse model, are an important addendum to the clinical treatment modalities that assist people with chronic and severe mental illness. Several studies have described the subjective experiences of personal recovery of individuals in the clubhouse context, but limited research has been undertaken on how clubhouses have operationalized recovery in practice. The research question addressed in this paper is: How are recovery-oriented practices reflected in the documentation of a clubhouse? The documents examined included representative samples of key documents produced or utilized by a clubhouse, including public health-promotion materials and policy and membership documents. Data were subjected to content analysis, supported by the Recovery Promotion Fidelity Scale. The recovery categories identified in the documents included collaboration (27.7%), acceptance and participation (25.3%), quality improvement (18.0%), consumer and staff development (14.5%), and self-determination (14.5%). These categories show how the clubhouse constructs and represents personal recovery through its documentation. The findings are important in light of the role that documentation can play in influencing communication, relationships, and behavior within organizations. The findings can also be used to inform future research related to recovery-oriented practices in clubhouse settings.

34. Tanaka, K. & Davidson, L. (2014). Meanings associated with the core component of clubhouse life: The Work-Ordered Day. Psychiatric Quarterly, 86(2), 269-83. https://doi.org/10.1007/s11126-014-9330-6 PMid:25417121

Abstract: Despite the clubhouse model’s 60-year existence internationally, the central nature of its core program, the “work-ordered day” (WOH) (Beard et al. in Psychosocial Rehabilitation Journal 5:47-53, 1982), is not well understood; hence, the primary focus of the present study was to explore members’ experiences of the nature and meaning of the WOH. The study drew on qualitative interview data collected in 2009-2013 through open-ended questions and probes with 102 members and 24 staff from 5 Clubhouse International-certified clubhouses (2 US and 3 Finnish). Participant observation supplemented the interviews and all data were analyzed using a grounded theory approach (Charmaz in Rethinking methods in psychology, 1995; Glaser and Strauss in The discovery of grounded theory: strategies for qualitative research, 1967). Two major themes clustered around: (a) WOH in service of autonomy (things to do, sense of accomplishment, respite, development of occupational skills) and (b) WOH in service of relationships (receiving support; collaboration; and making contributions to the clubhouse community). Clubhouse members appeared to experience the WOH as meaningful because it helps them, as its best, reconstruct a life, develop their occupational self and skill sets, and experientially learn and live what parallels a good life in the general community. It appears that these experiences, interconnecting with the fundamental human needs for autonomy and relationship, point to wellbeing and recovery as part of personal growth. These findings can guide clubhouse daily practice in assessing members’ psychosocial strengths and needs pertaining to recovery. Future research should elaborate on influences of sources of meaning, including work designs and the contributions of everyday socio-cultural interactive and reciprocal processes to these meanings

35. Tsoi, E., Lo, I., Chan, C., Siu, K., & Tse, S. (2014). How recovery oriented are mental health services in Hong Kong? Snapshots of service users’ perspectives. Asia Pacific Journal of Social Work and Development, 24, 82-93. https://doi.org/10.1080/02185385.2014.885211

Abstract: Today we are witnessing a slow paradigmatic shift in Hong Kong’s mental health services to becoming more recovery oriented, the context, meaning and process of which, however, is highly individualised as well as culturally sensitive. Therefore, it is imperative to gather the voices of service users. This paper serves to capture the views of a group of service users on the changes they have seen and the ongoing challenges in mental health services in Hong Kong; and to compare the Hong Kong experience with international experience with a view to reflecting on the directions for future development. Today we are witnessing a slow paradigmatic shift in Hong Kong’s mental health services to becoming more recovery oriented, the context, meaning and process of which, however, is highly individualised as well as culturally sensitive. Therefore, it is imperative to gather the voices of service users. This paper serves to capture the views of a group of service users on the changes they have seen and the ongoing challenges in mental health services in Hong Kong; and to compare the Hong Kong experience with international experience with a view to reflecting on the directions for future development.

36. Chen, F.P., Oh, H. (2019). Staff views on member participation in a mental health Clubhouse. Health & Social Care In The Community, 27, 788-796. https://doi.org/10.1111/hsc.12697The clubhouse model is a community psychiatric rehabilitation program aiming to provide a restorative environment for people with severe mental health problems. These clubhouses provide their members with opportunities for friendship, employment, and education, which help them on their paths towards mental health recovery. Towards that end, the model features clubhouse members and staff working side by side to execute clubhouse activities. That is, unlike most of the community mental health programs where staff provide services to their clients, clubhouse staff are required to partner with members in their work. The aim of this qualitative study was to understand how the clubhouse staff elicited member participation and facilitate recovery. The research was conducted between Year 2013 and Year 2014 at the world’s first clubhouse: Fountain House in New York City. The first author conducted 262 hr of active participant observation in 41 visits to Fountain House, and in‐depth interviews with 38 staff members who had worked at Fountain House for at least 1 month during the study period. The dimensional analysis procedure was used to analyse the observation notes and interview transcripts. Results showed that participation was a key to rebuilding members’ self‐confidence, which further encouraged members to seek more opportunities for self‐enhancement and personal growth. Specific organisational policies, programming, practical considerations, and other strategies shaped a positive environment for members to exercise autonomy, experience self‐efficacy, and model behaviours after others who have succeeded. Findings of this research support the egalitarian staff–member relationships and the maintenance of an open and transparent atmosphere of the clubhouse, as observational learning enables members to move forward with their journeys to recovery. Findings also may inform efforts to shift traditional psychiatric services towards recovery‐oriented care.

37. Li, L., Deng, M., Liu, Z., & Rohrbaugh, R. (2019). A Qualitative Study of Implementation Challenges of Mental Health Clubhouse Rehabilitation Services in China’s Hunan Province. Psychiatric Services, 1-7. https://doi.org/10.1176/appi.ps.201800549

Objective: Psychosocial rehabilitation has been established as a critical component of client-centered recovery-oriented services for people with serious mental illness. Despite its importance, the implementation of mental health rehabilitation services in low- or middle-income countries has not been well studied. In this study, the authors document the regional challenges of planning and implementing mental health rehabilitation services in clubhouses in Hunan Province in the People’s Republic of China. Methods: Participants were purposively selected and consisted of diverse stakeholders, including rehabilitation directors and psychiatric hospital leaders in Hunan Province, China. Information was collected from 33 individuals by using three focus groups, 23 semi-structured interviews of key informants, and participant observation. Interview transcripts were coded and analyzed by using standard qualitative methods. Results: Implementation challenges were characterized by four themes: skepticism toward psychosocial rehabilitation services, resource shortage, insufficient system integration and incentives, and stigma of mental illness. Conclusions: Psychosocial rehabilitation is an emerging public health priority in China. This study on clubhouses in Hunan Province used qualitative methods to inform future directions for service development and research. Early identification of regional implementation challenges is a first step in assessing the applicability of psychosocial rehabilitation services locally in Hunan Province. Successful implementation of clubhouse psychosocial rehabilitation services will benefit not only from strong government commitment but also from developing standard evaluations of evidence-based practices, tackling stigma, and addressing low resource investment.

38. Ritter, V.C., R. Fekete, O.R., Nordli, H. & Bonsaksen, T. (2019) Measuring perceived outcomes from participating at a clubhouse for persons with mental illness: Psychometric properties and associated factors, Scandinavian Journal of Occupational Therapy, 26:3, 219-225. DOI: 10.1080/11038128.2018.1508496Background: The clubhouses are part of a growing international movement concerned with providing work-oriented psychosocial rehabilitation for people with a history of mental illness. Instruments used for measuring outcomes from clubhouse participation is in a developing phase. Aims: This study aimed to assess psychometric properties of an outcome survey tool used at a Norwegian clubhouse, and to explore factors associated with members’ perceived outcomes from participation at the clubhouse. Methods: A cross-sectional design was used. The instrument’s factor structure was examined with Principal Components Analysis (PCA), and internal consistency was assessed with Cronbach’s α. Associations with the derived outcome scale score were examined with linear regression analysis. Results: All scale items belonged to the same latent factor, and internal consistency of the items was α = 0.81. Members, who used the clubhouse more frequently perceived the outcomes from participating to be better, compared to their counterparts. Conclusion: The outcome scale was unidimensional and the items fit well together. Active members were likely to evaluate outcomes of clubhouse participation as more positive, compared to less active members. Significance: The scale can be useful for exploring clubhouse members’ perceptions of the outcomes they relate to their participation at the clubhouse.

39. Valkeapää, T., Tanaka, K., Lindholm, C., Weiste, E., & Stevanovic, M. (2019). Interaction, Ideology, and Practice in Mental Health Rehabilitation. Journal of Psychosocial Rehabilitation and Mental Health, 6(1), 9-23. https://link.springer.com/article/10.1007/s40737-018-0131-3

This paper investigates how two ideologies of mental health rehabilitation—recovery ideology and communal approach—are realized in interactional practices associated with psychosocial rehabilitation. More specifically, the paper discusses employee selection in the context of the Clubhouse-created Transitional Employment (TE) programme, which offers employment opportunities for rehabilitants. The paper describes how joint decisions are established during the moment-by-moment interactional processes at the Clubhouse. Drawing from the data set of 29 video-recorded rehabilitation group meetings, and Conversation Analysis as a method, the paper analyzes two questions: (1) How do the participants talk about the decision-making process associated with the TE on a “meta” level? And (2) how are the TE employees actually selected in the turn-by-turn sequential unfolding of interaction? When discussing the TE employee selection procedure on a “meta” level, the values of recovery ideology focusing on client empowerment and self-determination are prevalent. Also, the central ideals of the communal approach—openness and collaboration—are defended as decision-making guidelines. However, in the meetings where decisions on the TE employees are concretely made, there is a mismatch between the two ideological approaches to rehabilitation and the actual practices observable in the relevant interactional encounters.

40. Gola S.M., Burton L.J. (2018) The Thrive Programme at Toowoomba Clubhouse: Building Social Connections and Reducing Stigma Experiences for People with a Lived Experience of Mental Illness. In: Ní Shé É., Burton L., Danaher P. (eds) Social Capital and Enterprise in the Modern State. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-68115-3_12

Toowoomba Clubhouse is a community-based mental health service in the Darling Downs region of Queensland, Australia. It was founded on the evidence-based Fountain House model for psychosocial rehabilitation and currently operates within the recovery model framework. Social connection, one of the elements of the recovery model, is recognised in existing literature as a key requirement for reducing stigma associated with the lived experience of mental illness. In May 2015, Toowoomba Clubhouse introduced a new programme called ‘Thrive’. Thrive is a supported socialisation programme which matches Clubhouse members (Clubhouse companions) with community volunteers (community companions) with the aim of reducing stigma experiences. Unlike more traditional peer and mentoring programmes, the links between Clubhouse companions and community companions are based on common interests and goals with an aim to develop companionships of equality and friendship. This programme is in line with existing ‘supported accommodation’ and ‘supported employment’ programmes that focus on facilitating natural experiences within the broader community. This chapter provides an overview of the Thrive programme and documents research findings focused on evaluating the effectiveness of Thrive as a stigma reduction programme for people with a lived experience of mental illness.

41. 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? Psychiatric Rehabilitation Journal, 41(1) 29-38. http://dx.doi.org/10.1037/prj0000262

Objective: The study examined factors associated with community integration experiences of adults with serious mental illness who were members of psychosocial rehabilitation clubhouses in New York City. Method: Ninety-two clubhouse members completed an online survey. The study examined relative contribution of adults’ reports of individual factors (self-reported psychiatric symptoms, self-esteem), community supports (self-reported employment status and perceived family support), and the clubhouse environment (self-reported time spent in the clubhouse, clubhouse supportiveness, and practical orientation) in accounting for variation in members’ reports of social integration within the clubhouse and within the larger community. Results: Hierarchical linear regression results suggest a differential pattern of variables associated with participants’ experience of social integration within the clubhouse versus outside the clubhouse with the larger non-mental-health consumers. Adults’ reports of more time spent in the clubhouse and perceptions of clubhouse environment as having a more practical orientation were associated with adults’ reports of greater social integration within the clubhouse. In contrast, greater self-esteem and being independently employed were associated with greater social integration outside the clubhouse. Perceived family support was associated with higher levels of social integration both within and outside the clubhouse setting. Conclusion and Implication for Practice: Greater social integration of clubhouse members both in and outside the clubhouse environment is essential in understanding community integration. Recommendations for the clubhouse model to improve community integration experiences of its members are discussed.

42. Jones, N., & Jansson Selim, A. (2013). Education – the rainbow at the end of the tunnel. A study of a supported education program in a consumer-operated organization, with a focus on experiences of stigma. Bachelor’s thesis Ersta Skondal University College, Stockholm, Sweden.

Abstract: Experiences of stigma, isolation and discrimination are major barriers to accomplished higher education for people with mental illness. It has been argued that students are not receiving sufficient support to overcome these barriers. This qualitative study explores perceptions and experiences of barriers to education with focus on stigma amongst participants in a Supported Education program. The Supported Education (SEd) program in this study is located in a consumer-operated organization, Genesis Club in Worcester, Massachusetts. The empirical material was collected through a two weeks participant observation in Genesis Club’s Career Development Unit and through six interviews with members of the Clubhouse. The results show that the informants’ experiences of stigmatization have acted as a barrier to education. The SEd program at Genesis Club assists the participants in overcoming barriers. Peer support, role models, empowerment, not using labels, focusing on what you can contribute are all examples of factors that are present in the informants’ narratives about the SEd program at Genesis Club. Earlier research has shown that these are all factors that can counteract self-stigmatization. To problematize the results, the study has been inspired by theories on labeling and stigma.

43. 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. Community Mental Health Journal, 54(8), 1199-1211. https://doi.org/10.1007/s10597-018-0257-5

To explore how member, staff, and family experience the contributions of the clubhouse model to outcomes for adults with severe mental illness. Given the significant role social and vocational arenas play in promoting wellbeing, irrespective of health status, explorations of the role such arenas can play in helping individuals accomplish their life and vocational goals may be useful in guiding policy and practice. A meta-ethnography was conducted using 11 qualitative studies published between 2000 and 2015. Four themes and an overarching metaphor were identified: (1) Stepping out of limiting realities; (2) anchoring; (3) creating ways of flourishing; and (4) prospects of a life outside the clubhouse. “Pushing out the boat” as a metaphor holds promise in facilitating discussions about the subjective outcomes of the clubhouse model and for expanding knowledge about clubhouses as multi-dimensional programs that provide social, educational, and vocational opportunities for adults recovering from mental health problems. Our findings show that clubhouses are valuable communities for meaningful doings for individuals to build self-confidence, relations, and perspective—all crucial for processes of recovery. Clubhouses provide people a place to establish an anchor in a supportive environment where they can try things out and regain their self-confidence. From there, they may choose to push their boat out. However, many members might need to choose not to—the seas may be too rough, or their boat may not yet be strong enough for the journey. Further research is needed to examine members’ experiences with integration into mainstream social networks and employment. It will also be important to examine how practitioners can intentionally interact with Clubhouse members and their families to promote the individuals’ processes of social integration outside the clubhouse.

44. Mutschler, C., Rouse, J., McShane, K., & Habal-Brosek, C. (2018). Developing a realist theory of psychosocial rehabilitation: The Clubhouse Model. BMC Health Services Research, 18:442, 1-12. https://doi.org/10.1186/s12913-018-3265-9

Background: Psychosocial rehabilitation is a service that supports recovery from mental illness by providing opportunities for skill development, self-determination, and social interaction. One type of psychosocial rehabilitation is the Clubhouse model. The purpose of the current project was to create, test, and refine a realist theory of psychosocial rehabilitation at Progress Place, an accredited Clubhouse. Method: Realist evaluation is a theory driven evaluation that uncovers contexts, mechanisms, and outcomes, in order to develop a theory as to how a program works. The current study involved two phases, encompassing four steps: Phase 1 included (1) initial theory development and (2) initial theory refinement; and Phase 2 included (3) theory testing and (4) refinement. Results: The data from this two-phase approach identified three demi-regularities of recovery comprised of specific mechanisms and outcomes: The Restorative demi-regularity, the Reaffirming demi-regularity, and the Re-engaging demi-regularity. The theory derived from these demi-regularities suggests that there are various mechanisms that produce outcomes of recovery from the psychosocial rehabilitation perspective, and as such, it is necessary that programs promote a multifaceted, holistic perspective on recovery. Conclusions: The realist evaluation identified that Progress Place promotes recovery for members. Additional research on the Clubhouse model should be conducted to further validate that the model initiates change and promotes recovery outcomes.

45. Pardi, J., Willis, M. (2018) How Young Adults in London Experience the Clubhouse Model of Mental Health Recovery: A Thematic Analysis. Journal of Psychiatric Rehabilitation and Mental Health, 5(2), 169-182. https://doi.org/10.1007/s40737-018-0124-2

Clubhouses are recovery orientated, participatory communities in which people with mental health diagnoses can take part in the running of the clubhouse. The objective of this research was to produce the first qualitative study of its kind, examining how the clubhouse model of mental health recovery is perceived and experienced by young adults aged 16–25. Five participants provided lengthy and detailed semi-structured interviews regarding their experiences as members of a clubhouse in London. Analysis produced themes including mixed age services as a distinct benefit, the benefits of getting involved in the work of the clubhouse, the mostly positive perception of the clubhouse compared with other mental health services, and the sense of personal change and social improvement experienced on becoming members of the clubhouse. While further research is needed, it was concluded that the clubhouse model was beneficial to all its young members, for reasons including its entirely collaborative and consultative process between staff and members, its humanitarian approach, its lack of rigid or inflexible time limits, and its reciprocal relationships, where members are expected to both provide and receive support.

47. Tanaka, K., Davidson, L., & Craig, T.J. (2018). Sense of clubhouse community belonging and empowerment. International Journal of Social Psychiatry 64(3), 276-285. https://doi.org/10.1177/0020764018759134
Background: People with psychiatric disability have been found to have a poorer quality of life (QOL) compared to the general population, and QOL is an important outcome from psychosocial rehabilitation. Aims: This study aimed at comparing users of two approaches to psychosocial rehabilitation in Sweden, community‐based mental health day centres (DCs) and clubhouses, regarding QOL. A further aim was to investigate predictors of QOL. Methods: People regularly attending DCs (n = 128) or clubhouses (n = 57) completed questionnaires at baseline and a 9‐month follow‐up about socio‐demographics, QOL, self‐esteem, social network, satisfaction with daily occupations, satisfaction with services and the unit’s organisation. Results: Quality of life remained stable over time in both groups. QOL at follow‐up was associated with baseline self‐esteem, social network, satisfaction with daily occupations and QOL at baseline. The strongest indicator of a higher QOL at follow‐up was attending a clubhouse programme followed by having scored high on QOL at baseline. Conclusion: Both approaches were suited for supporting their users in maintaining QOL. Visiting clubhouses seems, however, advantageous for QOL in a longer‐term perspective. Although this study contributed some new knowledge, research should further address which circumstances are associated with maintaining stability in QOL.

48. Torres Stone, R.A., Sabella, K., Lidz, C.W., McKay, C., & Smith, L.M. (2018). The Meaning of Work for Young Adults Diagnosed with Serious Mental Health Conditions. Psychiatric Rehabilitation Journal, 41(4), 290-298. http://dx.doi.org/10.1037/prj0000195

Objective: Despite the increased recognition of the importance of work for social and psychological well-being, the meaning of work for young adults with serious mental health conditions is understudied. This study uses a participatory action research approach to explore the economic, social and psychological significance of work for young adults diagnosed with psychiatric disabilities. Method: We conducted 57 one-hour semi-structured interviews with young adults between the ages of 18 to 30 enrolled in 3 well established vocational support programs. NVivo 8 software was used to sort and systematically organize the interview data. Results: Young adults with psychiatric disabilities work in part for financial independence from their family but also for additional reasons. Work provides the opportunity for social engagement and feelings of contributing to society as a whole. For some young adults, work provides the opportunity to enhance their self-esteem, self-confidence, and a positive self-image. For Latino young adults, work provides a way to cope with their mental illness. Conclusions and Implications for Practice: Our findings provide pertinent information for vocational rehabilitation services, recovery programs, and even parents on the importance of connecting young adults to jobs that enhance self-esteem and self-efficacy and are in line with their personal interests. Future research is needed to understand potential cultural and age differences in the meaning of work.

49. Chen, F., Oh. H. (2017). Building a working community: Staff practices in a clubhouse for people with severe mental illness. Administration and Policy in Mental Health and Mental Health Research, 44, 651-663. https://link.springer.com/article/10.1007/s10488-016-0757-y

The trademark of mental health clubhouses is that members and staff work side-by-side in partnership to enhance members’ autonomy, competency, and recovery. To explore the intricacies of this unique approach, the author conducted 53 in-depth interviews and 262 h of participant observation in 41 visits over a five-month period in a clubhouse. Findings indicated that staff members built the clubhouse as a “working community” by skilfully integrating three practice domains: social relationships, unit work, and individuals’ needs and pursuits. Distinctive skillsets helped to develop genuine relationships with members and facilitate community building, suggesting a model of generalist practice with specific intentionality.

50. Pernice, F.M., Biegel, D.E., Kim, J.-Y., & Conrad-Garrisi, D. (2017). The mediating role of mattering to others in recovery and stigma. Psychiatric Rehabilitation Journal, 40(4), 395-404. http://dx.doi.org/10.1037/prj0000269

Objective: This study examines the role of mattering to others as an intrapersonal construct that may mediate the relationship between social support and 2 separate criterion variables: recovery and internalized stigma associated with living with a serious mental health condition. Adults living with serious mental health disorders, such as schizophrenia, face numerous social challenges that may leave them feeling isolated, stigmatized, and that they do not matter to others, thus thwarting the potential for recovery. Theorists and researchers conceptualize the sense of mattering to others as the perception that 1 is valued, recognized by others along with the feelings that others are concerned about our well-being. Method: Clubhouse members (N = 119) completed 1-hr, in-depth personal interviews assessing perceived social support, experiences of mental health recovery, and stigma associated with living with a mental health condition as well as a sense of mattering to others. Results: Mediation analyses revealed the significant effects of mattering to others as explaining the relationship between social support and recovery as well as the relationship between social support and internalized stigma. Conclusions and Implications for Practice: The findings illuminate our understanding as to how social support interventions can enhance recovery and reduce stigma associated with living with a psychiatric condition by attention to perceptions of whether one is valued and recognized by others. Mattering to others among consumers of social and health care interventions can serve to engage individuals who may withdraw from supports or internalize negative self-stereotypes based on internalized stigma.

51. Roth, G. (2017). Perspectives from Within the Clubhouse: A Qualitative Investigation into a Peer-to-Peer Vocational Support Program for Adults with Serious Mental Illness. Journal of Psychosocial Rehabilitation and Mental Health, 4(1), 5-17. https://doi.org/10.1007/s40737-016-0070-9

Adults with serious mental illness consistently have the highest rate of unemployment of all disability groups and in some regions, the rate exceeds 90%. To redress this, mental health clubhouses offer a unique form of vocational rehabilitation built upon peer support. Through the analysis of 14 interviews of clubhouse members, this phenomenological study provides details of the clubhouse experience and its broad effect. The findings reveal that clubhouse members, despite some situational disappointments, find the clubhouse to be an important and highly beneficial resource that provides a sense of connectedness, along with its aims of vocational rehabilitation.

52. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2016). Employment, community and recovery, lessons from a psychosocial Clubhouse. International Journal of Mental Health Nursing, pp. 46. ISSN 1445-8330.

OBJECTIVE: Employment prospects for people with mental illness in Australia are bleak. Four out of every five adults who live with a psychotic illness are unemployed and mental illness is currently the most commonly cited reason for commencing the disability employment pension. A variety of government reports have highlighted the need for new models of care that can assist people towards mental health recovery and employment. This paper reports findings from PhD research that has explored one such service. The ‘Clubhouse model’ of psychosocial rehabilitation is a consumer centered approach that is popular worldwide. There are currently over 300 Clubhouses operating in more than 30 countries, including 6 in Australia. METHOD: Case study design informed by self-determination theory was used to explore how recovery practices are implemented within an Australian psychosocial Clubhouse. The first stage involved content analysis of data collected during a comprehensive documentation review. The second stage involved 120 hours of participant observation and 18 interviews with staff and members of a Clubhouse, this data was subjected to thematic analysis. FINDINGS: The Clubhouse strongly presents recovery principles such as collaboration, acceptance and participation in its documentation. Themes identified from data collected during participant observation and interviews then suggest the Clubhouse translates recovery principles from its documentation into practice in two main ways. Firstly, it provides a ‘social environment’ that is consistent, participatory and respectful. Secondly, it provides ‘autonomy support’ to members as they work towards recovery, by encouraging self-expression, identifying talents and building confidence. CONCLUSION: The findings of this study highlight that assisting people towards recovery and employment does not necessarily need to be focused on mainstreaming, promoting normalisation and the pursuit of independence. It may also include providing an alternative social environment that supports the autonomy of people with lived experience of mental illness as they naturally pursue their personal recovery journey. The Clubhouse model is an approach with potential to provide insights for mental health nurses as they seek to assist people with lived experience of mental illness, to overcome health and employment disparities.

53. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2016). The use of social environment in a psychosocial clubhouse to facilitate recovery-oriented practice. BJPsych Open, 2(2), 173-178. DOI: https://doi.org/10.1192/bjpo.bp.115.002642

Background: Recovery-oriented language has been widely adopted in mental health policy; however, little is known about how recovery practices are implemented within individual services, such as psychosocial clubhouses. Aims: To explore how recovery practices are implemented in a psychosocial clubhouse. Method: Qualitative case study design informed by self-determination theory was utilised. This included 120 h of participant observation, interviews with 12 clubhouse members and 6 staff members. Field notes and interview transcripts were subject to theoretical thematic analysis. Results: Two overarching themes were identified, each comprising three sub-themes. In this paper, the overarching theme of ‘social environment’ is discussed. It was characterised by the sub-themes, ‘community and consistency’, ‘participation and opportunity’ and ‘respect and autonomy’. Conclusions: Social environment was used to facilitate recovery-oriented practice within the clubhouse. Whether recovery is experienced by clubhouse members in wider society, may well depend on supports and opportunities outside the clubhouse.