Employment, community and recovery, lessons from a psychosocial Clubhouse

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 centred 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.