In the beginning of July, I was afforded the opportunity to travel to Lisbon, Portugal with Dr. Ralph Aquila and Alan Doyle, Fountain House’s Director of Education. The three of us, along with Dr. Juan Pedro Sapene of Argentina and Bertil Hartoch, a social psychiatric nurse from Holland, presented at the 21st World Congress of Social Psychiatry. The aim of our presentation was to share with mental health providers from all over the world the Fountain House model of recovery as it is now linked with integrative care and the Sidney Baer Jr. Center.
It was truly an amazing experience. I have never travelled very far from New York City. Everything was new for me: international airports, passports security screening, currency exchange, and simply being a foreigner in a European country. I believe that there is a lot of similarity between the states of anxiety and excitement; at times, I felt both.
Dr. Aquila and I flew out together from Newark airport on Sunday night June 29, 2013. We arrived in Lisbon on Sunday morning at around 10:00 AM. I can now sympathize with frequent travelers—jet lag is a really weird feeling. It’s like having a massive hangover minus the headache. Somehow, I managed to attend a couple of presentations by other participants on the same day that we arrived. What I learned was truly an eye opener for me.
What we do here at Fountain House is really cutting edge. It became obvious to me that mental health care in other countries, including “first world” nations, leaves much to be desired. Most mental health care providers still seem to be at a point of just trying to reach and provide basic psychiatric care to those in need within their respective populations; the critical issues of rehabilitation, recovery, integration, and healing into wholeness are barely addressed. It truly gave me a much deeper and profound appreciation towards our Fountain House community.
Our panel presented on Tuesday morning, July 2, 2013. We spoke at the University of Lisbon in a huge auditorium that seemed like it could seat 1000 people. I counted about 100 or so audience members. Each of us took turns and shared to the best of our ability various aspects of the Fountain House model. As everyone in our community knows, it’s hard to qualify and quantify exactly what occurs within our doors—so much is nuance here. What I tried to share was the fact that members here at Fountain House have the opportunity to define their own recovery as they discover and actualize their own innate talents. Consumers in many other countries are simply considered patients. The pursuit of self-realization and actualization is not even approached.
I have been a member of Fountain House for some time; I became a member in 1996. However, representing Fountain House members on this trip to Lisbon was a first for me. I learned so much about myself as a consumer in recovery, as well as the deep and genuine dedication our professional facilitators have toward us.
In recent years, the Wellness, Culinary, and Horticulture Units have been working together to introduce healthier food into our community. In addition to growing our own food at Fountain House and at High Point Farm, staff and members of the Wellness Unit explored ways we could benefit from the greenmarkets throughout the city, perhaps by van trips to the markets. Instead, an even better way for members and staff to enjoy fresh, local produce was devised. The greenmarkets came to us in the name of GrowNYC.
Fountain House purchases each week a variety of bushels of fresh produce. Interested members and staff purchase a burlap Fountain House Wellness Market bag and fill it with either a $4 selection of produce or a $7 selection of produce. As an added convenience, simple recipes for cooking the vegetables are available. The Wellness Market opened for business at the beginning of June and consistently sells to more than 50 customers each week.
The first week I shopped I forgot to get the recipes. I didn’t recognize the gourmet salad lettuce, and I steamed it. Actually, it was pretty good steamed, but now I get the recipes. This past week I cooked Swiss chard. It was the first time I tried this vegetable, and it was delicious. I also made peas on the pod with a spring onion. I understand next week we are getting heritage colored carrots and strawberries.
Not only is this food very economical but many members like me eat too much of the wrong food. GrowNYC food is diverse and encourages us to eat healthy. It is available every Tuesday from 2 to 4 PM in the Wellness Unit.
Vivian Palazzolo Reception Unit and Board of Directors, Fountain House
What do we do about Olivia? Olivia is a 50-year old African-American woman who has schizophrenia, a Fountain House member who is currently homeless. She also has an assisted outpatient treatment (AOT) order which legally mandates her to take her medication and go to treatment. And yet, two days ago, Olivia was sitting on a nearby stoop on 47th Street with thirty bags of stuff spread out over all the stairs, talking to the voices in her head, ignoring any entreaties from passers-by.
It’s disheartening, because we have seen her be so much better.
We’ve spoken to her psychiatrist, but she doesn’t really have an answer except to tell us to call 911. We have called 911 many times in the past, and Olivia has gone to the hospital many times in the past – at least three times this year alone. When she enters the hospital, they help stabilize her medicine, but they only keep her for a short time. When they release her, she is once again on the street. She is lost to her intensive case manager because she has no phone and no address.
The face of healthcare, especially mental healthcare, is changing. Many of the new integrated care scenarios rely on computer tracking systems to manage cases and coordinate service delivery. However, these solutions will not work for someone like Olivia. Computer systems can neither develop relationships nor attract people to them.
Even though her illness doesn’t allow Olivia to trust anyone right now, she continues to show up on 47th Street because she has friends at Fountain House. When we see her, we try to reengage her into our working community as the first step toward getting her to slow down, take her medicine, and find a place to live. Ultimately that’s what will reach Olivia: one good, solid relationship with a worker or member of Fountain House who will take the time to convince her to do what needs to be done. And she’ll do it because, even through the haze of her illness, she trusts that person.
A few weeks ago, I had just walked into the education unit after taking a final. I was tired and just wanted to eat my lunch when Susan walked over and asked if I could help out with something. I replied, “What does it entail?” She said that the Massachusetts Clubhouse Coalition Conference was coming up. The plan was for Bevin, Betty, and I to talk about the educational supports offered at Fountain House; we would be leaving on Wednesday afternoon and returning on Thursday evening. Being that I’m taking an online class and can do the work from anywhere – and that I’m feeling underwhelmed by the work load - I agreed, and we began preparing for our discussion.
The three of us (Betty, Bevin, and I) sat down to develop an outline for our presentation, which included topics such as relationships with universities and other educational institutions in the city, in-house programs (tutoring, student gatherings, scholarship programs, etc.), and the unit community being a support for potential and current students. We also talked about incorporating our own experience(s) with education into the presentation, which would give it a more personal touch. Additionally, we were paired with Forum House (a small clubhouse in Massachusetts) and worked together to prepare a cohesive presentation.
With our agenda set, we made the long trek up north to Nichols College and prepared for a day chock-full of learning and networking. The morning kicked off with a plenary that included clubhouse as evidence-based practice, the new clubhouse contract, employment, and two members recounting their clubhouse experiences and how it contributed to recovery. There were some influential people in attendance, such as the Commissioner of the Massachusetts Department of Mental Health.
Following the plenary, the three of us divided into different workshops; there were six to choose from, and I attended “Transitional Age Young Adults & Clubhouses,” which was facilitated by members and staff from Genesis Club. I was very familiar with the topic, as I have been part of the young adult coalition (formerly known as Crossroads), and it was nice to see old friends and learn about young adult issues that other clubhouses face. It was basically a round-table discussion that featured topics such as improving reach-out, meaningful work for young adults, effective outreach and social media, differentiating between young adults’ and older members’ needs, and how to motivate young adults.
Bevin went to a Health and Wellness workshop that touched upon the new guidelines of the Massachusetts Wellness Clubhouse contract. Representatives from Tradewinds Clubhouse presented on ways they made meals healthier while staying within their budget. They also talked about how they incorporated wellness and exercise into their everyday culture of the clubhouse. Many small clubhouses don’t have the luxury of having an actual Wellness Unit like we do here, so it was interesting to see the creative ways that units incorporate healthy living into everyday activities. There also was a presentation about a Dual Recovery twelve step program that was heartwarming and very motivating from Crossroads Clubhouse.
I attended a workshop on peer support within the clubhouse. There I learned that the Massachusetts Clubhouses have had to track each outreach call to members meticulously, but it has left them with unintended positive consequences along with the added time and paperwork. The old system was to make reach out calls and write down who you talked to. Now there is a script about what is going on in the house for the week if you reach the member, a script for what kind of message to leave on an answering machine, and one for what to say if a person who is not the member answers. The tracking system allows input on how the call went, if the person expresses the need for additional help, and if they want to sign up for any activities for the week.
Then the talk moved on to Peer Support. Like our UNITY Project, some of the clubhouses in MA have implemented a system to train members to be Peer Support Specialists and help prospective members to navigate the mental health and wellness systems including welfare, social security, education, job searches, doctor visits, benefits, and more. The system works well because learning from our peers is learning from someone who has been through it. This is a system I believe New York City and State are going to pilot and pay for through insurances, and I hope Fountain House jumps on the bandwagon to get as many paid peer support people coming from our organization as possible!
During our presentation we not only told the group about all of our amazing educational resources, but we also learned about theirs. Some of the things I was interested to learn more about were the use of computer training software and guides to teach people Microsoft Office, Graphic Design, Computer Networking and Computer Literacy. Learning disabilities were brought to the forefront as well as cognitive decline due to mental illness and medication. These are remedied by hooking members up with organizations that work to limit disabilities and by offering Cognitive Remediation Computer software for use. Job training along with educational training was mentioned as being integral in some of the clubhouse work order days. I believe we’ve been given a great opportunity to learn from younger clubhouses in how they have dealt with the economy, changing governmental involvement, and implementing innovative ideas that maybe a larger clubhouse doesn’t always think about due to our size.
Just one last thing, I had a wonderful time representing Fountain House and I want to thank all of the people who made that happen.
Melissa Hollander, Bevin Reilly, and Betty Spindelman Education Unit, Fountain House
Clubhouse Europe, in concert with Fountain House New York, Fountain House Stockholm, and Ersta Skondal Hogskola announces the Second International Symposium on clubhouse research scheduled for August 8 and 9, 2013 in Stockholm Sweden. The Symposium continues the work of the initial gathering in June 2010 sponsored at Fountain House New York that resulted in the publication of an international journal on the practice of mutual aid in clubhouse communities (International Journal of Self Help and Self Care, Volume 7, Number 1 / 2013). The August Symposium will provide an opportunity for those involved in clubhouse-related research to meet and share the results of their inquirieswith clubhouse practitioners.
Presentations by international researchers on the course of their field studies will include the following:
Thomas Craig, MD (UK), TBA
Bjorn-Anders Larsson (Sweden), TBA
Magnus Karlsson, PhD (Sweden), "Developing the Clubhouse Model - Some Findings from the Past"
Rosario Larata, PhD (Japan/Italy), "An Examination of the Structures of Governance within Clubhouses in Japan, UK, and Italy."
Outi Hietala, PhD (Finland), "Fluid Orientations and Multiple Meanings - Three Complimentary Modes of Membership at Clubhouse"
Esko Hanninen, Chair of EPCD Research Committee, "Choice for Recovery"
Kimiko Tanaka, PhD (USA), "Clubhouse Culture and Psychiatric Recovery"
Yoshiko Boregren Matsui, PhD (Sweden), TBA
Frank Wang, PhD (Taiwan), TBA
The Symposium intends to publish a compendium of presentations and a selected bibliography of related research.
The Symposium will be hosted by Ersta Skondal Hogskola with accomodations on their campus located outside Stockholm, Sweden. Participants (excluding presenters) will be charged a nominal fee to cover costs for meals and operational support. Accomodations are limited and participants are encouraged to register their interest in attending with Bjorn Asplund.