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.
What has largely been missing, though, is an intervention to help these young people get back on track - that is, a means of successful social rehabilitation. Often, they are forced to interrupt their education, they lose their social networks, and they’re faced with the fear of being diagnosed with a mental illness and living with the stigma it carries. It’s easy for these young people to become discouraged, hopeless, and isolated. Fountain House has been at the forefront of innovative community mental health initiatives for 65 years, so it was only natural that we would try to address this pressing need.
Young adults experiencing mental illness for the first time have many obstacles to overcome in seeking support from traditional mental health programs. First, they often lack needed benefits to afford effective mental health care. Second, young people frequently receive incorrect and/or multiple diagnoses, so they may not even be eligible to participate in programs designed to help people with mental illness. Adolescence is a transitional period, and it can be difficult to tease out an emerging illness from other behavioral or adjustment problems. Lastly, they are often isolated and ashamed of their illness, so reaching out for help becomes very difficult.
The new UNITY Project (Understanding, Networking and Integrating Transitional Youth) was created to reach out to these young adults and help them connect to resources and support to continue on to achieve their goals. We made it a point to lower the threshold to admittance so young adults could easily and quickly start to receive much-needed support. We don’t use a complex and lengthy intake process; the on-line application is so simple that young adults can fill it out themselves in 30 seconds. Rolling admission allows applicants to start the program within a few days of filling out the application, thus getting them connected before they change their mind or get discouraged. Fountain House funds the project entirely, so participants don’t need to have any health insurance to join the free program.
We also know that lengthy programs don’t work for young adults, who are eager to move on with their lives as soon as possible; thus the UNITY Project is only eight weeks long. A lot can be accomplished in this short but intense timeframe. The goal is to connect every participant to a support system that can be accessed throughout recovery. For some, this might be membership to a program like Fountain House; for others it might be getting back to school and enrolling with the mental health services provided on campus; while other people might be best served by finding a suitable mental health residential program. The goals are generated by the participants with an eye on realistic, short-term interventions that can have lasting results.
For example, one young woman, “Isabella,” 19, came to UNITY through her foster care residence. She wasn’t receiving proper treatment because she had been given several different diagnoses in her mid- teens, due to a substance abuse problem at that time. Additionally, she wanted to go to college, but she only had an IEP diploma - a diploma that’s granted in a variety of special-needs situations but isn’t recognized by colleges and universities. We connected her to good clinical care at The Sidney Baer Center, where she was diagnosed with schizophrenia and prescribed medication that alleviated her psychiatric symptoms. We also referred her to an alternative high school so that she could complete the coursework she was lacking for college admittance. At a recent UNITY reunion, she told us that she would finish high school in June and that she has already been accepted as a freshman at LaGuardia Community College for the fall.
UNITY is unique in that it’s a hybrid of professional mental health services and peer support. Participants have ready access to trained social workers and clinical services from psychiatrists. Participants are also assigned peer-mentors—young people who have successfully managed their own mental illness. These peers meet weekly with participants to provide support, inspiration, and guidance through the entire eight-week program.
UNITY is not only one-on-one support; it creates a social network for the participants. By socializing, cooking, and eating dinner together before meeting with their mentors or social workers, they can build friendships with people who understand and face the same challenges. During their eight weeks with UNITY, they work to reach their goals, become integrated into a social and understanding community, and connect to the supports they will need to further their recovery and life’s ambitions.
More than 300 programs around the world have been modeled on Fountain House’s unique clubhouse approach, 195 of them located in the United States. We envision that, as awareness of the UNITY Project grows, these organizations will develop similar initiatives to help young adults more easily access the support they need to build healthy, productive lives.
Despite the rainy morning, thousands of participants turned out at the South Street Seaport on Saturday, May 11, 2013 to help the National Alliance on Mental Illness (NAMI) raise money and awareness for mental illness and fight stigma by joining in their annual walk.
Each month the Education Unit hosts a monthly student gathering, which is a time for current and future students to come together and offer support to each other. We discuss topics such as using the resources in college accessibility offices, time management, and how to overcome the anxiety of talking to professors; a common theme is advocacy. How can you empower yourself to get what you need?
While we were in the brainstorming/planning phase of the gathering, I brought up an idea that piqued people’s interest: how to write an academic paper. I thought that it would be helpful, as quite a few members are in college or aspire to attend in the future. I got the “go-ahead” and started working on creating a PowerPoint presentation, which involved several components.
First, I discussed the importance of getting specific directions for the assignment. The professor might give you a handout about the assignment, but more than likely the information will be found in the syllabus. A syllabus is basically a guide to the class, which lists the professor’s office hours, grading policies, and the class schedule/assignment due dates; you might also see “syllabus subject to change” towards the end of the document. This is because there might be a snowstorm, other natural disaster, or a day when the professor can’t be in class. As a result, assignment due dates might be pushed back, but always be prepared. By the time that you’re a junior or senior in college, the phrase “I didn’t know” uttered by some students will guarantee a professor’s response of “Not my problem.” Some professors will be nice and include a grading rubric along with the paper’s directions found on the syllabus; this will break down evaluation into different categories.
I also discussed how the library can assist you in the paper-writing process. At my school, the library staff regularly holds workshops on Modern Language Association (MLA) and American Psychological Association (APA) citations, give tutorials on accessing databases that contain scholarly journal articles, and help students navigate various resources. To expand a little on MLA and APA citations, there are specific academic fields for the two categories; for English and humanities courses, MLA is the preferred method for referencing your sources. Conversely, if you’re attending a college that focuses on math or natural and social sciences, you will be using the “gold standard” known as APA.
Following this brief overview, I turned to the serious matter of plagiarism. Many times, college students think that they can “get over” on their professors and just slip somebody else’s words into a paper - and they couldn’t be more wrong. From what I understand, some colleges subscribe to websites such as Safe Assign and turnitin.com, and if a professor suspects that their students’ work might not be genuine, they can view statistics that indicate the likelihood of a student “copying-and-pasting” their work. This means that the student will have stolen other work and claimed it as his or her own. I understand that college is stressful and the temptation to “borrow” other sources may sound appealing, but a remark from a past professor always comes to mind: “I would rather have something genuine and a little late than a product that is thrown together at the last minute.” If you have to take an extension, then talk with your professor and express your concerns. More often than not, you’ll find that professors are human and will work with you to ensure the best possible outcome.
Overall, I thought that it was a successful gathering. Hopefully people can apply this advice to their current and future goals.