Toby Raeburn

An overview of the clubhouse model of psychiatric rehabilitation

Objective: The aim of this article is to provide an overview of the clubhouse model and its capacity to assist people with severe mental illness. Method: The paper uses a sample vignette (with all identifying information removed) and survey of literature describing clubhouses over the last 15 years. Results: Strengths of the clubhouse model include its ability to provide a safe environment, supportive relationships and supported employment activities. Criticisms include its failure to provide onsite psychiatry clinics and a risk of promoting service dependence. Conclusions: Modern clubhouses continue to provide useful models of psychiatric rehabilitation which are popular worldwide. Studying and describing the model is challenging due to its complexity. Mixed methodological approaches and recovery-orientated measurement tools may assist future research and development.

Clubhouse model of psychiatric rehabilitation: How is recovery reflected in documentation?

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 behaviour within organizations. The findings can also be used to inform future research related to recovery-oriented practices in clubhouse settings.

Leading a Recovery-oriented Social Enterprise

Recovery-oriented mental health services promote the principles of recovery, such as hope and optimism, and are characterized by a personalized approach to developing consumer self-determination. Nurse leaders are increasingly developing such services as social enterprises, but there is limited research on the leadership of these programs. Leading a recovery-oriented mental health nurse social enterprise requires visionary leadership, collaboration with consumers and local health providers, financial viability, and commitment to recovery-focused practice. This article describes the framework of an Australian mental health nursing social enterprise, including the service attributes and leadership lessons that have been learned from developing program sustainability.

Self-determination theory: A framework for clubhouse psychosocial rehabilitation research

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.

Autonomy support and recovery practice at a psychosocial clubhouse

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.

The use of social environment in a psychosocial clubhouse to facilitate recovery-oriented practice

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. Declaration of interests None. Copyright and usage

Life of Martha Entwistle: Australia's first convict mental health nurse

The present position paper provides an account of the life of Martha Entwistle, the earliest recorded convict nurse who worked within the Castle Hill Asylum. In our review of primary historical sources, Australias first convict mental health nurse was found to be a resilient woman who endured several traumatic life experiences. Her nursing within Australias first mental health asylum was highly valued by the superintendent of the service. She nursed in a harsh colonial environment, short of adequate resources, during an era of fast-paced industrial and technological a change. Martha Entwistles experiences provide a historical account of the role of the early convict mental health nurse. Her life story enables modern-day nurses to reflect on the advances made in mental health nursing and contexts of care for nurses today.

Supporting recovery from hoarding and squalor: Insights from a community case study

People with hoarding behaviours acquire a large number of possessions that are often of limited or no monetary value and which they are unable or unwilling to discard. Such behaviours can substantially impair a persons ability to attend to their normal daily activities, cause substantial distress and lead to squalid living conditions. Living in squalor can compromise a persons health and safety, be a public health issue and present substantial challenges to family, carers, social service agencies and clinical mental health services. Hoarding and squalor behaviours are more common among people with co-morbid organic and mental illness, such as developmental delay, schizophrenia, alcohol dependence and/or obsessive-compulsive disorder. This paper provides a narrative that explores the role of one Australian mental health nurse practitioner in the recovery of a person with hoarding behaviours.

'Slipping through the Cracks': Mental Health and Recovery in Older Person Care

Mental health and well-being are important across the lifespan and impacted by biological, psychological and social factors (World Health Organization, 2016). In developed countries worldwide ageing populations are the fastest growing, bringing with them increasing prevalence of chronic illness, including mental health disorders (Holroyd-Leduc et al., 2016; Moyle, Parker, & Bramble, 2014). An increasingly common approach to mental health service delivery is recovery-oriented care (Sklar, Groessl, O’Connell, Davidson, & Aarons, 2013). Developed in response to advocacy by working aged adults with a lived experience of mental illness, recovery-oriented approaches suggest that mental health recovery is a personal developmental journey towards a satisfying and meaningful life. Whilst there is no single definition of recovery, common principles include hope, self-determination, self-management, empowerment and advocacy (Slade et al., 2015). Whether or not current approaches to recovery-oriented care are entirely transferable to services that deliver care to people who experience mental ill health in older age, or whether some principles may need to be adapted, is unclear. This column provides an overview of risk factors influencing mental health well-being in older adults and advocates for the development of recovery frameworks and interventions that support people who experience mental ill health in older age. Individually and collectively, multiple factors influence the health and well-being of older adults whilst increased longevity compounds the likelihood of mental distress in older age. Chronic illness is not uncommon amongst older adults and frequently associated with disability (Hung, Ross, Boockvar, & Siu, 2012). In Australia for example, people aged 65 years and over live with two or three chronic conditions and associated disability, and those living beyond 85 years are increasingly likely to also be affected by disability (Australian Institute of Health and Welfare, 2014). Chronic illness, disability, alcohol and substance abuse are risk factors to the mental health of older adults (World Health Organization, 2016). Pain, limited mobility, and frailty arising from these health issues influence the independence of older adults, and may cause anxiety, social isolation and feelings of hopelessness and helplessness. Other contributing factors may include financial stress, bereavement, and changes in socio-economic status (World Health Organization, 2016). Loss of past roles, loss of friendships and the impact of increasing reliance on carers, along with the potential impact of elder abuse, (occurring in one in 10 people aged sixty years and over and

Issues in Mental Health Nursing

A secret involves the intentional and deliberate concealment of information from a person and consists of information that individuals actively and consciously withhold from at least one other individual (Frijns & Finkenauer, 2009; Kelly & Yuan, 2009). By sharing information the notion of a confidant is implied, the information is confidential and should be held between those involved – be it two or sometimes more people (Frijns & Finkenauer, 2009). Concealment of information is part of everyday life and may involve family, friends, peers, and colleagues. Secrecy occurs in public and private situations including the workplace (Rappert, 2010). Critically, the way in which secrets or information is held and used impacts the individuals sharing the secret as well as others the secret may be about (such as a perpetrator of abuse), involve (a peer, colleague or manager, or a client) or impact (family, friends, relationships, the workplace or organization) (Rappert, 2010). This column reflects on the nature of secrets, and the reasons for keeping a secret. One type of secret is called an open secret. This is defined “as unarticulated knowledge that everybody who is party of a transaction knows about but that no one discusses in a direct way” (Ledeneva, 2011, p. 725). This is what we may colloquially refer to as “the elephant in the room” – where we may perceive there is no secret because everyone knows what the information is but it is not discussed openly. However, adopting this view may be problematic as not everyone may have privilege to all of the information/the big picture or the ramifications of the information at different levels (Ledeneva, 2011). Open secrets are not necessarily disclosed in official contexts but are considered “open” because insiders have knowledge of them whereas outsiders may (or may not) need to be made aware of them (Ledeneva, 2011). Open secrets can be problematic as the secret holders try to maintain a degree of containment as they know that full public disclosure could be harmful to those or the organization they are endeavoring to shield. This can also be problematic when balancing organizational or situational formalities and informal practices (Ledeneva, 2011).