The People's Perspective on Medicine

Show 1069: What Is the Clubhouse Model for People with Mental Illness?

In the clubhouse model, people with mental illness can support each other while doing meaningful work and living more normal lives.
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What Is the Clubhouse Model for People with Mental Illness?

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The treatment of mental illness has a discouraging history in this country. Even in the 21st century, psychiatrists rely principally on antipsychotic medications without much else in the way of support. These drugs have serious side effects, and although they are helpful for those who truly need them, they are too often prescribed inappropriately.

Finding Community Support:

There is another approach that can complement antipsychotic drugs. When people with mental illness are invited to participate in a community as equal partners and given the support they need to do so, the results can be encouraging. Find out about the clubhouse model of caring for those with mental illness and why it works so well.

The photo is of Club Nova clubhouse members, Carrboro, NC.

This Week’s Guests:

Allen Frances, MD, is a professor emeritus at Duke University School of Medicine where he previously chaired the department of psychiatry. Dr. Frances chaired the task force that created the DSM IV manual for psychiatric diagnoses. He is author of Saving Normal: An Insider’s Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life.

Matthew Cox is a clubhouse member at Club Nova in Carrboro, NC. He serves on the board of directors there and is on the faculty for clubhouse development with Clubhouse International.

Ralph Aquila, MD, is the medical director for Fountain House, the original clubhouse located in New York City. He is the executive director of the Center for Reintegration.

Pauline Nichols was formerly clubhouse director for the state of Pennsylvania. She was director of development for Clubhouse International for ten years. Currently she is the CEO of Nichols Global and Associates.

Websites are, Club Nova and To reach Pauline Nichols, find her on Facebook or LinkedIn.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I would like to know anything you have to offer on bipolar mental disorder.

My grandmother only went to the 6th grade but she had a good job during The Great Depression. She was a cook in a mental hospital. They made over 800 meals a day for all the patients and staff.

In the early 70’s,they tore that mental hospital down and my grandmother who had long since been retired asked “I wonder what they will do with all those people?”. Today, I often wonder that myself.

I am considered to be Bi-Polar. I was born with a chemical imbalance, among other birth defects, as my mother took DES back in the 1950’s to prevent miscarriages. I have had, so far, 17 major surgeries since I was 23 and need 2 more that I know of. I have been on antidepressants and anxiety medications since I was 13, and probably will be for the rest of my life. I am over 60 now.

My problem is this. Every time I get a good psychiatrist, within the first 4-7 years they decide to retire. I do so well with them, they have my medications set to keep me on an even keel and I don’t have trouble with my blood pressure or anything else. So I get put in with another doctor in the same practice (I had no choice of the doctor) and she promptly goes about changing my medications. I insist that I am doing well and have been on them.

They say “well here is something new/different we want you to try…” and then I start with the extremely high blood pressure, being stressed completely, my blood sugar is off and everything changes for the worst… Why can’t these doctors, who don’t know me, try to get to know me instead of immediately switching my medications.? I’m in that process again now, and it’s no fun having to find a new doctor, with that being the only practice in my town… Now I will have to drive 30+ miles to the next big town just to see a good one just to get my medications straightened out again.

This is not an easy task, as it took me seeing 5 people before I found my doctor that just retired 6 months ago… I hope when I go out of town to find a new doctor they won’tdo the sane thing… I will post again with an update on what I find… Thank you for your time… God bless… with many thanks to the Graedons and love to my family and friends…

Ones mental health has nothing to do with prescribing medications unless the patient wants to be dumbed down and all that does is put the sufferer into a cyclic existence with no end. I volunteered with mental health for many years after my now x wife was diagnosed being by- polar.

First off no one will come right out and admit they have an issue and if you question their reality they will lash out in a rage. Yes a person can heal themselves but first and foremost they have to admit they have a problem its like a gay person coming out of the closet and seeing the light. These people need validation but unfortunately if you validate their ever thought and action soon you to will be suffering as they can suck the life right out of you and everyone else around you which is especially damaging to interpersonal relationships! Drugs certainly are not the answer because in many cases it was drugs that caused the chemical imbalances in their heads

One thing you or the sufferer can not be or do is become codependent as then you have two people who are questioning their own reality. The only way to mitigate the damage and still stay together is communication and with out that run for the hills and take the children with you. One has to have empathy toward the patients due to the fact that most if not all mental health issues have there etiology in fear and for many that is the fear of the unknown the worst fear of all.

Having the opportunity to work at a club house I saw many good things for people with mental illness.
Meds are needed but with the clubhouse as a part of therapy has help decreased use of so much meds and visits to mental facility

I encourage open communication and programs that use integrative means toward healing.

I’ve worked in the WA mental health system for some 30 years. A lot of that involved the “clubhouse model,” also known as “day treatment.” While the groups offered (if they were offered) might’ve been beneficial, most of the time the patients just sat around, nodding off or watching bad TV that you couldn’t hear anyway because of the small but reliable subset of patients who were always loud, arguing with their voices or other patients, out of control, etc. Other patients would just waft about, forlornly walking the hallways for hours.

The ABSOLUTE WORST THING about today’s mental health treatment? It’s something I call “HABITUATION TO STIMULUS,” and it affects the caregivers, not the patients. Most of these workers have been there for years. They’ve seen just about every tragic, heartbreaking, complicated, frustrating situation there is. After awhile, they seem UNABLE and UNWILLING to deal with patients in an energetic, creative, dedicated manner.

There’s the “Mandate for Care” on the wall for all to see (especially visiting loved ones), talking about how dedicated they are to teaching the little bird how to fly on his own, so he can leave the nest strong and make a good life (etc., etc., blah blah…). In point of fact, the great majority of the staff sit around gossiping and socializing in the nurses’ quarters or staff offices. They interact with patients only long enough to get charting material (often flippantly called “mining”) so they can chart adequately and discuss the patient’s situation with other caregivers, sounding “informed” and professional. They RARELY sit down and counsel with patients, giving them helpful new information to help them understand and gain more control over their disorder. Sometimes they sit and watch TV with patients, doing small-talk. Staff interactions rarely IMPART new information to the patient; rather, they EXTRACT information that the patient already knows, in order to make the STAFF look good. The patients do get 1:1 time with the MDs and RNs, but this is very quick and just covers stuff like meds, “How’re ya sleeping”?, “Didja eat lunch today”?, etc. This describes every workplace I’ve worked at. And I’ve worked at some of the “very best” and most respected treatment facilities in the city of Seattle.

Believe me, I’m telling the truth. I’m not exaggerating, more like the opposite. It is heartbreaking that caregivers throw meds at patients, citing their continuing symptoms, when OF COURSE the symptoms continue, because patients aren’t getting pertinent counseling or education! In these days of increasing mental health problems (and related criminal behavior) in the population, this situation is heartbreaking. Mental health treatment could be made SO MUCH MORE EFFECTIVE and successful with no significant increase in funding if not for this “habituation to stimulus” so prevalent in caregiving staff. I’ve fought against this as much as I can. But I’m no big-wig, and “rocking the boat” is tantamount to suicide in the mental health system. You just don’t do it if you want to keep your job and your standing with “peers.” (sigh.) Thank you.

Thank you Cindy, I appreciated all that you wrote. You are an
Extremely longtime worker in this area. I hope there are ‘some
People’ of ‘authority’ whowill read this and step up to ‘change the things that could be changed’ to truly be helping the patients!

I would like to share some information about the treatment my son is receiving for schizophrenia. He is on anti-psychotic medications but is also working with a Naturopathic doctor who uses homeopathy to treat mental illness. We have seen good results, and his medications have been cut in half.

Like so much this programs.
Thank you.

Clubhouse is an outdated model of treatment. It is segregating, stigmatizing and not a best practice in 2017!
Even the VA has embraced Recovery using natural supports in the larger community, individualized goal setting and most importantly, based on personal strengths.


I have not read your book and hope to soon. I had been on various antidepressants for over 30 years and can tell you from my experience they caused more harm than good.

Going many Psychiatrists over this time I have learned more than any Physician that may have numerous degrees behind their belt.

You go to a Psychiatrist for approximately 15 minutes. Get a label and get a drug. and that drug does not work. So on and so on. You go back and get another drug, maybe another label. You do not get better, but far worse and attempt suicide several times.

As a culture back on overuse of Pharmaceutical Drugs we much seek a better solution because the drug companies and doctors are benefiting on our behalf and doing considerable harm.

I agree that the Clubhouse Motel could be a great approach to this rising dilemma.

I too, was diagnosed and medicated for 30 years; hospitalized several times w/ inhuman treatment & shock treatments. Psychiatrists never took time to examine THE CAUSE or what may have triggered it. They actually released me back into the abusive family that caused and perpetuated my condition.

So-called professionals and rich pharmaceutical companies who controlled my life were the only ones who benefited.

My body AND mind was OVER-FUNCTIONING. NO proper healthcare was offered (supplements to build immune system while on the damaging meds), and NO alternative means of expression that might help speed up the healing process. At the time, there were no programs as there are today.

Twenty years ago I tapered off meds, and wrote my memoirs, but as a short, comic/graphic parable encouraging open communication between parents & children BEFORE unhealthy situations or medication rules their life. (Little Rose Lost and Found). I hope others will gain from my experiences. From hopeless to hope.

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