Social Support + Purpose = A New Mental Healthcare
The most intractable, progressive, disabling, and deadly of mental health conditions are not treated most effectively in locked facilities or medical institutions. While hospitalization or medical intervention may sometimes be utilized at the outset to stabilize an acute crisis, ongoing care and prevention from further crisis, as well as the catalyst for a full, productive, and joyous life comes through social and community supports. These are free, they are available to all who suffer with these illnesses, and they are available for a lifetime. As a member myself in 12 step recovery, and as someone who has worked closely with Clubhouses, I can not help but be intrigued by the similarities, and wonder whether there is something here that can and should be more widely adopted. If these core elements can have such a striking impact on turning around the lives of what some would call the most hopeless cases, what effect might it have on those with less severe forms of mental illness, and is there a hidden opportunity here to solve our growing mental health crisis?
There are countless examples of people who struggled with intractable anxiety, depression and low self-esteem; years prior to meeting criteria for alcoholism. These comorbid diagnoses pre-dated the drinking, and thus were not secondary, but perhaps primary diagnoses that were not responsive to treatments that included everything from medications, to EMDR, to talk therapy, and CBT. Yet, these individuals have discovered remission from these symptoms in alcoholics anonymous. AA not only led to sobriety, but treatment for otherwise treatment resistant anxiety and depression.
There are a few core elements in both models that are indispensable, and yet not incorporated in traditional mental health settings.
Volunteerism
While volunteerism is not required in either model, it is highly encouraged and is often communicated as a core component for effective recovery. There is research that demonstrates the healing nature of volunteerism. According to a study from United Health Group, volunteers are significantly more likely to feel they have greater control over their health and well-being. Other studies have shown a link between being of service and improved health outcomes, as well as decreased anxiety in youth. Fountainhouse, the signature Clubhouse website outlines it perfectly: “Working together in a community promotes a feeling of shared achievement. The work allows members to try out different roles and identities, while also forming a variety of community connections (both professional and non-professional) and long-lasting social relationships and friendships.” Clubhouse members join committees, participated in a work-ordered day. Likewise, members of AA take service commitments to remain accountable to the group, to create structure, and to have a sense of purpose outside of oneself. The medicine in both models is not a pill, but giving to someone else.
No Leadership
Both communities are self-run, allowing each member to feel valued; everyone has a sense of ownership, a sense of pride, and thus also a sense of belonging and respect for the community and one another. There is very much a sense of togetherness, and that that network and bond must be maintained for the community to continue. There is also an implicit moral and ethical obligation to fellow members, to “give back what was freely given to me”; there is a mutuality in which the fellow members need one another in order to thrive, and hence there is a protective element to the overall community, with each member feeling responsible for helping it to thrive, lest they lose the benefits they have reaped themselves. The message is: we’re only as strong as the collective whole.
Continuous
These are lifelong memberships, and it is instilled in every member that in order to remain well, you must continue to participate. Care doesn’t stop just because you are better. In fact, AA says you can’t keep your sobriety, peace, or serenity unless you continue to show up–both for yourself, and for others. Clubhouse and AA members are both tasked with reaching out to those who have slipped away, creating a social safety net.
This is very different from traditional mental health services, in which treatment occurs during illness only, or when there is a problem. Further, therapy is designed to conclude at the point in which the problems have resolved. This gives an individual no safety net. In AA, members are taught that if you do not remain “in the herd” (closely connected with others in recovery), you will have no “defense against the first drink”. And time and again, you see people as examples who slip away from the program, who get better then go back to their normal life. More often than not, they return, more beat up than before. Or they go on living, but are not able to hold on to the peace and serenity they felt when they were immersed. These become cautionary tales.
You show up for you, you show up to maintain, you show up when times are good, you show up when times are bad, and first and foremost, you show up for others more so than you show up for you, to “carry the message”, to teach those who are new or returning about the hope that can lie ahead, to show others that this is available to them, too, to give a kind word, a hug, and also to be reminded for oneself about what it was like at the beginning, so that you reinforce that continuing to come will prevent you from ever feeling like that again.
There are hundreds of Clubhouses worldwide, and millions of members in AA. When you compare these models with traditional care, the success rates are phenomenal, and the costs are minimal. And it is important to note that these are illnesses that a) tell people they don’t have an illness, and b) are chronic, pervasive, progressive, and debilitating. Again, it begs the question about how such models would impact those with insight, those who are motivated, and those who desperately need a sense of purpose and belonging (which is 70% of people).
Building communities of healing, baking in these elements, seems like a no brainer. 4C is tackling this head on.
