In her comments regarding the recent two-day symposium, “Partners for Wellness,” held at Fountain House (June 2012), Lori D’Angelo, Executive Director of Magnolia House, stated: “We hope to reverse the current tragic tide for those who live with mental illness and ensure that our members do not have lives that are 25 years shorter than others.”
We at TandC Associates were struck by the significance of that remark particularly as it relates to the emerging partnership efforts by clubhouses with the psychiatric and primary care community. It is clear that the time has come for us in the clubhouse movement to understand the seriousness and depth of the impact of co-morbidities on our collective memberships.
Building on what Lori was talking about at the Symposium, co-morbidity data were presented with reference to 107 Fountain House members served at the Sidney Baer Center:
Co-Morbidity No. % of 107
Obesity 62 60%
Substance Abuse 35 33%
Hypertension 33 32%
Diabetes 26 24%
COPD (Asthma, etc.) 11 10%
Only three of the 107 men and women had none of these co-morbidities. Given the woeful physical condition that many face, such maladies have the psychological effect on many members that lead to their not wanting to go through the interview process for a job, for example. The contributing factors in these conditions are both enormous and varied including, but not limited to: 1) psychotropic medication; 2) lack of knowledge; 3) nutrition; 4) financial conditions; 5) lack of easy access to work-out centers; and 6) lack of social support.
What both Fountain House and Magnolia House are demonstrating in their partnering with outside medical caregivers is a crucial and cost-saving easy access method to handle these problems. Key to this partnership is the trust which has been established among the participants. Frequently most people are daunted by having to present their concerns to both the psychiatric and primary care givers. Having a third person involved, chosen by the member contributes to overcoming this anxiety. For the member, some trusted person can help ask the questions or present the concern which is the reason for the appointment. For the doctor, both clarifying the reason for the visit and subsequent time saved are more efficient use of treatment time. In addition, the fact that the appointment is not “fee-for-service” means that a clear and useful course of treatment is more likely to occur, including follow-up efforts.
A high priority at both the Sidney Baer Center and the Carriage House Clinic is the presence of additional services not available within the clubhouse: Weight Watchers groups; 12-step programs for alcohol, drug and smoking-cessation; and other activities. Essential to these services is that they are voluntary and non-time limited program components.
We at TandC Associates believe the next step must be documentation of the short- and long-term outcomes – both psychiatric and physical – from both of these “storefront” programs. These results must then be shared with the larger clubhouse community. Moreover, clubhouses elsewhere need to examine carefully the almost epidemic presence of serious co-morbidities within their membership. Those clubhouses then could consider such services as the “Rehabilitation Alliance” as well as working partnerships with local psychiatrists and primary care givers. Our proposal is that those members most in need of such services could thus obtain easy access to essential treatment for their co-morbidities. In so doing, clubhouses would be responding head-on to the issue posed by Lori D’Angelo above.
Having been around the Clubhouse world since 1973, I have unfortunately known many members who have died way before their time. We must struggle to help overcome the increased health risks which are often the “side effects” of severe psychiatric illness, like complications of necessary medications, obesity, smoking, poor nutrition. lack of exercise and lack of timely and effective medical services. Very crucial to improving this very serious situation, is greater access to and partnership with psychiatric and medical services. Many of our programs have already established excellent wellness programs. The next step, I believe, means evolving to a stage where our Clubhouse model is both better understood and recognized by psychiatry and the medical community. Also if we are to continue to provide the gold standard in psychiatric recovery we need to increasingly help raise the standards of psychiatric and medical care for our members in as accessible and effective way we can in the community. We have always in our Clubhouse history helped members get psychiatric care, now we to need find better ways to integrate this care into the opportunity ecosystem which includes employment, housing, and education, all flowing from the Clubhouse, where members find their sense of purpose. self confidence and dignity. Greater recognition and partnership from psychiatry and better access to medical services will both greatly improve our ability to help transform member’s lives and strengthen our Clubhouse movement.