TandC Associates, LLC

Core Values Enhance Relationships

One of the first things I learned upon joining Fountain House was the value system key to the survival of the clubhouse community.  The WANA group was responsible for the first three of these values: self-help through mutual help, member ownership of the program, and membership has no time limits.  There will be much to say about self-help through mutual help as a specific lesson later.

Member ownership is a key component of this community.  It can be best understood by presenting two examples.  Early in my career at Fountain House, I had the opportunity to travel to a psychosocial rehabilitation program in Philadelphia.  The staff worker who conducted the tour strongly requested that I should not look into the eyes of participants, as this would make them nervous as if they were “animals in a zoo” (the staff worker’s expression).

In contrast, the tour I was given when I applied for employment at Fountain House was conducted, as all tours are, by a member.  Miriam was my tour guide and the pride of ownership she expressed as we went through the program was clearly evident.  Of another tour, the wife of the Governor of Massachusetts noting the presence of the same pride commented that she felt like she was really being shown the tour guide’s home, not an institution.

Mark had this to say about the idea of no time limits in his speech in Maryland:  “You can proceed at your own pace…At this point I felt the program wasn’t for me and I left for about two years…The problem was I couldn’t find a job… So I went back…and was warmly received… A member can always return…

“This time things went much faster and I was out on a placement…(then) to my next placement for eight months…(and to a third) placement… At this time I stopped going to Fountain House during the day. This was a mistake that many members make…I found myself in such a state that I had to…return to the hospital…

“I returned once more to Fountain House upon leaving the hospital… It’s four months now since I left the hospital and although my life is still sometimes like a roller coaster ride I do have stability.”

Other core values evolved after John Beard became Executive Director.  The basic activities offered in the daytime had to do with the essential care and maintenance of the clubhouse environment.  These included cleaning, lunch preparation, reception and various clerical functions such as answering incoming phone calls, filing, and record keeping.

From the very beginning of Beard’s tenure, he made sure there was more work to be done then there were staff to do it on their own.  Thus, members were needed in order for the clubhouse to function.  This need meant that members were expected to be in attendance; if they weren’t available the work could not be completed.  If a member did not attend on a given day, reach-out efforts were made to ascertain why and to convey the message that the member was missed.  At the end of the day, after the needed tasks are completed there is opportunity for staff to express appreciation for members’ contributions.

It should be noted that these values represent a staff-consumer role reversal from almost all other mental health service delivery systems. Typically, in clinical settings consumers need the clinician, there is little reason to expect an appointment to be kept, and little effort is made to reach-out if there is no attendance. Any appreciation felt in these settings is that which the consumer has for the provider. It should also be noted that many clinical programs are purposefully designed to be time limited.

In another key way, the clubhouse system is diametrically opposite of most clinical settings, in that staff and members work on tasks together, based on the dynamic of “working with” rather than “working on”.

Mark’s comment on this:  “The idea of ‘working with someone’ as opposed to ‘working on me’ is fascinating. The concept we speak of all the time is working ‘together’ as the ideal but you have to wonder about how much shifting of the psyche of the staff takes place and the ‘working on me’ takes place.”

Because there was so much work to be done each day, staff will accept any help at all, and show appreciation for even the smallest contribution – a place setting for lunch, the planting of one flower, the answering of a telephone.  It is with the expression of need, expectation, missing and appreciation that provides the basis for the development of a longer-term relationship.

John summarizes the results of such an approach in the following way:  “The growth process I went through at Fountain House is similar to what hundreds of other people (fellow members) experience. It is made possible by the organization of a service delivery system which provides normalizing opportunities frequently unavailable to people coming out of the hospital. These deinstitutionalized patients are professionally designated as chronically ill or severely disabled, something which may well contribute to the continuation and maintenance of the disability that traditional delivery systems try to overcome.

“The…program achieves a variety of short- and long-term objectives. Initially the clubhouse setting provides patients with a place to go, away from an often troublesome living situation, and gives them something to do which is satisfying and rewarding, both to themselves and to others. It also brings together a range of people with different strengths and weaknesses who offer each other support, encouragement and, very importantly, friendship. In the long run, the delivery system allows the individual to undertake gradually increasing responsibility to the extent they feel able to handle it. And the clubhouse environment promotes the growth of close relationships which help sustain the willingness to change.”

Again, TCA advises the reader that this posting is part of a larger body of work  in process for publication.  Any references to it, or quotations from this or other postings on this website must be with the express permission of the authors.  Readers may contact us through the space provided below, or at

tandcassociates@gmail.com

As always, we welcome your comments and suggestions, through which dialogue we hope to expand our knowledge in all aspects of psychosocial rehabilitation including the clubhouse model.  

Lesson #6 presents three very different examples of the great courage found in those recovering from their experiences with mental illness.

Lesson #6– People with Mental Illnesses are Courageous

Cora was first hospitalized at the age of 16, when she received drugs and shock treatment, but left hospital saying she felt worse than when she entered.  She spoke at an Employment Dinner meeting at Fountain House:

“Well, I’m going to tell my age.  Okay, I’m 28 years old. I’m a Dictaphone secretary at a big textile company… I go to school two nights a week and I’m studying to be a court reporter.  I have my own apartment, and I have a cat, and I have a boyfriend, and I have a driver’s license, and I have a piano and that’s now… I came (to Fountain House) ten years ago, when I was 18 years old.  I had a small, little tiny room in the Y.  I had no job, and I collected money from Welfare… I was very, very nervous, and very, very frightened; and I think it showed all over my face.”

Cora joined the clubhouse, became involved in day program.  She went to school but had a rehospitalization.  When she was discharged , she returned to Fountain House and participated in some part-time placements before going on to full-time jobs.  At the time of the 1978 dinner she had been independently employed for 18 months and went on to say:

“I don’t know – I came here tonight and spoke to somebody, and I tried to get the feeling of what it was like before. I remember being terribly afraid of a full-time job. I mean they would tell you about full-time jobs, and it was the one thing I really didn’t want, you know? I was worried about (losing) my…Welfare, by risking a full-time job.
“Now, it amazes me that I felt that way, because I don’t feel that way now. Like this is the first summer that I’m keeping cool by my own air conditioner that I saved my own money to buy. I’ve seen bad things happen to people and I’ve seen good things happen, but, nowhere is there a place where you get so much support …It’s like a secret thing I learned from Fountain House and I may not want to tell anybody else about it; but you know, I was at work today and I knew I was coming to this dinner tonight, and I know to me this dinner’s very important, but I’m not going to tell anybody I’m coming here.”

Since that dinner Cora went on to marry her boyfriend, complete training and a successful career as a court stenographer.

The second example of courage is found with Richard W., a tall (6’6”) fellow, a year younger than I, whom I met in 1965. He has demonstrated over the years what courage it takes to fight against the demons of mental illness.  We got to know each other as he was learning a transitional employment (TE) messenger placement.  It was clear from the beginning that this was one conscientious man who wanted to do the job well even though most of the time he was tormented by his demons.

After completing that placement, Richard went on to a second TE and then obtained a full-time messenger job with an advertising company that he held for over 20 years until he was forced to leave due to increased physical problems.  He was physically fit enough, however, to then procure a job as a civilian employee with the New York City Police Department that he held until age and physical condition led to retirement.  Throughout his career, his courage was demonstrated by his lack of complaint, his desire to be productive and most of all a cheerful attitude, again despite the continuous struggle with his demons.  He has also been helped a lot over the years by the support of his good wife.

The third courageous person is Richard S., a 21-year old young man, who came to Fountain House after a short hospitalization.  He benefited from involvement in the in-house program, but he reacted to the conflict in Viet Nam.  Richard decided to enlist in the Army to serve his country. The day before he left I gave him my brass army belt buckle, as a token of our short, but meaningful, relationship. We never saw him again, as he killed in action in Viet Nam. His name is forever etched on the Viet Nam War Memorial in Washington, DC, for all to honor.  Many veterans returning from military service benefit from involvement in rehabilitation programs, such as clubhouses.  Richard S. is, to my knowledge, a unique example of someone who went from a rehabilitation program to military service – an ideal example of courage.

As a reminder, this series is drawn from a larger work pending publication.  Any reference to (or quotation from) its contents must be with the express permission of the authors, which can be secured by contacting us at:

tandcassociates@gmail.com

or the URL below. We welcome your feedback and comments at either site!

The previous three lessons in this series identified the facts that individuals with severe mental illnesses are first and foremost people, who have normal needs and can benefit from prepared-for actions as much as any other group.  The next examples offered in this series will identify some strong positive characteristics associated with these men and women.

Lesson #4 – People with Mental Illnesses are Compassionate

I was first impressed with this lesson when I was working as an attendant at Westborough (MA) State Hospital in 1957.  John and five other patients on one ward all claimed to be either Jesus Christ or at least the Son of God.  Each thought the other four were “sadly delusional,” but they also were respectful, caring friends.  From them I learned that most patients treat their fellow patients with an unconditional sensitivity, even though others such as their providers and caregivers  might think they should be in competition with each other.

While there are many other examples of compassion could be cited, the following should serve as a significantly clear demonstration. Norman arrived at Fountain House after a long period of hospitalization followed by homelessness.  Among other experiences, Norman survived a couple of years living off the land in New York City’s Central Park. He was discovered by a Fountain House reach-out team and describes his arrival at the clubhouse as “being washed up on the shore of life after a long period of being marooned on the sea of despair.”   A college graduate, he soon completed a couple of part-time job placements and secured a full-time independent job with an international bank, where to my knowledge he is still employed, even after having survived the destruction of the bank site at the World Trade Center.

Norman has demonstrated his compassion in two very different ways. On a personal level there was his relationship with his apartment mate, Henry.  They had been in a Fountain House supported apartment for a few years, when Henry was diagnosed with advanced cancer.  Instead of moving Henry into the medical model of care, Norman insisted on keeping his roommate in their apartment, under his caring eye until the very end of Henry’s life, providing the comfort and friendship so greatly appreciated by Henry.

Norman’s second area of demonstrated compassion was toward the needs of Fountain House, where, although employed full-time, he has given considerable personal time to researching and summarizing the ways in which the agency could generate its own energy through wind control and other means generated at the High Point Farm area.

The last example of such compassion focuses on some 70 Fountain House members who joined over 5,000 New Yorkers in the city’s Annual Walk to support mental health and fight the stigma people affected by mental illness and their families face every day.  Proceeds fund NAMI’s free support and education programs for families and individuals living with mental illness.  Joe’s comment sums up the meaning of compassion:  “My favorite thing was seeing the Fountain House community represented as one.”

This series is part of a larger work in progress, pending publication.  Any quotations or references must be with the author’s permission.  As always, we welcome all comments and feedback at the URL below, or our e-address:    

                                       tandcassociates@gmail.com