Commentary: Early Intervention in Youth Mental Health

A psychiatric social worker reflects on what it would take to improve the U.S. mental health system, with techniques and programs that have been shown to work.

by Barbara B. Smith

Much too frequently in America, we bear witness to horrific shootings. We try to make sense of these events and ask ourselves why they happened and how to prevent future tragedies. We call for gun control – anything – to stop the insanity. No doubt, stricter gun laws are needed in this country. But we also need a humane and effective mental health system that gives priority to young persons with emerging severe mental illness.

In the aftermath of these events, people with mental illness, particularly schizophrenia and other psychotic disorders, become demons in the eyes of their fellow citizens. This ugly public perception of mental illness affects what happens privately – if a young person with a promising future develops psychosis, we don’t want to believe it. We ignore it or call it something else. And because many have this notion that a person with schizophrenia is equivalent to a monster, the person with psychosis isn’t likely to embrace that label. Denial delays treatment, and the cycle continues.

I know these challenges because I have spent the past 20 years working with people with schizophrenia. I love my clients. They are not monsters. They are your brothers and sisters, mothers and fathers. They are part of the human family, with the same hopes and dreams we all have.

Most people with emerging mental illness are in distress, and open to help if it is humane and addresses the problems they define. If psychosis is treated, perhaps we can prevent violent acts that stem from paranoid delusions.

As with any other illness, early intervention has the potential to create better outcomes in schizophrenia. But in the U.S., it’s almost impossible for young people with emerging severe mental illness to get the help they need. Over the past 30 years, our mental health system has suffered from fragmentation and underfunding. The resources we do have are sometimes misdirected. We have over-relied on medications – hoping for the quick and simple cure – for disorders that are complex. The emergence of a severe mental illness can affect every aspect of a person’s life. People with severe mental illness are best treated with a comprehensive approach that includes psychological treatment, and social and vocational supports, in addition to medication. For those with very severe psychosis, we also need safe and humane settings for treatment.

The international community is far, far ahead of us in the area of early intervention in mental health. Can you imagine the U.S. being so far behind in the treatment of cancer or cardiovascular disease? We can look to other nations – Australia, Canada, the UK, Japan, Finland and Singapore – to learn how to help our youth.

So, what can we do to improve our own nation’s mental health system? We need to strengthen our efforts at prevention and early intervention in psychosis. We need to put just as much emphasis on mental health as on physical health. We need to get the message across that psychosis is treatable, recovery is possible and mental health can be restored. Let’s do the following:

• Treat emerging psychosis like a true medical emergency.
• Make youth mental health a public-health priority.
• Provide education to young people, their families, their teachers and their faith communities about early-warning signs of mental illness and how to get help.
• Create specialized early-intervention teams that can respond rapidly and humanely to persons with emerging severe mental illness.
• Strengthen the mental health workforce by developing training initiatives that focus on persons with severe mental illness.
• Broaden the dominant medical model to include psychological treatment, social interventions, psychiatric rehabilitation and peer support.

Ultimately, as a clinical social worker, what I’d like to see is what I’d want for myself or someone in my family: early intervention, easy access to care, the best treatment from a multidisciplinary team of professionals, shared decision-making and enough support to lead a meaningful life as a contributing member of the community. If we had those things in our mental health system, we would all be better off.

Barbara B. Smith is a clinical assistant professor at the UNC-CH School of Social Work and the department of psychiatry. In 2012, she was recognized as “Social Worker of the Year” by the N.C. chapter of the National Association of Social Workers.

This commentary was originally published in the Durham Herald-Sun

ICYMI: “Straight Up Proud” of a Proven Mental Health Model

For people with mental health disabilities, a clubhouse is more than just a place to hang out – they’re places to learn work skills and receive help to recover from mental illness. Most importantly, clubhouses are a place to belong.

This story was originally published on January 25, 2012.

By Taylor Sisk

Sometimes a simple sense of belonging can make all the difference in the world.

That’s particularly true for those living with severe and persistent mental illness, and it’s the foundation of a model of mental health care.

It’s called the clubhouse model, and it was introduced 64 years ago with the opening of Fountain House in New York City. There are now more than 300 clubhouses around the world, eight in North Carolina, which follow standards set by the International Center for Clubhouse Development.

These clubhouses are founded on the belief that “recovery from serious mental illness must involve the whole person in a vital and culturally sensitive community,” with the individual as a partner in that recovery.

Essentially, clubhouses are community centers, offering hope and opportunity.

Club members participate in the management and upkeep of Club Nova, and the club offers an employment program in collaboration with the local business community. Transitional employment helps bridge the gap between work within the clubhouse and independent employment. Members are then often placed in permanent jobs, with ongoing support.

“Before Club Nova,” said Jim Huegerich, director of Crisis and Human Services for the Chapel Hill Police Department, “like clockwork, those with chronic and persistent mental illness would cycle in and out of state mental hospitals every six months, initially surfacing with law enforcement in a crisis. For those who are members of Club Nova, this cycle has essentially been broken.”

“Throughout my career as a police officer, I’ve met many people associated with Club Nova, and I’ve grown both professionally and personally through those contacts,” Carrboro Police Chief Carolyn Hutchison said. “I value the collaborative relationship that exists between the Carrboro Police Department and Club Nova.”

Why aren’t there more clubhouses in North Carolina?

My first-hand experience with clubhouses is as a board member of Club Nova in Carrboro. Club Nova operates under a Community Bill of Rights comprising four guarantees: a place to come, meaningful work, meaningful relationships and a place to return. I often wonder why there aren’t more places like Club Nova.

Clubhouses are “the most cost-effective treatment for the persistently mentally ill,” said state Sen. Ellie Kinnaird, a longtime supporter.

Threshold Clubhouse in Durham compiled some statistics in 2010 that help define the cost-effectiveness of the model. Based on its Medicaid reimbursement rate, six months of care at Threshold cost $10,412, less than the price of eight days of psychiatric care at Central Regional Hospital. (That reimbursement rate has since been reduced.)

Studies have shown the rehospitalization rate for people with severe and persistent mental illness to be as high as 40 percent after six months and 75 percent after five years. For 2011, Threshold had a rehospitalization rate of 7 percent after one year, a number consistent with past years and with other clubhouses in the state.

Places of employment for Club Nova members have included Staples, the YMCA, Carolina Fitness, the UNC School of Social Work, Open Eye Cafe and the Mental Health Association.

“Club Nova members gain real work experience and renewed self-confidence,” state Rep. Verla Insko said, “and the business people gain insights into the strengths and abilities of people with mental illness, as well as some very good workers.”

Clubhouse members aren’t just good workers, they’re good teachers.

“Club Nova has been a place of learning for me and for my students that is penetrating and constantly renewing,” said Sue Estroff, a professor in UNC-CH’s School of Social Medicine. Club members have been guest lecturers in her classroom for years, and she sometimes moves her classroom to the clubhouse.

“The visit is indelible for the students,” she said.

Welcome

These are all compelling arguments for the funding of clubhouses. But the importance of that simple guarantee of a place to go shouldn’t be downplayed. In a fundamental regard, the clubhouse structure itself is salvation.

Susan Coppola is a clinical associate professor in UNC-CH’s division of occupational science. We build ramps for wheelchairs and make other adaptations for conditions like vision or hearing loss, she points out.

But “invisible conditions, like mental illness, require more subtle environmental adaptations that are difficult to understand,” she said. “Because of the complexity, and, let’s face it, the stigma of mental illness, we are reluctant to invest in environmental situations that reasonably accommodate and support these conditions.

“Individuals with mental illness and their families have had to work outside the system to create these environments, and do so at a very low cost.”

Clubhouses, Coppola said, are such efforts in action.

Recent research into the phenomenon of resiliency finds that people recover from illness – both physical and psychological – better when they have social support.

“Clubhouse member” may just sound like pretty words, said Jacquie Gist, a Carrboro alderman. “But that’s what it’s about, and it really makes a difference. Not ‘patient’; not ‘client.’ ‘Clubhouse member.’ It’s a sense of belonging, and an indication of how members are valued.”

Some years ago, Jonah Pierce, a nurse now working with HIV/AIDS patients, was receiving treatment after two suicide attempts and was progressing well. But, he said, “I desperately needed to be needed in some way.”

The desire to belong is universal, Pierce said, but it’s especially true for those with a stigmatizing illness. “Immediately upon coming to Club Nova, I felt this incredible sense of welcome.”

“I’ve known some members for 30 years now,” Gist said, “and I’ve seen how they’ve been given the resources to get by, the support tools they need to live and thrive.”

And, she adds, “Most importantly, it’s done with dignity.”

The clubhouse experience can help people with mental health disabilities overcome not only their symptoms but the feelings of despair that can develop when their lives are turned upside down by mental illness.

“These are the things that can disable you,” said Larry Fricks, a national advocate for peer support in mental health treatment, “your symptoms, the stigma and the way your self-image changes when you experience mental illness.”

“I have no desire to go back to my former days before Club Nova,” said member Charlene Lee. “I have a strong desire to move forward,” and she has.

Insko said that among her priorities as a member of the House Appropriations Subcommittee on Health and Human Services is protecting funding for clubhouses across the state.

“Club Nova is something our community can be straight-up proud about,” Gist said. “It’s something we’ve done right as a community. … It saves lives.”

Taylor Sisk is a board member of Club Nova, a freelance journalist and a frequent contributor to North Carolina Health News.

Medical Education Contributes to Culture of Overuse

In a commentary, NC Health News contributor Nancy Wang, who has completed three years of medical school at UNC-Chapel Hill writes that medical training contributes to overuse of expensive testing, training doctors to function in a way that continuously increases cost.

By Nancy Wang

Even after completing three years of medical school at the University of North Carolina, I still have trouble identifying abnormal heart sounds. But if I’m given the lab results to the most simple and routinely ordered blood test, I can immediately tell if the patient has an infection, has signs of leukemia, is low on certain vitamins and minerals, needs a blood transfusion or is having problems forming clots and may be at risk for severe bleeding.

Unfortunately, I’m not alone in my reliance on medical technology.

Earlier this year, the Institute of Medicine (IOM) released a report stating that of the $2.5 trillion spent on health care in the U.S. in 2009, approximately $750 billion was wasted on unnecessary treatments, ineffective services or missed opportunities for preventive care.

“This isn’t new,” said Sue Tolleson-Rinehart, an adjunct assistant professor of political science at the University of North Carolina at Chapel Hill. “The opportunity to overuse and misuse technology in health care began when the technology itself began in the ‘70s.”

According to the IOM report, the largest category of waste was an estimated $210 billion that was spent on tests, medications and services that were not needed or supported by current medical evidence. This problem is referred to as overuse or overtreatment in the medical field.

“We’re human beings. If you put a tool in our hands, we’re going to use it, and we don’t necessarily use it so well,” said Tolleson-Rinehart who is also the assistant chair for faculty development at the UNC School of Medicine.

Hospitals, insurance companies and even tech industries are all trying to find ways to get doctors to use the tools we have effectively and efficiently. Many hospitals are offering doctors financial incentives to cut back on tests, whereas insurance companies are threatening to reduce reimbursements to physicians who use unnecessary services. Medical tech industries, on the other hand, are creating electronic medical record systems that help track, identify and reduce overuse.

All of these approaches, however, overlook the root of where this habit of overuse starts: medical school.

Part of the problem stems from the structure of the U.S. medical education system. Currently, the majority of U.S. medical students spend the first two years studying basic sciences and learning how to perform a physical exam. Then, during their third and fourth years, they enter the clinical setting and actually take part in the care of patients.

This division can lead to a disconnection between physical exam skills and actual diagnostic skills.

“In the first two years we were taught physical exam skills in small groups and lectures, but the emphasis was dropped during the third year,” said Elena Adamo, a fourth year medical student at UNC. “Instead, we spent more time learning about tests, labs and drugs than we did about how to diagnose patients from examining them.”

Many medical professors agree.

“I do feel like we’ve lost the physical exam in the last 30 years because we’ve focused more on basic sciences,” said Dr. Kurt Gilliland, assistant professor of anatomy and neurobiology at UNC School of Medicine. “Assessments also drive instruction, and in the basic sciences we want to test objective things such as lab values and x-rays, so that is what we end up teaching.”

Given such training, it’s no surprise that the current health care system places a similar emphasis on labs and test results.

According to estimates provided by Judy Melton, who works in revenue management at UNC Hospitals, one of the most routine blood tests ordered by physicians, a complete blood count with differential, costs approximately $91 for the test and $31 for the physician to read it. Other less routine but still common tests such as a CT scan of the head, which is basically a 3-dimensional X-ray of the head, can cost up to $1,538 with an addition $724 for the doctor to read the scan.

Even for patients with insurance coverage, the costs of these tests can add up quickly. And for the country’s overall health care bill, excessive use of these tests easily contribute to the wasteful spending reported by the Institute of Medicine.

A physical exam, on the other hand, doesn’t cost patients anything extra. Indeed, it is the essence of what patients are paying for when they go to see their doctor, whether they get it or not.

So in the midst of the current political spotlight on how the Affordable Care Act and other policies will affect U.S. health care expenditure, more focus needs to be placed further upstream to where it all starts.

“We need to change medical education back to a more patient-centered orientation where we use diagnostic tests and imaging to enhance doctors’ understanding of their patients and not to replace their knowledge of their  patients,” Tolleson-Rinehart said.

Instead of just spending billions regulating, punishing and coercing physicians and other health care providers to be more efficient, it may be necessary to re-evaluate our current medical education system and figure out how to train more efficient doctors to begin with.

Nancy Wang completed her third year of medical school and is completing a masters in public health this year at UNC-Chapel Hill.

Documentary Focuses On Problems in Healthcare System

Escape Fire is a new film that aims to spotlight problems in the U.S. health-care system and offers examples of solutions – escape fires – that could point to new ways of making the system sustainable.

Film review by Rose Hoban

Those not familiar with some of the numbers behind the U.S. health-care system – $2.7 trillion in annual spending, more than $300 billion each year on pharmaceuticals, tens of thousands who die from medical errors – might be stunned by the magnitude of them.

The makers of the new documentary Escape Fire use those numbers to good effect to draw a comprehensive portrait of a health-care system that is irrevocably broken and in need of structural reform.

Equally stunning in the film is the optimism, in the face of great odds, that some people have about fixing the system. Chief among the optimists is one who knows health care well, former Medicare head Dr. Don Berwick, who presents the analogy of the title, “escape fire.”

Berwick recounts the spontaneous innovation of a Montana firefighter during the infamous Mann Gulch fire of 1949 that killed more than a dozen “smoker jumpers.” One firefighter, realizing that he could not outrun the quickly moving fire, decided to drop a match and burn the area around him to deplete the fuel on the ground. When the main fire caught up with him, it passed him by. His quick thinking had provided him with a safe area to huddle and wait for the conflagration to pass, saving his life, while those of his more traditionally operating co-workers were lost.

After a sobering hour detailing the structural problems of the health-care system, Berwick and others in the film spend the final half hour describing what “escape fires” are being innovated by individual practitioners and institutions as potential fixes to the system.

Avoiding polemics

The filmmakers initial critiques are not unfamiliar to people on the left: Access to care for many poor and uninsured is inadequate, with too few doctors who are then forced into providing mechanistic care to too many for too little reimbursement.

Noted health journalist Sharon Brownlee is blunt, pointing out that much of the system is set up as a “disease-care” system rather than a health-care system.

“The disease-care system doesn’t want you to die and it doesn’t want you to get well, it just wants you to keep coming back for care of your chronic disease,” she states.

But the filmmakers also make an effort to address critiques of health care from a more conservative perspective: that Americans don’t get enough quality for the money spent, that overtreatment ends up harming patients – especially those who can afford it – and that the cost of the U.S. health-care system is fast becoming unsustainable.

They drive home the idea that the current fee-for-service payment system is one of the roots of the problem.

“When you reward physicians for doing procedures instead of talking to patients, that’s what they’re going to do, is do procedures,” explains Dr. Leslie Cho from the Cleveland Clinic. “If I spend five minutes with you and put in a stent, I will probably get $1,500. But to spend 45 minutes with you … to figure out what’s the problem, I’ll probably get $15.”

The filmmakers’ vision becomes one that could be accessible to people of any political stripe. Staying far away from the polemics of Michael Moore’s Sicko – and hardly mentioning politics – the film focuses instead on facts and figures, and uses footage that ranges from a Fox News interview with Senate minority leader Mitch McConnell, a Republican, to interviews with Berwick, who was appointed by President Obama, to build its argument.

And when the filmmakers go looking for answers, they focus on innovations being developed by groups as disparate as the corporate leadership of the Safeway grocery chain, doctors at the Cleveland Clinic and the U.S. military health-care system.

Particularly compelling is the story of Army Sgt. Robert Yates, who we first meet as he is being med-evaced from Afghanistan on a military transport. Yates is so doped up on narcotics for pain that he falls out of bed.

Yates eventually ends up in a pain-treatment program at Walter Reed Army Medical Center in Washington, where he is helped to withdraw from the dozens of pain pills he takes daily and cope with his post-traumatic stress by using acupuncture, meditation and yoga.

Yates, who describes himself as a “good ol’ boy” from Louisiana, embraces the unconventional treatments because they work for him. The filmmakers document the military’s use of these techniques, which have been successful at helping wounded veterans and active-duty military reduce dependency on pain medication at less financial and human cost.

Missing pieces of the puzzle

Even with their cogent critique of the system, the filmmakers miss some important points. There’s little focus on the role of early intervention in the lives of children, even though obesity, and associated conditions, is skyrocketing in children and adolescents. That oversight could be a function of the difficulty of getting access and permission to film minors, but it’s a critical omission.

And the filmmakers almost completely overlook the role of nurses, nurse practitioners, therapists and many other professionals who provide care that’s often more effective and cheaper than expensive specialty intervention, but which requires more time and hands-on care than doctors are empowered to supply in the current system.

Despite those shortcomings, Escape Fire is worth 90 minutes to watch with a friend of a different political stripe. Then you should follow up with a cup of coffee (or perhaps something stronger) to discuss what each of you took away.

Health Care Reform Brings Major Medicare Changes

While most of the attention on health care reform has focused on expansion of coverage to the uninsured, tremendous change in the way health care is delivered and paid for is playing out on the Medicare stage.

Commentary by Gina Upchurch,
Executive Director of Durham’s Senior PharmAssist

While many provisions of the Affordable Care Act don’t go into effect until 2014, many of the Medicare payment and delivery reforms began last year and this month.

The political rhetoric around health care reform has made it difficult to separate fact from fiction. However, several facts about Medicare are accepted across party lines:

• Our population of seniors is growing. Currently in North Carolina, just more than 12 percent of the population is 65 and older; by 2030, that will jump to 18 percent.
• The cost of Medicare has outpaced inflation for years, although slower than private insurance.
• All political persuasions understand that the Medicare balance sheet cannot continue bleeding, and we must do something to “bend the cost curve.”
• Changes in Medicare will affect not only the access and quality of care for current Medicare beneficiaries but also future seniors and people with disabilities.

Bending the cost curve

The Affordable Care Act, often referred to as Obamacare, is designed to slow the rate of previously projected Medicare increases by $716 billion from 2013 to 2022. The Medicare provisions in the Affordable Care Act include savings – mainly by reducing payments to Medicare Advantage plans (privately administered health plans that replace traditional Medicare A and B), paying some providers and hospitals less, and increasing premiums paid by higher-income beneficiaries.

Additionally, the Affordable Care Act created new revenues designated for Medicare: a 0.9 percent increase in payroll tax on wages for individuals earning more than $200,000 or couples earning more than $250,000 a year (from 1.45 percent to 2.35 percent), a 3.8 percent tax on certain unearned investment income for these individuals beginning in 2013, and fees on brand-name drug manufacturers.

Many of the Medicare insurance and health system payment reforms from the 2010 health legislation are already in place. The Medicare Annual Election Period expanded to seven weeks and now runs from Oct. 15 through Dec. 7.

In 2011 and 2012, there have been discounts on brand-name (50 percent) and generic medications for those who fall into the coverage gap or “donut hole.” These discounts expand in 2013 and will continue to grow until 2020, when Medicare beneficiaries will be responsible annually for 25 percent of the cost of medicines covered by their private Part D plan, after meeting a deductible. Those who reach catastrophic spending levels pay five percent of the costs of their covered medicines from that point forward.

Starting in 2011, many preventive screenings and immunizations no longer have co-payments, and providers can now offer – and bill Medicare for – an annual wellness visit for beneficiaries (not to be confused with the one-time welcome-to-Medicare physical). Medicare Advantage plans that have higher quality and outcome ratings will be paid more, and those with lower ratings will be paid less. The web-based rating system is becoming more transparent to the public.

The Affordable Care Act established a new innovations center as part of the Centers for Medicare and Medicaid Services that is testing new care and service delivery models. Several of those large grants and contracts have been awarded to providers in North Carolina.

In addition, Centers for Medicare and Medicaid Services has begun this month reimbursing hospitals for Medicare services based on how well they follow “best practices” or clinical guidelines and how their patients respond to satisfaction surveys. This is known as “value-based purchasing” or “paying for performance.” Some hospitals will be paid less while higher-performing hospitals will be paid more. Beginning this month, Medicare is reducing payments to hospitals that had higher-than-expected readmission rates over the last three years for patients who returned within 30 days of being discharged after pneumonia, heart attack or heart failure. More conditions will likely be added in the future.

These payment revisions are incentives for providers and health systems to place more emphasis on quality of care rather than volume of services or procedures ordered, moving away from the fee-for-service model.

All of these changes aim to both reduce costs and to improve health outcomes. Consumers can now view much of the hospital quality data online and will soon benefit from greater billing transparency, which will more easily identify potential insurance fraud.

With our current health care system, many un- and underinsured individuals seek care only when they are very sick. The system pays for this by charging the insured more than their care actually costs. Health care reform seeks to provide affordable and earlier coverage for more Americans. Preventive services, patient engagement, and incentives for providers to focus on health outcomes shift costs in the right direction.

Medicare’s new payment programs for nearly 50 million Americans are critical to the overall success of reform. Our leaders must make honest attempts to both improve the quality of care that Medicare beneficiaries receive while trying to reasonably find savings. Today’s older adults and younger people with disabilities – and those of the future – deserve a reliable system without being relegated to a retirement filled with worry about their access to health care and how this affects their financial security.

 

ICYMI: “Straight Up Proud” Of A Proven Mental Health Model

For people with mental health disabilities, a clubhouse is more than just a place to hang out – they’re places to learn work skills and receive help to recover from mental illness. Most importantly, clubhouses are a place to belong.

This story was originally published on January 25, 2012.

By Taylor Sisk

Sometimes a simple sense of belonging can make all the difference in the world.

That’s particularly true for those living with severe and persistent mental illness, and it’s the foundation of a model of mental health care.

It’s called the clubhouse model, and it was introduced 64 years ago with the opening of Fountain House in New York City. There are now more than 300 clubhouses around the world, eight in North Carolina, which follow standards set by the International Center for Clubhouse Development.

These clubhouses are founded on the belief that “recovery from serious mental illness must involve the whole person in a vital and culturally sensitive community,” with the individual as a partner in that recovery.

Essentially, clubhouses are community centers, offering hope and opportunity.

Club members participate in the management and upkeep of Club Nova, and the club offers an employment program in collaboration with the local business community. Transitional employment helps bridge the gap between work within the clubhouse and independent employment. Members are then often placed in permanent jobs, with ongoing support.

“Before Club Nova,” said Jim Huegerich, director of Crisis and Human Services for the Chapel Hill Police Department, “like clockwork, those with chronic and persistent mental illness would cycle in and out of state mental hospitals every six months, initially surfacing with law enforcement in a crisis. For those who are members of Club Nova, this cycle has essentially been broken.”

“Throughout my career as a police officer, I’ve met many people associated with Club Nova, and I’ve grown both professionally and personally through those contacts,” Carrboro Police Chief Carolyn Hutchison said. “I value the collaborative relationship that exists between the Carrboro Police Department and Club Nova.”

Why aren’t there more clubhouses in North Carolina?

My first-hand experience with clubhouses is as a board member of Club Nova in Carrboro. Club Nova operates under a Community Bill of Rights comprising four guarantees: a place to come, meaningful work, meaningful relationships and a place to return. I often wonder why there aren’t more places like Club Nova.

Clubhouses are “the most cost-effective treatment for the persistently mentally ill,” said state Sen. Ellie Kinnaird, a longtime supporter.

Threshold Clubhouse in Durham compiled some statistics in 2010 that help define the cost-effectiveness of the model. Based on its Medicaid reimbursement rate, six months of care at Threshold cost $10,412, less than the price of eight days of psychiatric care at Central Regional Hospital. (That reimbursement rate has since been reduced.)

Studies have shown the rehospitalization rate for people with severe and persistent mental illness to be as high as 40 percent after six months and 75 percent after five years. For 2011, Threshold had a rehospitalization rate of 7 percent after one year, a number consistent with past years and with other clubhouses in the state.

Places of employment for Club Nova members have included Staples, the YMCA, Carolina Fitness, the UNC School of Social Work, Open Eye Cafe and the Mental Health Association.

“Club Nova members gain real work experience and renewed self-confidence,” state Rep. Verla Insko said, “and the business people gain insights into the strengths and abilities of people with mental illness, as well as some very good workers.”

Clubhouse members aren’t just good workers, they’re good teachers.

“Club Nova has been a place of learning for me and for my students that is penetrating and constantly renewing,” said Sue Estroff, a professor in UNC-CH’s School of Social Medicine. Club members have been guest lecturers in her classroom for years, and she sometimes moves her classroom to the clubhouse.

“The visit is indelible for the students,” she said.

Welcome

These are all compelling arguments for the funding of clubhouses. But the importance of that simple guarantee of a place to go shouldn’t be downplayed. In a fundamental regard, the clubhouse structure itself is salvation.

Susan Coppola is a clinical associate professor in UNC-CH’s division of occupational science. We build ramps for wheelchairs and make other adaptations for conditions like vision or hearing loss, she points out.

But “invisible conditions, like mental illness, require more subtle environmental adaptations that are difficult to understand,” she said. “Because of the complexity, and, let’s face it, the stigma of mental illness, we are reluctant to invest in environmental situations that reasonably accommodate and support these conditions.

“Individuals with mental illness and their families have had to work outside the system to create these environments, and do so at a very low cost.”

Clubhouses, Coppola said, are such efforts in action.

Recent research into the phenomenon of resiliency finds that people recover from illness – both physical and psychological – better when they have social support.

“Clubhouse member” may just sound like pretty words, said Jacquie Gist, a Carrboro alderman. “But that’s what it’s about, and it really makes a difference. Not ‘patient’; not ‘client.’ ‘Clubhouse member.’ It’s a sense of belonging, and an indication of how members are valued.”

Some years ago, Jonah Pierce, a nurse now working with HIV/AIDS patients, was receiving treatment after two suicide attempts and was progressing well. But, he said, “I desperately needed to be needed in some way.”

The desire to belong is universal, Pierce said, but it’s especially true for those with a stigmatizing illness. “Immediately upon coming to Club Nova, I felt this incredible sense of welcome.”

“I’ve known some members for 30 years now,” Gist said, “and I’ve seen how they’ve been given the resources to get by, the support tools they need to live and thrive.”

And, she adds, “Most importantly, it’s done with dignity.”

The clubhouse experience can help people with mental health disabilities overcome not only their symptoms but the feelings of despair that can develop when their lives are turned upside down by mental illness.

“These are the things that can disable you,” said Larry Fricks, a national advocate for peer support in mental health treatment, “your symptoms, the stigma and the way your self-image changes when you experience mental illness.”

“I have no desire to go back to my former days before Club Nova,” said member Charlene Lee. “I have a strong desire to move forward,” and she has.

Insko said that among her priorities as a member of the House Appropriations Subcommittee on Health and Human Services is protecting funding for clubhouses across the state.

“Club Nova is something our community can be straight-up proud about,” Gist said. “It’s something we’ve done right as a community. … It saves lives.”

Taylor Sisk is a board member of Club Nova, a freelance journalist and a frequent contributor to North Carolina Health News.