Opinion & Commentary:
Laurel House: A solution, a home, and an open door for mentally ill
By Jackson Toby
Feb. 29, 2008

In the fall of 2008, Laurel House, a club for persons with serious mental illnesses, will open its doors in New Brunswick, initially for a small number of people. Why does Middlesex County need another program for the seriously mentally ill? Because, although a clubhouse does not replace family or psychiatric services, sometimes the emotional support of the fellow members of a clubhouse can be less stigmatizing and therefore accepted more readily than professional or parental help.

My daughter, Gail, was treated for many years for a bi-polar disorder during which her mother and I tried hard to help her. Gail was not a member of a clubhouse. Gail committed suicide three years ago; had she a clubhouse to go to, perhaps that could have been prevented.

Although Laurel House will be a first clubhouse for the mentally ill in New Jersey, such clubhouses are not new. The first clubhouse was Fountain House in New York City, and there are now clubhouses in many American states and in some foreign countries. The International Center for Clubhouse Development recognizes more than 370 clubhouses worldwide in 28 countries, including Russia, China, Albania, Egypt, Estonia, South Korea, Western European countries, and North American countries.

The meaning of clubhouse membership

The single biggest difference between clubhouses and conventional therapeutic programs for the seriously mentally ill is the concept of "membership." Clubhouses do not have "patients" or "consumers" who are the recipients of services provided by staff. They have "members." Once a person with a mental illness is accepted as a "member" of a clubhouse, that person is a member for life. He or she can walk out of the clubhouse in a day or two and not be heard from again for years, but he is still a "member," which means that if he wishes to visit the clubhouse because of loneliness, failures, psychiatric problems, or just a desire for companionship, he is as welcome as if he had been coming every day for the past month.

This may sound as though club membership is as ephemeral as the audience of a movie theater, but that would be the wrong conclusion. All of the clubs count their total members but distinguish these from "active" members. Active members are those who come to the club at least once every few months. Within the category of active members are some who make the club the center of their lives as well as some who come more sporadically.

Since members are not compelled to come to the clubhouse by the requirements of membership, the active members come by their own choice. That the members choose to come contributes enormously to the hopeful cultural climate of the clubhouse. Members smile at visitors, introduce themselves by name, and ask the name of the visitor. They sometimes offer to show a visitor around if a tour is not scheduled at the time of the visit. Of course, skeptics can point out that a self-selected clientele is obviously in better spirits than persons compelled to attend. Nevertheless, those members whom a visitor sees on a visit to a clubhouse seem hopeful rather than listless.

Members can, if they wish to do so, sit around, watch television, or smoke a cigarette outside of the building — that is, not participate in the many tasks of a "work-ordered day." But this rarely happens. The clubhouse culture creates an expectation that staff will solicit help from members in doing the work of the clubhouse, and these solicitations usually succeed in enlisting cooperation. Members who do not participate in paid employment outside of the clubhouse (and even some who hold outside jobs) volunteer for work assignments in the clubhouse.

Why not? It is their clubhouse. They take visitors on tours of the clubhouse; they keep records in the clerical unit and enter data on members into clubhouse computers: they cook food in the kitchen and help to serve it to members; they answer telephones; they sweep the floors.

The meaning of work in the clubhouse culture

The second important difference between clubhouses and most treatment programs is the centrality of work. Members do not get paid for work in the clubhouse, but every clubhouse tries to coax members to attempt to get outside employment. Some members have never worked, and some have not worked in a very long time because of their illness. They have two major obstacles in the way of their getting into the labor market: (1) They lack work skills and self-confidence; (2) They lack a resume that can account for the time spent being ill. Nevertheless, clubhouses subscribe to the idea that doing a job is possible and that a job can be rehabilitative.

There are four levels of work recognized by the clubhouse culture:

Work in the clubhouse to help keep it running (when the member volunteers or accepts an invitation to help);

Transitional Employment Placements (six to nine months);

Supported employment (when and if the member feels ready);

Independent employment (when and if the member feels ready).

A clubhouse member in both a transitional employment placement and supported employment has a staff member called a placement manager backing him or her up.

The placement manager speaks to potential employers in order to line up jobs. That is to say, they "sell" potential employers on taking on a worker who is recovering from a serious mental illness.

Placement managers explain to potential employers that the job is in trust for the clubhouse rather than the job being the sole responsibility of the individual member. That is to say, the clubhouse guarantees that the job will be done. If the member in the TEP does not feel well enough to come to work on a given day, the placement manager will do the job. This is a selling point to business people; since the placement manager covers for the member in the TEP job, the business does not lose productivity for sick days and vacation time, as with ordinary workers.

Before the member starts on a new TEP, the placement manager works at the job and learns it for several days or more. When the member is ready to start the job, the placement manager works alongside him or her until the member is ready to work on his own.

The placement manager is available to discuss with the member any problems that arise on the job with fellow workers, with work supervisors, or with the tasks assigned. There are basic questions that the member may need to be asked. "Do you have money for lunch?" "Do you know how to get there by public transportation?" For members who drive their own cars: "Do you know where to park?" "What do you do about the job if you get sick?"

They should know that they must call the placement manager and the employer. Some members think that once they get a placement they have less of a role to play in the club. The placement manager points out that member holding a successful TEP job is a role model for other members who are afraid to try TEP; this means that he has a responsibility to come to the club and let members know that TEP has worked for him.

Supported employment involves the member holding a permanent job, although perhaps a part-time job. What makes it supported employment is that a placement manager is available to help with problems.

The Middlesex County Board of Chosen Freeholders allocated $50,000 at its last meeting to help Laurel House get started, and the planning committee is working on obtaining the additional financial support needed to keep Laurel House running. In addition to money, the planning committee wants to spread the word that a clubhouse will soon be available. My daughter was so lonely and desperate that she killed herself. I and the other members of the planning committee believe that through Laurel House membership, some mentally ill persons in our community won’t be tempted to do that.

Jackson Toby, Professor of Sociology Emeritus at Rutgers University, taught for 50 years at Rutgers before retiring in 2002. He was director of the Institute for Criminological Research from 1968 to 1994. He is the author of professional publications as well as several dozen op-ed pieces (directed at the general public) concerning his major research interest, the causes of and remedies for school violence, in such newspapers as the Wall Street Journal, the New York Times, the Washington Post, and the Los Angeles Times. He has been listed in Who’s Who in America for 30 years.