Improving Health Equity and Overall Wellness for People Living with Mental Illness

Nature of the Problem

People living with serious and persistent mental illness are not accessing primary healthcare to the same degree as the general population. The co-occurrence of serious health concerns and premature death is at an alarmingly higher and disproportionate rate to those without mental illness. The lifespan of people with severe mental disorders is shorter compared to the general population. Cardiovascular disease, which includes coronary heart disease, atherosclerosis, hypertension and stroke, is one of the leading causes of death among people with severe mental disorders. People with severe mental disorders also have higher than expected rates of Type II diabetes, respiratory diseases, and infections such as HIV, hepatitis and tuberculosis. The medical conditions experienced by this group are associated with preventable risk factors, such as smoking, physical inactivity, obesity, and side effects of psychiatric medication.

Program Description

This is an initiative that will improve the overall health and wellness of people living with mental illness in the United States, and help rectify existing health inequities through improved navigational assistance at nearly 200 locations across the country. This is a national initiative focused on the 70,000 participants with mental illness of 190 U.S.-based Clubhouses (known as members). With new network-wide criteria implemented through Clubhouse International, Clubhouse programs across the United States will become better equipped to help their members 1) understand and adopt healthy lifestyle practices, 2) improve access to healthcare providers; and 3) be better able to navigate and participate in their healthcare system. Clubhouse International will implement a program that will transform Clubhouse engagement with members across the network in a way that significantly strengthens opportunity for improved health outcomes for our members and others outside the network. The program has two main components: • Strengthening the Clubhouse model and training to better serve members. • Improving opportunities for members to receive medical care and information.

Disruption

Mental illness often has the devastating effect of separating people from others in society. The Clubhouse offers a complete change in this perspective. It is designed to be a place where a person living with mental illness is not treated as a patient and is not defined by a disability label. At present, there are 190 Clubhouses in the United States, each serving as a local community center aimed at improving the overall wellness of its members. The program criteria and methodology used at all of these Clubhouses is established by the International Standards for Clubhouse Programs (TM), which are consensually agreed upon by the worldwide Clubhouse community, and define the Clubhouse Model of psychosocial rehabilitation. This work will build upon existing Clubhouse programming, ensuring that current and innovative best practices are highlighted and fully incorporated into all training, technical support and evaluations for Accreditation.

Leadership

Although the majority of members have some kind of insurance or entitlements that technically allow them access to healthcare, our studies demonstrate that there remain many challenges related to utilization and compliance. It is often difficult for members to set up, get to, or keep appointments. Barriers like stigma and discrimination from providers and other patients, poverty, lack of transportation, poor wellness education, fear, and lack of assistance often prevent members from getting early intervention. The program criteria and methodology used at all Clubhouses is established by the International Standards for Clubhouse Programs (TM), which are consensually agreed upon by the worldwide Clubhouse community, and define the Clubhouse Model of psychosocial rehabilitation. The International Standards for Clubhouse Programs (TM) (Standards) are the ‘Best Practices’ and value statement of the Clubhouse model. The Clubhouse model of psychosocial rehabilitation is included in the US National Registry of Evidenced-Based Programs and Practices (NREPP).

Scalability

This work will build upon existing Clubhouse programming, ensuring that current and innovative best practices are highlighted and fully incorporated into all training, technical support and evaluations for Accreditation. New resources will be developed for members that emphasize awareness, education and member guidance. In addition to setting a new standard on wellness promotion and member assistance for all Clubhouses, we will help facilitate a process through which they will be able to meet the mandate of the new requirements. Activities conducted will include the following: • Incorporate the standard and best practices into our Comprehensive Training Program. • Develop resources for training and follow-up. • Train the Accreditation Faculty to review and evaluate Clubhouse success at meeting all standards. • Create recommendations and action plans to help Clubhouses improve performance where needed. This will be done as part of our training and accreditation programs.

Results/Outcomes

a. Develop a comprehensive Clubhouse Wellness Manual (Toolkit) for use in all training and consultation programs. b. Organize annual teaching “institutes” highlighting best practices within Clubhouses based on wellness and healthy lifestyle programming. The institutes with be presented at our USA national conferences and our biennial World Seminar. c. Organize a series of webinars, each engaging 8-12 Clubhouses in an interactive educational program designed to help Clubhouses improve health-promoting activities and programs. d. Create self-evaluation criteria emphasizing the Clubhouse “culture of wellness.” e. Conduct an end of project assessment of Clubhouses regarding improvement in wellness related activities. f. Identify best practices for engaging and educating healthcare providers about the unique needs of people living with mental illness. g. Increase the number of activities and direct interactions with external health care providers. h. Increase wellness related data collection in our annual survey of Clubhouse Characteristics (Clubhouse Profile Questionnaire).