A Pound of Cure…

by Richard Edwards

This morning, at my church, we did a small, share-the-plate fundraiser for a local non-profit service provider to persons with mental illness, specifically, a psychosocial rehabilitation setting.

Psychosocial Rehabilitation settings–PSRs (warning: pdf)–or clubhouses, as they are commonly called, provide a daytime setting in which individuals with significant mental health issues can find support. Typically, and in the case of this provider, they are provided in concert with other services, such as supported employment, or even supported residential apartment settings.

Sounds positive, right? In this case, it is–the people who work there are compassionate and committed, and they have undoubtedly had a positive impact in the lives of many, many people. But here’s where it goes wrong–in the words of one of its own board members (paraphrased, but not by much), “People with mental illness need clubhouses like this one because they do not feel comfortable in the community.”

That’s where the wheels come off the wagon, as far as I’m concerned, for PSR models. They are, essentially, congregate service settings. They are a place to go. And they are a workaround to the central problem, which is–that people with mental illness do not feel comfortable interacting with the community, because they are not welcome in the community. And because PSRs are congregate settings–they will never in a million years solve that problem.

Instead of talking about creating places in the community where people with mental health issues–and indeed, this could apply to all people with disabilities–feel welcome, my angle is that we should be creating communities where people are included. It is only when people have access and are expected to participate in the life of the community that they can truly be members of that community.  Location is not the same as membership.

But that’s just my angle…what are your thoughts?


One Comment to “A Pound of Cure…”

  1. While I agree that it would be ideal of we all could have full access to every part of the community, being a member of a “club” is a common component of all communities. Where it gets complicated is when the “club” is no more than a euphemism for a congregate setting. PSR’s can truly be “clubhouses” if there are reciprocal relationships between the members and the community. For example, when the PSR members contribute to the well being of others and are seen as valuable by the community in general, then their “club” is no different than the Rotary or the Junior League. Members are valued for their contributions. I have seen this work; unfortunately, it is not the norm for PSR’s. But why not? Maybe the change started when PSR’s had to adopt a medical model to bill Medicaid. I remember the time when the state funded PSR’s, allowing freedom to develop each program in response to member’s needs and those of the community. The clubhouse in Henderson had a catering business and many weddings and other events were held at their “club,” which was a beautiful antebellum house. They bought the house with money made from their various enterprises. I think it is called social entrepreneurship, which was not a term when they were in existence.

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