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Finland’s Clubhouse StudyReport 2009

Data collected in years 2004 - 2006

14/09/09 Esko Hänninen, Helsinki, Finland 1

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The Clubhouse is not one-idea model

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• Clubhouses are consisting of several components bringing in the positive outcomes for persons recovering from mental illness.

• Clubhouses are linking the integrative rehabilitation pathway from dependency to independent living.

• Since 1980s the scientific community has produced a growing evidence on the positive impacts of the CH model (e.g. UMASS, Worcester USA, data on R&D findings).

• Finnish study report 2009 confirms the previous research findings.

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The Finnish Research Team

• Hietala-Paalasmaa Outi

• Hujanen Timo

• Härkäpää Kristiina

• Reuter Anni

Study covers:

18 Clubhouses in Finland in 2004

2630 CH Members

Living in 92 Finnish Municipalities

Research Data were collected in years 2004 - 2006

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Finland’s 18 CHs in 2004

Are owned by 5 municipalities/cities 3 CHs 1 Espoo Diaconia Foundation 1 CH 12 NGOs in mental health or related fields 14 CHs

And financed by Gambling profit, collected by RAY (Finnish Slot

Machine Association) Allocated annually by the Ministry of Social Affairs and

Health to NGOs & Foundations 46 Finnish Municipalities/Cities

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Population Served by CHs in Finland

Population (N)

• Less than 25.000

• 25.000 – 100.000

• More than 100.000

Clubhouses

3 16.5 %

8 44.5 %

7 39.0 %

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Participation rate in CH Activities

Attendance

• Daily• 2 - 4 times in week• Once in week• 1 – 3 times in

month• Non-active

members (attending less than one visit per month)

Percentage

8 % 17 14 17 44

(56 % of all were active

members in 2004)

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Members’ Age in Finnish CHs

Age groups

• 18 – 24• 25 – 34• 35 – 44• 45 – 54• 55 – 64• 65 +

Percentage

4 % 24 % 29 % 26 % 15 % 2 %(53 % of all members

belong in age group 25 – 44)

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Growth of TE placements in Finland

Years

• 1997• 1999• 2001• 2004• In 2008

CH Members in TE

4 26 87 101 (TE jobs

69)

circa 200 ??? Ville ?

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The Components of a Clubhouse

Work Day in the CH Peer Support Supported Education and

Training Employment Programs

TE, SE, IE Housing Support Case Management Evening, Weekend and

Holiday Programs Quality Assurance &

Certification process

Outreach Advocacy for People with

Mental Illness (including research)

Health Promotion Activities

Administration and Management of the Clubhouse

Supporting the Development of Other Clubhouses

(All these components are identified in Finland’s CHs)

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Main Findings of the Follow Up Studyin FINLAND, published in March 2009

→ General well-being of Clubhouse participants/members developed positively during the 3-years follow-up.

→ Use of mental health and other health care services decreased in average about 50 % during the follow-up period.

→ Both the amount of hospital days and the costs of hospitalization decreased 75 % (costs in average from EUR 2060 to EUR 480) during the participation in the Clubhouse activities.

→ The total costs of all services used by Clubhouse members decreased from the level of EUR 2710 to EUR 990 in average .

→ The outcomes of this Finnish study confirms the similar findings of many earlier studies, which has been published since 1980's.

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Development Needs Reported by CHs

• Organizing the Transitional Employment is a continuous challenge for many CHs

• Content of the work-ordered day

• Need for increase of staff

• Financing problems – more money….

• Certification

• Free-time programs

Integrative Pathway from Dependency to Independent Living

Clubhouse as Learning Community

• Psychosocial rehabilitation• Work-ordered day • Pre-training / learning to learn / Computer skills etc.• Peer support

Individual Empowerment Process

Mental Health servicesSupported education & training. Transition to and employment in the open labour market

Psychiatric Medical care and

treatment

FunctionalRehabilitationDay Centres

Other activities

Supportededucation &

training

EmploymentTransitional Supported

Independent

Clubhouse

• Social skills• Education & Employment Programmes

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Classification of Clubhouse Research Outcomes

Type ofEvidence on the participa-tion inthe CHactivities

Class I Class II Class III

Benefit>>>Risk Benefit>Risk Risk>Benefit

Multiple randomized clinical trials (RCT) or Single site RCT’s with matched participants

CH Services & Support SHOULD be performed and offered, becauseadvantages of active participation in Clubhouse activities are e.g.

IT IS REASONABLE to provide Clubhouse services because they have positive impacts on e.g.

No additional studies needed. Service should NOT be offered, IT IS NOT HELPFUL & MAY BE HARMFUL

• Less hospital care ++ • Outreach ++• Quality of Life ++• Satisfaction ++

• No this category

findings on CH model

ObservationalStudies

• Employment +• Social Relations +• Social Inclusion +

• No this category findings on CH model

Expert consensus or testimony by experienced individuals

• Education + (Source 2009:

• Work-ordered day + Colleen McKay,

• Wellness + UMASS Medical School

• Housing + Worcester MA USA)

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Clubhouse Development in Europe

Esko Hänninen 15

Existing European Clubhouses – 90 Clubhouses in 18 countries

About 90 Clubhouses serving over 11000 members annually

Albania 1Austria 3

Denmark 6England (?) 17

Estonia 1Finland 22

Germany 3Iceland 1Ireland 4

Italy 1Kosovo 1

Macedonia 2Netherlands 1

Norway 3Poland 2

Romania 1Russia 4

Scotland 7Sweden 9

TOTAL 90

14/09/09

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Europe is divided in the use of CH model:

• Best CH practice countries have included CHs in their Government Mental Health Policy, e.g. Finland, Sweden Denmark, Iceland, Norway and Scotland/UK;

• In 13 other countries in Europe CHs are approved but not actively promoted;

• In the 35 other WHO – Europe countries CH model is not used and decision-makers are not aware about the CH integration & inclusion possibilities;

The strategic goal the experienced Clubhouse countries start to transfer their positive outcomes for use in other European countries!

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CLUBHOUSES ARE PART OF SOCIAL SERVICE SYSTEM

• CHs belong to the Community Mental Health services & cooperate with relevant stakeholders

• CHs work together with Companies & Employers, and Education, Housing, Employment, and Social Security Benefit Agencies

• CHs follow the Community-Based Rehabilitation (CBR) approach, recommended jointly by the WHO, UNESCO and ILO (1990s & 2004 & 2008) www.who.int/en/disability/cbr

• Continuous Improvement of Clubhouse Activities is supported by ICCD - The International Center for Clubhouse Development (e.g. Training, Standards, Quality Assurance & Certification) www.iccd.org

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European Partnership for Clubhouse Development - EPCD

(was created in March 2007 in Stockholm City Hall in the ELECT partners’ meeting)

The overall goals of the EPCD will be to

• Improve the social inclusion, education and labour market integration of people with mental health problems by enlargement of the net of European CHs.

• Promote and coordinate the European research on the Clubhouse model.

• Next phase is permanent formal organisation for the EPCD.

• Strategic Choice: 1 – 2 EPCD Office in Europe or should we create Alliance with some existing one?

• Do we open EPCD as a collaborative network of all interested parties and actors?

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1914/09/09 Esko Hänninen, Helsinki, Finland 19

www.elect-project.eu

ELECT is a consortium of 11 partners from 7 EU countries & ICCD, USA

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Additional Information in websites:

ICCD: www.iccd.org

CBR (WHO, ILO & UNESCO): www.who.int/en/disability/cbr

ELECT-project: www.elect-project.eu

Helsinki Clubhouse: www.helsinginklubitalo.org

Esko Hänninen, Coordinator of the EPCDe-mail: hanninen.esko@gmail.com

Tel (gsm): +358 40 503 7095 (Finland)