By Ralph Aquila, M.D.

Reintegration becomes a reality when we bring together state-of-the-art psychiatric treatment with good clubhouses. This year’s annual clubhouse conference powerfully drove that point home to 500 or so attendees of The Asian Clubhouse Conference 2004, held halfway around the world mid-November in Hong Kong. It was the first annual clubhouse conference ever held in Asia, and I was privileged to attend.

Phoenix Clubhouse, the first certified clubhouse in China, hosted the event in collaboration with the International Center for Clubhouse Development (ICCD) and The Hong Kong Association of Psychosocial Rehabilitation. Phoenix Clubhouse is organized under the auspices of the University of Hong Kong and the Queen Mary Hospital.

The conference reaffirmed that the clubhouse model, which originated in Fountain House in New York in 1948, works, whether it’s in North America, Europe, Asia or anywhere else. Over and over, we heard how the core values of the clubhouse model succeed by emphasizing the empowerment of members and respect for their choices.

About half the attendees of the conference were clubhouse members, and, as is often the case, the best moments came from the testimonies we heard from members in recovery. These people are working, going back to higher education or just getting ahead with their lives. Their stories are inspiring.

One such testimony came from Yumiko Sawada, from clubhouse Habataki Japan. Here’s what he said:

I have been mentally ill since I was a little child. While regularly going to the outpatient clinic and taking medicine, I finished Bible college and worked hard for many years. Then I stopped treatment–got so bad that I was re-hospitalized. I felt hopeless for five years. Then I joined clubhouse Habataki, and this made a great change in my life. After becoming a clubhouse member I got much better. I regained my memory, intelligence, confidence, and pride. I became cheerful and made many friends in the clubhouse. I was very glad and satisfied that I was trusted, thanked, and treated as a respected adult and worker.  I have gotten involved in more and more activities in the clubhouse. I now also carry responsibilities as a representative of the clubhouse. I would like to become a staff person at some clubhouse in the future. I’d like to help to expand the clubhouse model.

While most of the attendees were from Hong Kong, there were also participants from Japan, South Korea, and Australia, with guests from the U.S. But what was most striking about this clubhouse conference was the energy felt because we were in China. It’s a pretty well-known fact that, in many aspects, China represents the future, and, when it comes to the work-ordered day for consumers, few parts of the world show as much promise.

But the obstacles to be overcome in China are at least as great as other places. Stigma from mental illness can be very destructive, as we have seen here in the U.S., and,  it’s a particular problem in the Chinese culture. Denial there is an everyday occurrence, with services often not being provided at all. A remedy to that all-too-pervasive stigma is employment. Employment, as a rehabilitative tool, shows Chinese society that persons with mental illness can thrive and contribute. In fact, we’re seeing that employment as the antidote to stigma works well everywhere in the world.

When it comes to employment, it’s always important to hear what the employers have to say, and we were greatly encouraged. Of particular note were the presentations we heard from Michael Webb of Morgan Stanley, Hong Kong, and David Fleming of Baker & McKenzie, Hong Kong, whose companies make it a point to set up partnership programs with clubhouses throughout the world. The notion of a corporation partnering with a clubhouse and the rewards the companies reap from having members on site was compelling. Other Transitional Employment employers at the conference included Eli Lilly, Hong Kong Economic Times, Shearman & Sterling LLP, The Walt Disney Company, Hong Kong University, and Paul Hasting.

Holding the conference in China also pointed out other social and cultural nuances that affect consumers and their relationship to work. One interesting aspect for an American to learn about was the fact that Chinese consumers never had access to anything akin to Medicaid or SSI benefits. In the U.S., those benefits, before the law was changed in 2003, often acted as a disincentive for American consumers to find work. Work meant they would lose their benefits. Today, even with the new law, it’s an unfortunate fact that unwarranted fears often persist among American consumers that they will lose their benefits, and they therefore hesitate to join the work force. They have to be convinced that their benefits are protected. Chinese consumers, on the other hand, never had a fear of losing benefits, because they never had any to lose. For that reason, along with their inherent cultural industriousness, Chinese consumers show a very strong inclination to find work.

I was also very interested to meet the twenty psychiatrists at the conference who came from other parts of China, including Shanghai, Beijing and Chang Sha. Regardless of whether it was these prominent psychiatrists from their cities or a social worker from South Korea, all of them agreed that the clubhouse programs presented at the conference represent a very promising model for gaining recovery from serious mental illnesses.

Joel Corcoran, director of the ICCD, agrees that the clubhouse model can have a major impact on the future of mental-health services in Asia. “As this part of the world looks for solutions for recovery from mental illness, I believe our model fits in well with this culture,” he said.

What is most exciting about the clubhouse model is that it can be successfully replicated in other cultures.

As is customary for any clubhouse conference, we enjoyed a tour of the local clubhouse, Phoenix House. All of us were inspired by its beautiful décor and its very apparent energy.  Phoenix House currently has about 103 active members, with a daily attendance of about 50.

There is much excitement about the expansion of clubhouses in China—excitement mixed with concrete actions. In one example, just after the conference ended, a preliminary agreement was signed for the establishment of a non-government organization (NGO) to start a clubhouse in Shanghai.

I thank my hosts in China for their wonderful hospitality and thoughtful insights. 

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Dr. Aquila is executive director of the Center for Reintegration and chairman of the Reintegration Today editorial board.