1. 1 Finland’s Clubhouse Study Report 2009 Data collected in years 2004 - 2006 14/09/09 Esko Hänninen, Helsinki, Finland 1

2. 2 The Clubhouse is not one-idea model _______________________________________________________________________________________________ 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.

3. 3 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

4. 4 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

5. 5 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 %

6. 6 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)

7. 7 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)

8. 8 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 ?

9. 9 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) 14/09/09 Esko Hänninen, Helsinki, Finland9

10. Main Findings of the Follow Up Study in FINLAND, published in March 2009

11. 11 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

12. 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 services Supported education & training. Transition to and employment in the open labour market Psychiatric Medical care and treatment Functional Rehabilitation Day Centres Other activities Supported education & training Employment  Transitional  Supported  Independent Clubhouse Social skills Education & Employment Programmes

13. 13 Classification of Clubhouse Research Outcomes Type of Evidence on the participa- tion in the CH activities Class IClass IIClass III Benefit>>>RiskBenefit>RiskRisk>Benefit Multiple randomized clinical trials (RCT) or Single site RCT’s with matched participants CH Services & Support SHOULD be performed and offered, because advantages 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 Observational Studies 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)‏ 14/09/09 Esko Hänninen, Helsinki, Finland13

14. 14 Clubhouse Development in Europe

15. Esko Hänninen 15 Existing European Clubhouses – 90 Clubhouses in 18 countries About 90 Clubhouses serving over 11000 members annually Albania 1 Austria 3 Denmark 6 England (?) 17 Estonia 1 Finland 22 Germany 3 Iceland 1 Ireland 4 Italy 1 Kosovo 1 Macedonia 2 Netherlands 1 Norway 3 Poland 2 Romania 1 Russia 4 Scotland 7 Sweden 9 TOTAL 90 14/09/09

16. 16 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! 14/09/09 Esko Hänninen, Helsinki, Finland16

17. 17 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 www.who.int/en/disability 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 www.iccd.org 14/09/09 Esko Hänninen, Helsinki, Finland17

18. 18 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? 14/09/09 Esko Hänninen, Helsinki, Finland18

19. 19 14/09/09 Esko Hänninen, Helsinki, Finland19 www.elect-project.eu ELECT is a consortium of 11 partners from 7 EU countries & ICCD, USA

20. 20 14/09/09 Esko Hänninen, Helsinki, Finland20 Additional Information in websites : ICCD: www.iccd.orgwww.iccd.org CBR (WHO, ILO & UNESCO): www.who.int/en/disability/cbr www.who.int/en/disability ELECT-project: www.elect-project.euwww.elect-project.eu Helsinki Clubhouse: www.helsinginklubitalo.orgwww.helsinginklubitalo.org Esko Hänninen, Coordinator of the EPCD e-mail: hanninen.esko@gmail.com Tel (gsm): +358 40 503 7095 (Finland)‏