Malinda Sanchez suffers from schizophrenia. Once a student services coordinator at a local high school, she struggled to hold down a job. She has received monthly disability income since the 1990s.
Today, she spends her days in the kitchen cooking meals for staff and members of the San Antonio Clubhouse, a self-help program for adults with a history of mental illness where they volunteer to work, keeping the building and organization running.
"[It's] fun and helps calm me down,” Sanchez said. "[And I don't] have to worry about losing my job" should she have a psychotic episode.
The daily activity of a Clubhouse is organized around community work: preparing meals, maintaining the building, running a snack bar and coffee operation, and producing promotional materials for the nonprofit. The philosophy behind Clubhouse International, the accreditation body for Clubhouses throughout the world, is that work is a common denominator in society and that people, regardless of their disabilities, feel value in being productive.
The hoped-for payoff is that members will thrive on their sense of belonging and feeling needed, which in turn helps control symptoms of their mental illness.
Mark Stoeltje, the San Antonio Clubhouse's executive director, said the program works because helping people with mental health issues build confidence is more effective than simply treating a diagnosis.
While a history of mental illness is the only criterion for Clubhouse membership, a person’s diagnosis is never a point of focus. There are no therapists or psychologists on staff. Participants are called members (rather than patients or clients) and volunteer their time working alongside paid Clubhouse staff members.
“We treat people like people instead of like something is wrong with them,” Stoeltje explained. “When you treat people with dignity and respect, it’s a really healing thing.”
Linda Williams has been a Clubhouse member for almost four years. Before joining, she was in and out of hospitals and treatment programs, she said, struggling to manage symptoms of obsessive-compulsive disorder and schizoaffective disorder, which may cause hallucinations, delusions, and mania.
Williams feels comfortable at the Clubhouse because no one talks about mental illness; instead, the emphasis is on feeling good and being productive.
“Here, people focus on what you can do and what you can contribute," she said. "You are not being told every day that you have this diagnosis, or this is what you can and cannot do because of your mental illness.”
A 2016 analysis in a medical journal found that Clubhouse members worldwide experience lower re-hospitalization rates, improved social relationships, fewer encounters with law enforcement, and improved quality of life as a result of their participation.
Stoeltje said that members may have a history of abuse in addition to a history of mental illness, and have been in and out of hospitals where they may not have been treated with respect.
"When they come here, oftentimes they are pretty broken," Stoeltje said. He said that people who go to the Clubhouse are looking for human connection and understanding, as opposed to more typical case management services, which includes medication management and symptom analysis. "Unless we have a reason to go look in someone's file, we don't know what their diagnosis is," Stoeltje said.
There are more than 320 Clubhouses worldwide, with six in Texas and one in San Antonio, located in a spacious, two-story building near the Medical Center.
“We started with nothing, and now we are one of the largest Clubhouses in the United States,” with up to 60 members participating on a given day, Stoeltje said.
At the San Antonio Clubhouse, it’s hard to differentiate the 10 paid employees from the members who attend the program as volunteers. There is a constant flurry of activity as members busily shuffle between rooms with task boards in hand, checking off items on their to-do lists.
Each day begins with a hot breakfast, followed by announcements and roll call, where members are assigned tasks within their work department, each led by a staff member helps keep the unit on task.
“Each unit has its own specific mission,” said Clubhouse staff member Kylie Clark. “If ... the three units do exactly what they are supposed to do ... when we leave at night the floor has been cleaned, the phone calls have been returned, grants written, emails returned, and everything is taken care of by the time we lock the door.”
Clark said that part of his role is being a cheerleader for the members of his unit. And while he helps organize and assign tasks in order to “keep the train on the tracks running the right way,” it’s the members who keep the Clubhouse going.
"Every day I have a different task, and it [helps] me accomplish little things," said Ben Stone, who battled major depression prior to becoming a Clubhouse member. "Everyone is trying to help each other get somewhere.” It's an approach that he said is unique to the Clubhouse compared to other mental health treatment programs.
People with mental health issues tend to isolate themselves and withdraw from their support system, Stoeltje said, but at the Clubhouse, giving members tasks to complete helps them see that “being around other people is a healing thing.”
In the general operations department, members may work in maintenance or in the kitchen, where they cook breakfast and lunch, which members can purchase five days a week for $1.50. Sanchez said concentrating on the task of preparing a meal for the group twice a day prevents her from focusing too much on racing thoughts and dramatic shifts in emotion.
Members who work in the media lab create all of the San Antonio Clubhouse’s marketing materials and merchandise, including T-shirts that are screen-printed in-house.
Williams, who has a bachelor’s degree in photography, has gained new computer program skills and improved her graphic design skills at the Clubhouse; she works to pass her knowledge on to others, which she says is key to keeping the Clubhouse running efficiently. It creates a “very accepting, very equal environment where people are always building each other up,” she said.
All Clubhouse members may do any of the work assigned to paid staff, and as they become more involved in the program they may also be selected to serve on the board of directors or on committees geared toward improving the program. Williams currently sits on the board.
The Clubhouse gives its members the opportunity to suggest and pursue their own initiatives, Clark said, which has led to the inclusion of a comics section in the staff newsletter and the creation of Clubhouse Coffee, a coffee sales venture that benefits the Clubhouse.
A conversation about how to start a small business turned into a member-run entrepreneurship that included on-site research at Big Bend Roasting Co., a coffee grower in Marfa, whose beans won a blind taste test in which members tasted several different blends to determine which one Clubhouse Coffee would package and sell. On any given day at the Clubhouse, members work grinding and packaging the beans, preparing them for delivery.
Through participating in a nurturing community that builds on people’s assets, Williams says she has become a stronger, better person. “I am able to see the goodness in me that I wasn’t able to [see] before.”