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NIMBY STRIKES A CLUBHOUSE: A CASE STUDY OF HOW
A SETTING FACILITATED AN EMPOWERING EXPERIENCE
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NIMBY STRIKES A CLUBHOUSE: A CASE STUDY OF HOW A SETTING
FACILITATED AN EMPOWERING EXPERIENCE

By

Tiffeny Reyleen Jimenez

A THESIS
Submitted to
Michigan State University
in partial ﬁﬂﬁllment of the requirements
for the degree of
MASTER OF ARTS
Department of Psychology

2007

Deborah Salem, Ph.D.

ABSTRACT

NIMBY STRIKES A CLUBHOUSE: A CASE STUDY OF HOW A SETTING
FACILITATED AN EMPOWERING EXPERIENCE

By
Tiffeny Reyleen Jimenez

This study sought to understand the impact of a Not in My Backyard (N IMBY)
response on the personal recovery processes of members of a clubhouse for people with
mental illnesses. Qualitative methods were used to gain an in depth understanding of the
experiences of clubhouse members. The sample included two different types of members:
1) members who were actively involved in the NIMBY response, and 2) members who
were involved routinely in the clubhouse at that time but not actively involved in the
NIMBY response. Inductive content analysis was used to identify themes and patterns
across and within participants’ stories. Results show that members who were actively
involved in the NIMBY response had very personal connections to the clubhouse and
were quite negatively impacted by the initial NIMBY response. NIMBY active members
demonstrated feelings of empowerment in the end. NIMBY active members identiﬁed
ﬁve contextual elements facilitated by the clubhouse that contributed to their empowering
experiences over time. These elements included: 1) taking action in response to NIMBY,
2) feeling support: knowing they were not alone, 3) keeping informed about NIMBY, 4)
maintaining business as usual, and 5) staying focused on positives. Members who were
not actively involved in the NIMBY response did not have similar experiences as those
who were actively involved. Findings discuss the importance of settings that build

strength, foster understanding, and facilitate leadership for people with mental illness.

TABLE OF CONTENTS

LIST OF TABLES .............................................................................................................. v
LIST OF FIGURES ........................................................................................................... vi
INTRODUCTION .............................................................................................................. 1
LITERATURE REVIEW ................................................................................................... 5
Research Questions .................................................................................................. 37
METHODS ....................................................................................................................... 37
Values, Biases, and Assumptions of the Researcher ................................................. 37
Setting Description .................................................................................................... 41
Participants ............................................................................................................... 42
Design and Use of Qualitative Methods ................................................................... 44
Measurement: Semi-structured open-ended interviews ............................................ 44
Procedures ................................................................................................................ 45
Recruitment ............................................................................................... 45

Interviewing .............................................................................................. 47

Methods of Analysis and Interpretation .................................................................... 48
Cross-case Analysis .................................................................................. 48

Within-case Analysis ................................................................................. 50

Authentication of the Data ........................................................................ 51

Saturation .................................................................................................. 53

RESULTS ............................................................................................ 54
Summary of Main Findings ...................................................................... 54

Impact of the NIMBY Response on Members’ Recovery: In the Beginning. . . . . ........54
Possible Reasons Why Differential Experiences of NIMBY in the Beginning... . . . . . .58

Direct & Indirect Exposure to the NIMBY Response... ... ....58
Members’ Individual Relationships with Clubhouse Prior to NIMBY ................ 59
The Impact of the NIMBY Case on Members in the End ................................. 73
Impact of NIMB Y on Active Members in the End ...................................... 73
NIMBY Active Members' Experiences in the End: Empowerment Perspective....77
Impact of the NIMB Y Case on Clubhouse Involved Members in the End ......... 79
How the Clubhouse Assisted Members through the NIMBY Case over Time ......... 81

How the Clubhouse Assisted NIMBY Active Members over Time... ...83
Experiences of Clubhouse Involved Members over Time: A Contrast... ...96
An Anomalous Case... .....97

DISCUSSION ....................................................................................... 99
The Impact of NIMBY on Members in Recovery in the Beginning .................... 100
The Impact of the NIMBY Case on Member’s Recovery in the End ................... 102
How the Clubhouse Assisted Members throughout the NIMBY Case .................. 104

The Clubhouse as an Empowering Organization... 105

iii

The Importance of Closely Examining NIMBY Protests against Clubhouses. . . . . ....1 10

Limitations ...................................................................................... 1 12
Implications for Settings and Future Research ............................................. 114
APPENDICES ................................................................................................................ 119
A. Member Interview Protocol ......................................................... 119

B. Staff Interview Protocol .............................................................. 125
C. Recruitment Letter to Active Members ............................................. 127

D. Recruitment Letters to Clubhouse Involved Members ........................... 129

E. Member Study Consent Form ....................................................... 131

F. Staff Study Consent Form ............................................................ 133

G. NIMBY Active Members: Open Coding .......................................... 135
H. NIMBY Active Members: First Framework ....................................... 138

I. NIMBY Active Members: Additional Coding Framework ....................... 141

J. NIMBY Active Members: Final Framework Prior to Revisions ................ 143
K. Clubhouse Involved Members: Open Coding ..................................... 149

L. Clubhouse Involved Members: Initial Framework ................................ 151

M. Clubhouse Involved Members: Final Framework Prior to Revisions ......... 153

N. Final Framework of Results Section ................................................ 155
REFERENCES ............................................................................................................... 167

iv

LIST OF TABLES

Table 1: Participant Demographics ................................................................................... 43

LIST OF FIGURES

Figure 1: NIMBY Active Members’ Shared Experiences of the NIMBY Case over
Time ................................................................................................. 163

Figure 2: Clubhouse Involved Members: Little reaction to the NIMBY Case over Time
......................................................................................................................................... 1 64

Figure 3: Clubhouse Involved Members: No reaction to the NIMBY Case over Time
....................................................................................................................................... . 1 65

Figure 4: Clubhouse Involved Members: No negative reaction to the NIMBY Case but
Increased Involvement in Clubhouse .............................................................................. 166

vi

INTRODUCTION

The impact of stigma on people with Severe Mental Illness (SMI) is becoming
increasingly recognized as a pervasive and signiﬁcant social problem (Corrigan, 2002,
2005; Hinshaw and Cicchetti, 2000; Matorin, 2002; Perlick, Rosenheck, Clarkin, Sirey,
Salahi, Streuning, and Link, 2001; US. Department of Health and Human Services,
1999). It has been demonstrated repeatedly over the years that stigmatizing attitudes can
have a damaging effect on the social functioning and recovery of people with SMI
(Corrigan, 1998; Corrigan & Penn, 1999; Pink and Tasman, 1992; Markowitz, 1998;
Ralph and Corrigan, 2005; Struening et al., 1995; Wahl, 1999). The rise of community-
based rehabilitation programs has been based on the expectation that the recovery of
people with SMI would be supported by local communities, yet stigmatizing attitudes
towards psychiatric symptoms within the United States persist (Link, 1987; Phelan and
Link, 1998; Rabkin, 1974; Roman & Floyd, 1981), and in some cases are on the rise
(Phelan, Link, Stueve, & Pescosolio, 2000), leading to various venues of protest and
social discrimination.

Service providers and mental health consumers have increasingly been
acknowledging and emphasizing the importance of consumer empowerment and self
determination in promoting recovery and community integration (Chamberlin, 1978;
Corrigan, 2002; Frese and Davis, 1997; Hinshaw and Cicchetti, 2000). This knowledge
has contributed greatly to an understanding of how best to structure and provide services.
Recovery from mental illness is not only about learning to deal with symptoms of a
disorder, but also entails learning to work with the effects of social and self-stigma

(Corrigan, 2002). In order to combat some of the social issues surrounding having a

mental illness, and sometimes due to certiﬁcation requirements, mental health services
are moving away ﬁ'om traditional mental health provider sites and branching out into
communities where consumers can work towards full community integration by learning
within social environments (MDCH/MSU, 2000).

In response to negative public attitudes, stigma, discrimination and other barriers
to attaining a satisfying community lifestyle, consumers of mental health services began
creating consumer-driven services to meet their individual needs (F rese & Davis, 1997).
In these settings they can become involved in a number of opportunities such as gaining
vocational assistance, skill building, feeling a sense of belonging, feeling accepted, and
gaining a sense of personal power (Beard, 1982; Murphy, 1998). With the beneﬁts
emphasized by the empowerment of people with SMI (Corrigan, 2002), and the positive
responses provided by consumers of those services (Murphy, 1998), these consumer-
driven services appear to be some of the more beneﬁcial services available today. Yet
even today, these organizations are being protested and discriminated against by local
community members.

A recent trend in the delivery of community mental health services has been the
expansion of sites to more accessible locations in order to be more convenient for
consumers, and to create a more natural experience of rehabilitation (MDCH/MSU,
2000). This involves placing services in more social and residential neighborhoods. There
then becomes a problem between the mental health facility and the neighborhood they’re
moving into when that community endorses the stigma of mental illness (Corrigan,

2002). When a mental health facility is placed in their ideal location, the community may

respond with resistance. This resistance is often called the “Not In My Backyard
(NIMBY) Syndrome” (Dear, 1992; Gilman, 1985).

The NIMBY syndrome is steeped in varying stages of prejudice and
discrimination. Much of the literature on NIMBY and social services has focused on the
affects of NIMBY on the organization or public agency involved. The literature reports
that some facilities have been closed due to the withdrawal of tax dollars, and that
organizations can experience various ramiﬁcations due to lawsuits against facilities
(Dear, 197 6; Dear, 1986; Dear, 1992; Enos, 1991). These organizational problems lead to
a lack of available services for consumers, which means they may be inconvenienced in
order to reach services or even completely out of options for needed services. For these
reasons, cases of NIMBY concerning human service facilities can have detrimental
effects on client well-being (Dear, 1992). An aspect of client well-being that has not been
addressed by the literature on NIMBY and human services is the affect that NIMBY can
have on the individuals who are members of organizations that are consumer-run.

The recent shiﬁs in the ideological focus of human services have gone from
professionals serving clients to consumers serving themselves in organizations
considered consumer-run services (Frese and Davis, 1997). Human services fall
somewhere on a continuum between these two extremes and clubhouses are considered to
be consumer-driven because of the critical role that staff play in their services. The
purpose of this type of an organization is that members come to feel a sense of
empowerment. Members of these organizations experience a special type of relationship
with the organization. They ideally feel a sense of ownership in the organization, and a

sense of power over the services available to them. In a consumer-driven organization,

members help design the services their facility makes available to them and others
depending on their personal needs for recovery. This synthesis between consumer needs
and organizational services is creating a more personal and empowering environment for
consumers. There is a possibility, however, that a NIMBY response1 from a community
could be impacting members more personally when those organizations are attacked;
possibly creating a more intense negative or positive impact on a person’s process of
recovery if and when stigma and discrimination strikes. The extent to which members are
actively involved in a NIMBY case2 could also play a role on the impact of NIMBY on
their recovery.

Over the last 30 years we have come to recognize the NIMBY syndrome with
regard to people with SMI (Dear, 1992), and although we know that there are a few
studies in the literature that has qualitatively examined community responses of NIMBY
on human services designed for people with SMI, they have chosen to focus on
community attitudes (Robert Wood Johnson Foundation, 1990; Solomon and Davis,
1984; Piat, 2000). Currently, there is no literature that seeks to understand the effects of
the NIMBY phenomenon on the recovery of organizational members experiencing these
discriminatory responses.

In order to ﬁrlly understand the impact of NIMBY on members of consumer-run
organizations it is important to then look towards the subjective experience of the stigma
and discrimination that people with SMI experience. Members of consumer-driven

organizations utilize those services in order to assist them through the process of

 

' The use of the term “NIMBY response” is used to describe the initial reactions that a community or group
has in response to the placement of something that they do not want in their neighborhood.

2 The use of the term “NIMBY case” is used very generally to describe the ongoing discussions, actions,
and legal proceedings that continue on after an initial response occurs. A case can very ﬁ'om situation to
situation.

recovery, and recovery from SMI entails dealing with the affects of stigma. How
members have responded to this community issue may say something for how clubhouses
can deal with these types of community responses in the future.

The focus of this study is to understanding more about the direct effects of
stigmatizing attitudes and discrimination people with SMI are faced with in organizations
they may personally identify with and their responses to it. This study explores: 1) how
the NIMBY response impacted persons in the process of recovery from SMI and 2) how
the clubhouse assisted members in dealing with the NIMBY response and throughout the
NIMBY case over time.

LITERATURE REVIEW

To understand why examining the experience of stigma and discrimination of a
NIMBY situation for consumer-driven organizations is important; we must ﬁrst
understand the role that consumer-driven organizations play in the lives of their
consumers. In order to gain this knowledge, this literature review will explore: the effects
of stigma and discrimination on recovery, the potential effects of active citizen
participation on recovery, the role of Psychosocial Rehabilitation clubhouses in the
recovery of people with SMI, and what we currently know about the NIMBY
phenomenon. This review will lead us to better comprehend why it is important that we
bring to light the experience of discrimination in a NIMBY protest against a Psychosocial
Rehabilitation clubhouse.

Effects of Stigma and Discrimination on Recovery
Over the last decade and through the consumer movement there has been a

paradigm shift in the way mental health service providers perceive, treat, and design their

services for people with serious mental illness. One of the major changes is the increased
concentration on a more consumer focused understanding of the mental health consumer
and identifying their needs for recovery within the community. Even the Unites States
Surgeon General’s report on mental health made recovery a guiding principle in it’s
initiatives in 1999 (U .S. Department of Health and Human Services, 1999). Not too long
ago it was thought that recovery ﬁ'om a mental illness was not possible. We have come to
understand the concept of recovery in more depth because people with serious psychiatric
disorders are coming forward to educate professionals and others of the fact that recovery
is possible for a person with a mental illness (Ralph and Corrigan, 2004).
Deﬁning Recovery

For people recovering ﬁ'om mental illness, recovery focuses more on the process
of self acceptance and learning to live with their illness (Deegan, 1993; Ralph and
Corrigan, 2004, Corrigan, 2005; Frese and Davis, 1997; Davidson et al., 2005; Matorin,
2002). This is different ﬁ'om the more traditional, and professionally deﬁned, sense of
recovery where the emphasis is placed more on particular outcomes where a person
might expect to return to some premorbid state (Deegan, 1993; Ralph and Corrigan,
2004). The outcome of recovery from SMI cannot be perceived in the same manner as
being cured (Liberman and Kopelowicz, 2005). In fact, some consumer-survivors feel
that the experience of a mental illness and the stigma attached to it makes it impossible
for them to ‘recover’ in the more traditional sense (Walsh, 1996). When attempting to
deﬁne recovery ﬁ‘om SMI, it is difﬁcult to separate the ideas of process and outcome
because “they are always in dynamic interaction with one another” (Liberman et al.,

2005,p.106)

In an article written by two psychologists who are recognized as professionals and
consumer-survivors, Frese and Davis (1997) tell us that, “Recovery is best understood as
a process, not an outcome.” (p. 244) To get other perspectives, in another article
examining qualitative studies of recovery from the perspective of people with SMI,
Davidson, Sells, Sangster, and O’Connell (2005) found through thematic analysis that:

Recovery involves a redeﬁnition of one ’s illness as only one aspect of a

multidimensional sense of self that is capable of identifying, choosing, and

pursuing personally meaningful goals and aspirations even when continuing to

experience the effects and side eﬂects of mental illness. (p. 150)

These deﬁnitions of recovery from the perspectives of people with SMI help us begin to
gain a deeper understanding of the multifaceted nature of recovery from SMI. In efforts
to demystify the process of recovery from SMI we can turn to the literature to identify
some of its more salient dimensions.

Understanding the Process of Recovery

Much of our understanding about the recovery process for people with SMI
comes from the writings of consumers and much of the early literature in this area
focuses on individual case reports of recovery experiences (Ralph and Corrigan, 2005).
The increased interest in the process of recovery in the literature is pulling those pieces
together. This has lead to more overarching efforts to empirically understand the process
of recovery which has lead to literature reviews and more formal qualitative analyses.

With the goal of deﬁning recovery for future measurement purposes, the Center
for Mental Health Services formed a group of consumer leaders called The Recovery
Advisory Group (Ralph & Recovery Advisory Group, 1999). This group met every

month for a year through teleconferencing to discuss their personal experiences with

recovery, while also considering the literature on recovery. The end result of their efforts

was a recovery model that describes the model of recovery. This model displayed the
point that recovery could be thought of like a spiral continuum that spanned eight stages:
1) anguish, 2) awakening, 3) insight, 4) action plan, 5) determination to be well, 6) well-
being, 7) empowerment, and 8) recovery. They thought that the spiral was most
appropriate in representing the process because they could ﬁnd themselves slipping in
and out of any stage at any day. They also felt that this process was experienced both
internally and externally. Their internal experience of recovery could be at any stage
depending on what was happening with them cognitively, emotionally, spiritually, and
physically. Their external experience depended on what was happening in their
interactions with others: activities, self-care, social relationships, and social supports. It
was also emphasized in a discussion of this study that external inﬂuences should be
considered highly in ones process of recovery, because negative outside inﬂuences (such
as discrimination, prejudice, and stigma) can severely deter recovery (Ralph and
Corrigan, 2005). Given this point, it is possible that negative social interaction within
communities, such as a NIMBY experience, can impede on one’s process of recovery.
Consistent with this work, in a literature review of the recovery literature done for
the U. S. Department of Health and Human services, Ralph (1999) reviewed personal
accounts of recovery. The authors identiﬁed four dimensions of recovery (Ralph, 2000):
1) Internal factors, 2) Self-managed care, 3) External factors, and 4) Empowerment.
Internal factors included experiences felt within the consumer, self-managed care
included how consumers coped with barriers in managing mental health, external factors
included the absence of people in their lives adhering to stigmatizing beliefs, and

empowerment included an interconnectedness of all the above dimensions that

contributes to an increase in their desire to care for themselves. What is similar about the
conclusions of these two inquiries, and is the key point, is that throughout the delicate
process of recovery there is a reciprocal relationship between a person’s internal mental
health and their social enviromnent (Jacobson and Greenly, 2001). This is what leads to
the consideration of the impact of stigma and discrimination on a person’s mental health
while undergoing a process of recovery.

In a very rich qualitative analysis of personal accounts of recovery from four
women with psychiatric disability, Ridgeway (2001) identiﬁed eight themes from their
narratives that included: 1) recovery is the awakening of hope after despair, 2) recovery is
breaking through denial and achieving understanding and acceptance, 3) recovery is
moving ﬁ'om withdrawal to engagement and active participation in life, 4) recovery is
active coping rather than passive adjustment, 5) recovery means no longer viewing
oneself primarily as a person with a psychiatric disorder and reclaiming a positive sense
of self, 6) recovery is a journey ﬁ'om alienation to a sense of meaning and purpose, 7)
recovery is a complex and nonlinear journey, and 8) recovery is not accomplished alone;
the journey involves support and partnership. Not surprisingly, this analysis comes to
similar conclusions as the two previously cited works, in that internal mental health is
directly related to our social environments, but it provides a more descriptive account of
how our social networks and negative environments can affect our very personalized
notions of mental health and sense of self.

Randall (2000) conducted a qualitative study of people with schizophrenia where
she interviewed 46 members of a mutual-help group. She identiﬁed four phases of the

recovery process: 1) mourning and grief, 2) recognition and awareness, 3) redeﬁnition

and transformation, and 4) enhanced well-being and quality of life. Phase 1 entails stages
of despair, anger, and denial; phase 2 entails the understanding of schizophrenia and how
it can affect ones life; phase 3 entails a change in beliefs about schizophrenia, the
managing of symptoms, the redevelopment of goals and focusing on strengths; and phase
4 entails valuing oneself, approaching life in a positive way, accomplishing goals, and
ﬁnding meaning and purpose in everyday life. The process of recovery identiﬁed in this
study displays nicely how the process can be thought of as a shedding of negative images
and beliefs about schizophrenia. This study demonstrates how a more positive and
strengths-based perspective on the part of the member is necessary in order to be able to
fully transform into later stages of recovery. This study also brings to light the fact that
this can be a very delicate process where the reinforcement of negative beliefs and
attitudes about SMI could severely impact a person in the process of recovery.

The studies cited here detail the process of recovery in very similar ways and
quite clearly point out that recovery ﬁ'om SMI is a very delicate process. Each study pays
particular attention to the reciprocal relationship between one’s recovery and their social
environment, identifying the need for positive social “spaces” where a person with SMI
can learn to become comfortable with one-self and others. Human services designed for
people with SMI are beginning to acknowledge the need for supportive and positive
social environments in the process of recovery, and they are designing services to be like
“safe spaces” so that members can feel comfortable and in control of their own personal
process of recovery. The idea of needing a safe space then brings us to acknowledge the
fact that there are unsafe spaces where people with SMI in the process of recovery may

feel threatened. Unfortunately this is a reality, and if members’ safe spaces are

10

threatened, as in the case of a NIMBY situation, it must follow that these negative social
forces are likely to negatively impact members in the process of recovery.

Eﬁbcts of Stigma on Recovery

In the many unsafe spaces in our society, people with SMI are faced with stigma
and discrimination in various ways and in various places. Overcoming the affects of
stigma, both self-stigma and social stigma, are only two of the many facets dealt with in
recovery ﬁ'om SMI (Davidson, 2005; Matorin, 2002). Stigma is a very old concept
created by the ancient Greeks and has been deﬁned by Goffman (1963) as “an attribute
that is deeply discrediting.” (p. 3) To better understand the affects of stigma on recovery
it is important to deﬁne both social stigma and self-stigma. Social stigma is different
from self-stigma in that social stigma takes into account the reactions of the general
public towards a stigmatized group (Corrigan, 2005).

Social stigma has been deﬁned by Jones (1984) as: “. . .a person whose social
identity or membership in some social category, calls into question his or her full
humanity- the person is devalued, spoiled or ﬂawed in the eyes of others” (Jones et al.,
1984). It is widely recognized that people with mental illness experience more negative
effects ﬁom social stigma than many other groups (Corrigan, 2004) and this fact is
reﬂected in the many ways in which their opportunities in life are restricted or withheld
by others. People with SMI experience many social and economic disadvantages due to
social stigma such as, being prevented from acquiring adequate housing, given little to no
opportunities for independent employment, and many are restricted from experiencing
satisfying relationships with family, ﬁiends, and signiﬁcant others. It is difﬁcult to

imagine a life so steeped in discrimination in the United States where all people have the

11

right to these very essential life opportunities. The experience of social stigma can best be
described by a person with a mental illness. In an article written by a consumer about her
experiences around hopes for recovery, Murphy (1998) tells us how social stigma
impacted her life:

Looking back, my biggest struggle was not with the illness itself but with being

tossed aside by the normally ﬁmctioning world and made an outcast of society.

Being treated as less than human because of mental illness sent me into the
darkest depression. (0. 185)

What is so very interesting about social stigma is that it is deeply imbedded in our
culture. One very useful ﬁ'amework for which to think about the origins and cycle of
social stigma is one presented by Rappaport (1999), which describes “dominant cultural
narratives”. Rappaport uses a narrative approach to explain dominant cultural narratives
to be common “community representations of life that are known by most people within a
culture” (p. 4). Rappaport states that these narratives are “over-learned stories
communicated through mass media or other large social and cultural institutions and
social networks.” (p. 4) In regards to people with SMI, these dominant cultural narratives
can be thought of as the more corrrrmon and salient beliefs and judgments that people in
communities have, and communicate about, people with SMI. These dominant cultural
narratives are quite negative and inﬂuence people in the community to have certain
beliefs and to make certain negative judgments about people with SMI, often times based
on exaggerated and presumptuous accusations. These beliefs and judgments play out in
their everyday encounters with people with SMI and thus recreate and sustain the social
stigmatization, and discrimination, of people with SMI in our culture. These dominant
cultural narratives are reinforced over tirme through the media and casual conversation,

making it almost inevitable that when a person is diagrosed with a mental illness later in

12

life, they then may also experience the debilitating effects of another type of stigma; self-
stigma.

Self-stigma is the internalization of the negative stereotypes and social stigma that
exists within the dominant cultural narratives of a certain culture. Living in a society that
promotes independence and monetary achievement, such as the United States, is difficult
when you have SMI because it also promotes and encourages negative views of life with
a mental illness (ie., they are dangerous, child-like). Independent living and job security
is scant for people with SMI because they experience daily discrimination in every area
of their lives, so it’s no surprise that people with mental illness would internalize these
social beliefs without some alternative. Once again, it is difﬁcult to imagine they ways in
which self-stigma can affect a person, and only a person with a mental illness can explain
to us what this feeling must be like:

I tortured myself with the persistent and repetitive thought that people I would

encounter, even total strangers, did not like me and wished that mentally ill

people like me did not exist. Thus, I would do things such as standing away from

others at bus stops and hiding and cringing in the far corners of subway cars.

Thinking of myself as garbage, I would even leave the sidewalk in what I thought

of as exhibiting the proper deference to those above me in social class. The latter

group, of course, included all other human beings. (Gallo, 1994, pp. 40 7-408)

It becomes quite difﬁcult to resist internalizing the negative cultural narratives
when every person and place in a person’s life adheres to the dominant cultural
narratives. Organizations and resources for mental health that are set up to assist pe0ple
with SMI through recovery are places where you would think that negative dominant
cultural narratives would not have permeated or be perrmitted. Many of these places are

desigred within the traditional medical model phiIOSOphy and are thus plagued with the

negative assumptions and expectations of people with SMI. Despite their efforts, these

13

organizations and services have a tendency to promote hopeless and stigmatizing
“community narratives”. Community narratives are best described as common stories
shared by a goup of people that tell them things about themselves as being a part of that
goup.

Self-stigma does not always affect everyone within a stigmatized group (Crocker
& Major, 1989; Hayward & Bright, 1997). It used to be thought that self-stigma was an
automatic reaction to being a partof a stigmatized goup (Allport, 1954/ 1 979; Erickson,
1956; Jones et al., 1984), but self-stigma only occurs when a person agrees with and
intemalizes the stereotypes associated with the dominant cultural narratives of the goup
that they are a part of (Crocker & Major, 1989).

The degree to which a person might agee with the stereotypes of their goup
depends in part on their level of personal identiﬁcation with that group (Corrigan, 2004).
Depending on a person’s level of identiﬁcation with a stigmatized group, the experience
of being stigmatized can vary, bringing some to oppose negative images of people with
SMI and cause them to create more positive self-images (Brehm, 1996) and others to not
identify with the stigmatized goup at all where they may feel and do nothing (Corrigan,
2004). Several studies in the literature support that despite having a psychiatric disorder
many people have positive self-images (Brehm, 1966) and react to stigma with energy
and righteous anger (Corrigan et al., 1999; Charmberlin, Ellison, & Cream, 1997). This
literature demonstrates the various affects that stigma can have on each person’s recovery
process.

One possible explanation as to why some people with SMI do not internalize the

dominant cultural narratives of this stigmatized goup is that they are identifying more

14

with an organization that adheres to an “alternative community narrative” (Rappaport,
1993; Mankowski and Rappaport, 1995, Rappaport, 1995). Rappaport (1993) describes
an alternative community narrative as “a story repeatedly told among many members of a
setting” that provides an alternative way of thinking about oneself that is quite different
ﬁom the dominant community narrative. Rappaport demonstrates this idea by describing
how self-help organizations are just one type of place where alternative community
narratives are thought to be useful:

...self-help organizations can be viewed as a special class of communities in

which an alternative identity is provided and that those who become embedded

members do so by transforming their personal life stories so as to conform to the

community narrative. (p. 249)
Organizations such as these seek to liberate their members and strive to provide for their
mermbers a community narrative and safe space in their community where they can use an
alternative world view to create their own personal stories of who they are. In essence,
these types of organizations are questioning the dominant stories in existence for people
with SMI, and they are creating new ways for their members to understand the world that
is more conducive to their mental and physical well-being. Depending on the degee to I
which members personally identify with or have internalized the organization’s
community narrative, there is then a possibility that these organizations are acting as a
buffer between the mass amounts of existing stigma and discrimination, and persons in
the process of recovery ﬁ'om SMI.

With a more detailed understanding of stigma, and its affects on recovery ﬁ'om

SMI, we can now attempt to understand how mermbers’ involvement in organizations that

encourage recovery provides a safe social forum and promote active citizen participation

15

are important resources and safe spaces needed in order for members to thrive and
survive in a very negative and stigmatizing world.
The Potential Affects of Active Citizen Participation on Recovery

In the processes of recovery identiﬁed from the literature above, many of the later
stages of recovery for people with SMI include elements of engagement, active
participation, and empowerment. This review will not go into the details of all of these
elements, but it is important to understand how active citizen participation can play a role
in the recovery of people with SMI, how it has the potential to promote empowerrment,
and its role in clubhouses. It is particularly irmportant to understand its potential effects on
recovery in this study due to the fact that there were some members who were active
participants in the NIMBY response and some that were not.
Deﬁning Active Citizen Participation

Active citizen participation is “a process in which individuals take part in decision
making in the institutions, progams, and environments that affect them” (Heller, Price,
Reinharz, Riger, & Wandersman, 1984, p.339). Research shows that becoming an active
participant in ones community and life issues can bring many beneﬁts to both the active
person and to the organization or goup of which they may be associated with (Pretsby,
Wandersman, Florin, Rich, and Chavis, 1990; Zimmerman, 1990). Active participation
can evoke new understandings and contribute to the acquisition of certain knowledge that
can only be learned through experience (Kieffer, 1984). Becoming an active participant
can also lead to an increase in a person’s sense of community (Chavis & Wandersman,
1990), which can also then lead to a sense of empowerment and control over ones life

(Kieffer, 1984; Zirmmerman, 1990; Zimmerrman and Rappaport, 1988). In fact,

16

Wandersman and Florin (2000) found that becoming an active participant in any
dimension of a person’s life can lead to “individual irmpacts, such as changes in attitudes,
beliefs, and skills” (p. 264). All of these ﬁndings have irmplications for the numerous
potential positive effects that active citizen participation can have on the processes of
recovery experienced by people with SMI.
Active Citizen Participation Can Promote Empowerment

Empowerment is a term that has become increasingly incorporated into practice
models associated with people with mental illness (Clark & Krupa, 2002) and mental
health advocacy associations such as the National Empowerment Center (Chamberlin,
1996). The concept of empowerrment is often difﬁcult to deﬁne (Barnes & Bowl, 2001),
and can be thought of as an outcome, an ideology, and as a process (Clark & Krupa,
2002; Fitzsirmons & Fuller, 2002; Zirmmerman & Warschausky, 1998). In applying the
concept of empowerment to people with SMI, Linhorst (2006) views it as a process and
deﬁnes it as “the meaningful participation of people with severe mental illness in
decision making activities that give them increased power and control, or inﬂuence over
important areas of their lives” (p. 9). As this deﬁnition irmplies, empowerment as an
outcome, is a result of becoming actively involved in processes that are empowering.
Processes that are empowering might include becoming an active participant in activities
that increase knowledge of resources, improve social skills, increase conﬁdence, or
exercise power and inﬂuence over ones life (Linhorst, 2006). Psychosocial Clubhouses
are examples of settings where people with SMI can become actively involved in such
empowering processes.

Active Citizen Participation in Clubhouses

17

It is possible that becoming an active participant in any meaningﬁrl area of a
person’s life can promote recovery and empowerment. Clubhouses are consurmer-driven
services where their members’ active participation in the clubhouse is a crucial elerment.
It is important for clubhouses to promote active participation among its members because
without their participation, they could not serve the individual needs of their members.
The effects of active participation are also consistent with the goals of clubhouses to
promote empowerrment, competency, and recovery within their members (MDCH/MSU,
2001; Herrman, Onaga, Pernice-Duca, & Oh, 2005). Since people with SMI can become
empowered through action, actively responding to opposition, such as a NIMBY
response, can be an empowering experience. Overall, the ﬁndings of this literature on
active citizen participation suggest that active involvement can potentially affect the
irmpact that a NIMBY response has on the recovery of clubhouse members.

The Role of Clubhouses

Negative public attitudes, stigma, discrirmimation and other barriers in daily
functioning gave rise to the consumer movement where consurmers of mental health
services began creating consumer-operated services to meet their individual needs (F rese
& Davis, 1997 ; Peckoff, 1992). With the focus on consumer power and the evolution of
community mental health, it soon became recogrized that people with SMI needed
various resources to function in the world, and this gave rise to psychosocial
rehabilitation services. One such consumer-driven service, of which is technically
considered to be a member-driven service, is the psychosocial rehabilitation clubhouse
model. It is important to note here that psychosocial rehabilitation clubhouses should not

be confused with consumer-run services because they are not run by consumers; they are

18

driven by consumers with the assistance of professional staff. Psychosocial rehabilitation
clubhouses fall somewhere in the middle on a continuum of services with consumer-run
services at one extreme and professionally run services at the other.

Psychosocial rehabilitation clubhouses can be thought of as safe space that seek to
break down the barriers of stigma, dependency, and isolation that prevent people with
SMI from experiencing full participation in their communities (Propst, 1997). Within a
psychosocial rehabilitation clubhouse, clubhouse members are engaged in operating all
aspects of the club with staff assistance. All clubhouses are considered to be following
the criteria of psychosocial rehabilitation prograrms but only some clubhouses follow the
guidelines and philosophy of the Fountain House Model of psychiatric rehabilitation in
full. In this section, the relevance and purpose of psychosocial rehabilitation programs
will be explained, followed by a thorough description of the unique philosophy and
values that underlie the Fountain House Model and clubhouse community narrative.
Purposes of Psychosocial Rehabilitation Programs

Psychosocial rehabilitation (PSR) progams for people with SMI have historically
lacked a clear deﬁnition, and due to the various agencies that have claimed to practice
PSR, certiﬁcation continues to be a necessity (Cnaan, Blankertz, Messinger, 1990;
Mueser, Drake, Bond, 1997; Corrigan, 2003). PSR includes services aimed at long-term
recovery and maximizing self-sufﬁciency separate ﬁom the stabilization of psychiatric
symptoms (Anthony, 1993; Barton, 1998; Barton, 1999). Psychosocial rehabilitation
services are focused on an individual level of change and are generally desigred to meet
six progarnmatic goals: inclusion, opportunity, independence, empowerrment, recovery,

and quality life (Anthony, 1993; Barton, 1999; Corrigan, 2003; Ralph, 2000). In order to

19

meet these goals, PSR focuses on six service strategies: skill training, instrurmental
support, goal setting, transfer training, cogritive rehabilitation therapy, and family
education and support (Barton, 1999; Corrigan, 2003). Although there are various
services available under the urmbrella of PSR, it is among these services that clubhouses
are included.

In a meta-analysis of outcome studies in the literature, Barton (1999) sought to
assess the empirical status of psychosocial rehabilitation within community support
systems and found that the literature strongly supports the use of these services. PSR
services have proven to reduce hospital utilization, positively affect employment
opportunities, increase skill development, increase client satisfaction and increase the
armount of time spent in the community (Arana, Hastings & Herron, 1991; Beard,
Malamud and Rossman, 197 8; Becker and Bayer, 1975; Bond, Dincin, Setze &
Witheridge, 1984; Bond, Miller, Krurmwied, & Ward 1988; Bond & Resnick 2000; Dion
& Anthony, 1987; Stein and Test, 1980; Witheridge et a1, 1982; Wolkon, Karrmen and
Tanaka, 1971). In particular, psychosocial clubhouses have proven to be an effective
venue where people with SMI can establish and maintain better work habits, enriched
social skills, and a more hopeful view of the future (Beard, Propst, & Malamud, 1982;
MDCH/MSU, 2001 ).

All PSR services can be considered to be of the more cost-effective community
resources available to people with SMI (Barton, 1999) that provide varying levels of
assistance to their members on an as needed basis. In fact, according to longitudinal
outcome research studies conducted in Maine and Vermont (Harding, Brooks, Ashikaga,

1987(a); Harding, Brooks, Ashikaga, 1987(b); DeSisto, Harding, McCormack, 1995), due

20

to the developmental aspects of having a psychiatric disability and the nature of recovery
ﬁom SMI, it was found that long-term rehabilitative interventions can have curmulative
effects on individuals over time (Mueser, Drake, Bond, 1997). The ﬁndings of these
studies suggest that the utilization of PSR services by people with SMI over extended
periods of time may also decrease the amount of needs and demands required of more
acute and costly mental health services (Barton, 1999; World Health Organization, 1996).
Many PSR clubhouses differ from other PSR services because they are trained within a
speciﬁc clubhouse community narrative called the Fountain House model.
The Fountain House Clubhouse Model

Many PSR clubhouses around the world are based on the Fountain House
Clubhouse model. The Fountain House model is a model of community rehabilitation
speciﬁcally desigred for people with SMI that was started by a self-help organization for
people with SMI called “We Are Not Alone” (W ANA) in New York City in 1948. Due
to its popularity among people with SMI, and the success of the model internationally,
this model gave rise to the International Center for Clubhouse Development (ICCD) in
1994. The ICCD functions to facilitate and support the development of clubhouses and
advocate for the rights of people with SMI around the globe. Many PSR clubhouses are
trained by the ICCD but only some actually maintain the standards inherent in the
Fountain House model due to local funding restrictions. Beard, Propst, and Malamud
(1982) provide the following description of the Fountain House model:

Fountain House itself is an intentional community designed to create a restorative

environment within which individuals who have been socially and vocationally

disabled by mental illness can be helped to achieve or regain the conﬁdence and
skills necessary to lead vocationally productive and socially satisﬁing lives. @. 7)

21

Clubhouses can be considered alternative settings within the community that
provide opportunities for their members to gain a sense of empowerment and to explore
their possible selves throughout their process of recovery. With voluntary membership
into clubhouses, members are ﬂee to make personal choices as they see ﬁt for
themselves, but all of the operations and standards of clubhouses are desigred to maintain
this unique safe space that is the clubhouse community. Daily operations of a clubhouse
all function within the philosophy of the Fountain House model and could not function
appropriately without it.

The “Heart ” of the Fountain House Model

In order to retain and maintain the restorative environment of clubhouses, the
Fountain House model is based on a fundamental belief system that includes four
essential parts: 1) the belief that all people with SMI have the potential to be productive,
2) the belief that work and employment is “a deeply generative and re-integrative force in
the life of every human being” (p. 7), 3) the belief that men and women should have a
place to socialize together and to provide support and encouragement for one another at
all days and tirmes, and 4) the belief that everyone is entitled to pleasant, affordable, and
adequate housing.

Not only does the Fountain House model have a ﬁrm belief system, they also
have four essential criteria that must be conveyed to each person as they choose to
become involved in the clubhouse. It is imperative that these four criteria must be
sustained throughout membership as these four criteria maintain the “heart” of the
Fountain House model. The four criteria include: 1) the clubhouse belongs to all

members who choose to participate in the clubhouse and that their membership is crucial,

22

2) the presence of all members is expected each day and their presence makes a
difference to everyone in the clubhouse, 3) each member should feel like they contribute
to the clubhouse where they also feel that their presence is wanted by other members and
staff, and 4) that each member feel that they are needed in the program; that the
clubhouse could not function without them.

The Fountain House Model as a “Shared Community Narrative ”

The most unique aspect of the Fountain House clubhouse model is that it follows
and functions within this very comprehensive “shared community narrative” that is the
heart of the Fountain House model. Again, it is helpful to use Rappaport’s (2000)
application of the narrative approach as a framework for understanding the Fountain
House model as a shared community narrative:

Shared narratives are the currents in which our individual lives move down the

river of time. They are the resources that empower or impede. They give our lives

direction and meaning. Who we end up being is to some extent determined by the
currents we are riding, i. e., those narratives we appropriate into our own

personal life stories. (p. 6)

It is believed that over time as a member of the clubhouse, members will
experience a shift in self-awareness where they will feel that their life is more rewarding,
less disabling, and less ﬁnancially dependent (Beard, Porpst, Malamud, 1982). If we
think about clubhouses as being conducive to the Fountain House model’s shared
community narrative, designed to empower their members, we can begin to understand
how mermbers can experience a more positive shift in self-awareness. The more
experiences people have within the safe space of the shared community narrative the less

they may be inclined to identify with the dorminant cultural narratives offered to them

within their local communities. The clubhouse community narrative is reinforced not

23

only through its verbal and written philosophies but through its daily activities and
operations, where the heart of the Fountain House model can be supported, conﬁrmed,
and challenged in the behavioral applications of it with other members and staff.
Daily Operations & Standards of Clubhouses

Clubhouses operations are based on ﬁve distinct and unique clubhouse standards.
Clubhouse standards include the following: 1) independent space requirements, 2) the
Work-Ordered Day, 3) independent employment, 4) equal staff and member
relationships, and 5) membership. The independent space requirements are in place to
ensure that each clubhouse has its own unique identity that includes its name, its address,
its phone number, and a comfortable welcoming location near public transportation and
away from mental health centers. The independence of a clubhouse from other mental
health centers is essential in order for the philosophy of the clubhouse model to function
completely independent of the formal mental health system.

Clubhouses function on the basis of the Work-Ordered Day. The Work-Ordered
Day is basically the daily work required of staff and members, working side-by-side, in
running the clubhouse. Daily work might include creating newsletters, cooking, cleaning,
accounting, and other activities that vary depending on each individual club. This Work-
Ordered Day is desigred speciﬁcally to ensure the continuity of the daily operations of
the clubhouse. Members are not paid for their contributions to the clubhouse community.
This work is completely separate ﬁom the independent employrment opportunities
available to members of the clubhouse.

The independent employrment piece of clubhouses is provided by a program

created by clubhouses called Transitional Employment (TE). The TE program provides

24

the opportunity for members to return to paid work positions in the community. The most
unique aspect of the TB progarm is that the clubhouse guarantees employers the coverage
of all placements in which the member is obligated to even when they need to be absent
ﬁom the job for whatever reason. All staff and members are available to support the
success of the employed member, and at no time will they attempt to discontinue any
opportunity for job placement based on previous placement history. This set-up is both
comforting and appropriate for members given the nature of the process of recovery that
members experience.

Clubhouses require that there be equal relationships among members and staff.
The distinction between staff and members is that staff are generally hired employees that
do not have a mental illness, but this is not always the case. Some clubhouses do have
staff with mental illnesses. Members are expected to run the clubhouse only utilizing staff
as needed, but staff and members all carry out equal duties in the day to day functioning
of the clubhouse. This non-hierarchical relationship between staff and members is
important so that mermbers feel a genuine sense of self-sufﬁciency. This set-up also
works to combat the hierarchical relationships inherent in other mental health services
that are working within more of a dominant cultural narrative. Clubhouses vary on this
dimension due to the fact that these services still function in a medical and social system
that utilizes hierarchical relationships in their training of professionals. These
relationships in the clubhouses will also vary because clubhouses utilize hired staff who
do not have mental illness and that have been trained in some profession prior to their

employment with a clubhouse.

25

Clubhouses are established and maintained based on membership, and as with any
membership, there is some level of ownership in the club by its members. Because
membership inherently involves some level of ownership in the organization, it is
expected that members each individually support and adhere to the Fountain House
model philosophy. Membership is available to anyone with a history of mental illness, it
is completely voluntary, it grants access to all clubhouses, and there is no expiration date.
There is no limit to the amount of involvement there can be by any one member and
involvement is always encouraged and supported. Members of clubhouses should not be
thought of as consumers undergoing rehabilitation they must be thought of as, and think
of themselves as, members. As members they are expected to contribute to the everyday
activities that make up the clubhouse prograrm and follow the community narrative of the
Fountain House clubhouse model.

Clubhouses create safe spaces conducive to empowerment, competency, and
recovery from SMI (MDCH/MSU, 2001; Herrman, Onaga, Pernice-Duca, & Oh, 2005).
They provide a context in which people with SMI can actively explore aspects of
themselves, their hopes, their identity, and their recovery. The daily operations and
distinct clubhouse philosophy quite clearly show that this is a distinct environment that
works very differently than many other structured services available to people with SMI.
The heart of this alternative community setting has the potential to ﬁnd its way into the
hearts of its members so that they may develop new, more positive personal stories of and
for themselves. These settings may better equip people to repel and transform the
negative dominant cultural narratives inherent in the world around them into more

positive and promising anecdotes. Regardless of the fact that these alternative settings are

26

positive places for their members, they are still required to function in a world where
their values are in contrast to the dominant cultural narratives; cultural narratives that can

create problems and make it difﬁcult for therm to fulﬁll their goals.

The NIMBY Phenomenon

The NIMBY (Not In My Backyard) phenomenon is a forrm of community
opposition that refers to “the protectionist attitudes of and oppositional tactics adopted by
community goups facing an unwelcome development in their neighborhood.” (Dear,
1992; p 288) This societal phenomenon developed over 30 years ago during a time of
much socio-political change and centered around the era of deinstitutionalization of
people with various disabilities. As people were being discharged from institutions there
becarme a need for community-based services (i.e., goup homes, supervised apartrments,
hostels). Along with the rise of Community Mental Health Services (CMHS) carme an
unexpected abundance of negative community reactions to people with SMI. Although it
seemed that the general public agreed with deinstitutionalization, and that community
based services were indeed needed services, the common response by residents was, and
still is, that they should not be located in their neighborhoods; hence we now have the
term “Not In My Backyard”.
Why NIMBY is a Problem for Human Services

The NIMBY response spans various controversial issues from prisons, to landﬁll
sites, to power plants, to low-income housing, and to a wide range of human service
facilities (Balukas & Baken, 1985; Bean et al., 1989; Berdiansky & Parker, 1977;Birch,

1985; Blendon & Donelan, 1989; Dear & Gleeson, 1991; Dudley, 1988; Fattah, 1984;

27

Gale et al., 1988; Green et al., 1987; Herek & Glunt, 1988; Kastner et al., 1979; Laws &
Lord, 1990; Lee et al., 1990; Marin, 1987; National Campaigr to End Hunger and
Homelessness, 1988; National Coalition for the Homeless, 1987; Page, 1989; Piper &
Werner, 1980; Smith, 1981; Rogers & Ginzberg, 1989; Solomon, 1983; Sontag, 1989;
Wolch et al., 1988; and Wolch & Akita, 1989). All of these facilities serve some purpose
in our society and need a place within our communities, but only human service facilities
deal with the issue of social exclusion based on goup identity when faced with a NIMBY
response in their community. Human service facilities that experience NIMBY have
included HIV/AIDS clinics, homeless shelters, disability centers, and community mental
health facilities for people with SMI (Dear, 1992).

Much of the literature in existence on the NIMBY phenomenon against hurman
service facilities examines only the attitudes and perspectives of the local community
members (Dear & Gleeson, 1991; Dear & Taylor, 1982; Gale, Ns, & Rosenblood, 1988;
Kastmer, L. A, Reppucci, N. D. & Pezzoli, 1979; Klein, 1968; Page 1989; Piat, 2000;
National Coalition for the Homeless, 1987; National Campaigr to End Hunger and
Homelessness in America,1988; Robert Wood Johnson Foundation, Program on Chronic
Mental Illness,1990; Solomon & Davis, 1984). Much of the research on community
attitudes is concerned with understanding how people feel about the people who utilize
those services and why they feel that way (Balukas, & Baken, 1985; Bean, Keller,
Newburg, & Brown, 1989; Blendon, & Donelan, 1989; Green, 1987; Herek, & Glunt,
1988; Lee, Jones & Lewis, 1990; Marin, 1987; Rogers & Ginzgerg, 1989; Smith, 1981).
Some literature has sought to provide resources to human services by creating text that

provides therm with the facts to understand the NIMBY phenomenon and ways that they

28

can cope with the potential problems associated with being involved in it as a service
center (Dear, 1992; Dear & Laws, 1986; Fattah, 1984; Foster & Roberts, 1998).
Currently, there is no literature that seeks to understand the experience of the NIMBY
phenomenon from the perspective of the consumer.

NIMBY protests against human service facilities can have devastating effects for
the consumers who need to use those services. NIMBY situations usually undergo
lengthy processes which delay service ﬁmctioning (Dear, 1992). This delay makes it so
that people who utilize the services may have to do without services or have to travel
long distances in order to obtain services elsewhere. Some human services may even lose
funding and have to close down completely as a result of not being able to function.
Going long distances or without services may seem like a facility location issue but at
some level one might ask what the exclusion of these facilities ﬁom local neighborhoods
might mean to the people who use those services.

When NIMBY tactics are used against the placerment of human service facilities it
is usually quite successfully masked as a simple protest against the location of a facility.
These facilities are not just buildings however, these are places that people need to go to
get the services they need in order to live successfully in the world. So when
communities protest the location of a human service facility in their neighborhood, they
are protesting the placements of vital services for certain types of people. This makes
NIMBY against human services a more socially acceptable means of discrimination
against certain groups of people in order to keep them out of their community.

NIMBY against Clubhouses

29

People with SMI have a long history of being socially excluded and discriminated
against, and the dominant cultural narratives that exist about this goup of people seem to
almost provoke NIMBY attitudes. Given what we already know about the delicate
process of recovery that a person with SMI experiences throughout their life, and that
their environment plays a sigriﬁcant role in that process, it seems only natural to wonder
what effects NIMBY responses by local communities might have on human service
facilities that they utilize. Clubhouses are of particular concern because of the unique role
they play in the lives of their members. Depending on how the members have responded
to this NIMBY response, that itself may play some role in the ways in which it has
impacted their recovery and generally.

As discussed earlier in this review, clubhouses can be thought of as an alternative
community where people with SMI can regain the sense of self and skills necessary to
lead meaningful lives. Clubhouses are also considered to be restorative environments
where their members can undergo their process of recovery on their own terms.
Individual mermbers of clubhouses are expected and encouraged to create and sustain the
clubhouse community, which creates within members some level of ownership and
personal identiﬁcation with the organization. In fact, adhering to the unique shared
community narrative of a clubhouse provides the foundation necessary for creating a
sense of empowerment and recovery. With the all encompassing nature inherent in
belonging to a clubhouse it leads one to wonder how a NIMBY response by a local
community against a clubhouse might impact its members. The relationship between the
consumer and the facility in this situation is reciprocal and interconnected. Therefore, a

protest against a clubhouse facility may also feel like a protest against all of those people

30

who compose its membership. Again, given what is known about the process of recovery
for people with SMI, there is little doubt that this NIMBY response has affected these
members in some way.

Opposition arguments of NHVIBY protests by local communities are almost
always the sarme (Dear, 1992). When we take the common arguments made in NIMBY
responses and place them in context with the members of clubhouses, it is easy to see the
blatant discrimination at play. Common statements made by communities center around
four points (Dear, 1992). Residents are against the location of the clubhouse in their
neighborhood because: 1) they think that the members of this facility (clubhouse) are a
danger to themselves and their children, 2) that the presence of the members of this
clubhouse being in their neighborhood will lower their property values, 3) that the
presence of the members of this clubhouse brings the potential decline of neighborhood
quality, and 4) that the mermbers of this clubhouse would be better off somewhere else.

Although these four argument points are common among all NIMBY responses to
all types of unwanted facilities, these points are quite similar to the dominant cultural
narratives in our culture that are used to describe people with SMI. These are the exact
types of dominant cultural narratives that clubhouses try so hard to rid from the lives of
their mermbers by adhering to their own shared community narrative. In a case of NIMBY
against a clubhouse, these negative discriminatory responses are shouted at them through
newspapers, in the news, in their front yards, at zoning meetings, and on the streets. This
is why current NIMBY efforts against Clubhouses in Michigan have been winning their
cases regarding relocating into new semi-residential neighborhoods, because the residents

in the communities are breaking the ADA and the Rehabilitation Acts. Members of

31

clubhouses are only trying to create for themselves positive narratives conducive to their
recovery but the world around them insists on reinforcing a version that leads to social
oppression and internal mental restraint.

The Impact of NIMBY on a Midwestern Clubhouse

This study was conducted in a Midwestern state, where there were 46 PSR
clubhouses. All of these clubhouses are ﬁrnded by and under provision of the Medicaid
provider. Many of them are ﬁrnded by Federal Block Grants to be trained by the ICCD if
their proposals are accepted, but some are not. Clubhouses are required to be certiﬁed by
the Commission on the Accreditation of Rehabilitation Facilities (CARF) to be sure that
they meet PSR standards. The end result of what actually composes a clubhouse in this
particular state is. based on certain standards created by the Medicaid progam which
includes PSR standards and some ICCD standards. Many clubhouses in this state are not
certiﬁed by the ICCD as Fountain House clubhouses because Medicaid does not fund the
continued assistance of the ICCD throughout the life of a clubhouse. Therefore,
depending on the clubhouse, only some actually are ICCD certiﬁed as a Fountain House
clubhouse. PSR clubhouses in this state all vary somewhat in meeting the many standards
required of them (CARF, PSR, ICCD, Fountain House, Medicaid), yet all follow the
Fountain House model’s “shared community narrative” to some extent.

Although some Clubhouse prograrms are located in long-standing community
mental health agency locations, many (63%) have re-located to locations in the
community away from mental health center operations (MDCH/MSU, 2001). There are
clubhouses that seek to meet ICCD standards and those clubhouses are encouraged to be

“ﬂee-standing” agencies. This status is important to ensure that the Clubhouse is not

32

viewed by members as a rehabilitation center. Unfortunately, the relocation of
community-based mental health services into certain neighborhoods has yielded negative

reactions from local residents called NIMBY.

A Case of NIMBY against a Clubhouse

This study focused on one clubhouse that experienced a NIMBY protest against
its efforts to relocate. In March of 2004, a clubhouse was proposing to relocate to a
facility in a semi-residential neighborhood just a few miles from their current location.
Residents in the community were invited by the clubhouse staff to attend an informal “get
to know us” gathering at the proposed site for their Planning Commission Public Hearing.
It was at this meeting that local residents brutally objected and loudly protested for two
hours against the relocation of the clubhouse into the proposed facility.

At this ﬁrst meeting, members of the press recorded and documented how
protesting residents sneered and booed anyone speaking in favor of the clubhouse move.
From that moment on, residents continued to voice a number of concerns such as: falling
property values, less business for local businesses, the possibility that the members will
stop taking their medications, but mostly fear of violence for themselves and their
children. These concerns were voiced through the media on numerous occasions, both
newspapers and on the news. This neighborhood also created a web page on their
community website where an ongoing conversation took place among local residents
about the relocation of this clubhouse and why they should continue to ﬁght it.

From the Perspective of the Clubhouse

33

This clubhouse needed to relocate because the owners of the land they were
located on were requesting their space back, but the clubhouse also wanted to relocate
because the current location of the clubhouse was not conducive to the social needs and
activities of the clubhouse community. The clubhouse applied for and received some
funding to ﬁnd a more suitable location for their club, so they proceeded to locate, begin
restructuring, and pay rent on the proposed facility. Since the beginning of this NIMBY
case, this clubhouse had patiently been waiting for their chance to relocate into a new
facility and diligently held fast to their right to do so. At the time the study was
conducted, it is important to note that, it was becoming clear that there was a good chance
the clubhouse would win the lawsuit against the city because the United States
government joined the clubhouse in their ﬁght against the city just two months before this
study began.

A T imeline: Major Events that Occurred Throughout the NIMBY Case

The ﬁrst part of this NIMBY case was experienced by the clubhouse through the
neighborhood protests; the NIMBY response. As the clubhouse had begun to work
towards their move to their ideal location, neighborhood goups had begun to organize
against the clubhouse. Although the clubhouse had tried to “rmeet and greet” local
community members in a very civilized way, community members did not react
sirmilarly. Local community members reacted with disgust and disdain at the members of
the clubhouse and attermpted to use clubhouse members’ personal characteristics against
them in building a case for them not moving into their neighborhood. This was
devastating to the clubhouse members who were involved in the NIMBY case in the

beginning.

34

After months of deliberation, the clubhouse was denied the request for a special
land use perrmit by the city’s Zoning Board of Appeals to move into the new facility. In
January of 2005 the clubhouse began considering their options and decided to work with
its auspice agency to ﬁle a lawsuit against the city in Federal Court on the premise that
the city denied the clubhouse the use of a special land use permit to use the proposed
facility on the basis of discrimination. This point is substantiated by the fact that the city
makes no provision for zoning anywhere within the city for services such as clubhouses
for people with SMI. Their auspice agency had become knowledgeable of this legal
process, and thus helpﬁrl in the more current NIMBY case, because they experienced this
a few years before when another clubhouse that they worked with tried to relocate and
was struck by a NIMBY response.

In June of 2005, in the Federal Court, the clubhouse had its ﬁrst hearing that
sought to compel the city to respond to the subpoenas. This was thought of at the time as
“our ﬁrst win” but the city promptly ﬁled a motion to dismiss it and had requested to be
heard on a later date. On July 20‘“, 2005 the city’s motion to dismiss was heard by the
court and the Attorney General’s Ofﬁce of the Civil Rights Commission stated they were
to ﬁle an amicus brief in addition to one submitted on behalf of Michigan Protection and
Advocacy Services (MP&AS). In waiting for the additional anricus briefs to be
submitted, and for a statement to be drafted by the judge, it was expected that the next
hearing would take place in mid-August of 2005. In September of 2005 the United States
Justice Department ﬁled a complaint against the city on the basis of discrimination and in
support of the clubhouse. On November 29th of 2005, the lawsuit against the city was

won by the clubhouse.

35

Winning the Case

After only four of the interviews had been conducted for this study, the clubhouse
had won their lawsuit against the city. As a result of their winning the lawsuit a number
of things happened: 1) the clubhouse gained the ability to move into their new location,
2) the city paid $300,000.00 in damages, 3) the city’s commission was ordered to attend
training and education on the requirements of Title II of the Americans with Disabilities
Act (ADA), 4) the US. government was granted authority to review the status of these
requirements if at anytime they believe they have been violated, and 5) a public advisory
board meeting is required to be held at the clubhouse on a regular basis in order to
continue educating the local community about the facts associated with people living
with mental illness.

Although the clubhouse won the case in the end, the point is that in the end, the
members of this clubhouse had been exposed to very brutal and extensive displays of
negative public stigma. Although NIMBY has been considered a socially acceptable way
for community members to protest the placerment of unwanted facilities in their
neighborhoods, discrinrinatiom is not acceptable and can affect people in varying ways.
Therefore, we must consider the repercussions that this type of protest might have on
consumers of human service facilities, especially those human services that seek to
devalue and eradicate the existing dorrrinant cultural narratives that contribute to social
stigma. Thus the goal of the proposed study was to ﬁnd out how a NIMBY response
affects members in the process of recovery from SMI.

Research Questions

36

This study sought to explore the affects of stigma and discrimination experienced
as a result of a NIMBY protest on the recovery of mermbers of a consumer-driven
Psychosocial Clubhouse. This study addressed the following research questions:

1. How did the NIMBY response irmpact members in the process of

recovery from SMI?

a. Was the experience of active participants in the NIMBY case
different from those members who were not actively involved?
b. How did the NIMBY case impact members’ feelings about the
clubhouse and their involvement with it?

2. How did the clubhouse assist members in dealing with the NIMBY

response and throughout the NIMBY case over time?

METHODS

Values, Biases, and Assumptions of the Researcher
Much of my desire to work with and for people who have mental illnesses today

comes from my past experiences working with people who have mental illnesses. My
career path began during my studies as an undergaduate at San Francisco State
University in California, where I worked as an intern at a Community Mental Health
(CMH) outpatient clinic that served the most severe clients with mental illness in the city.
I chose this placement for my internship because I thought I wanted to pursue a career as
a clinical psychologist. I wanted to work with people with mental illness in that capacity,
with the goals of understanding them and helping them. I had not expected my

perspective on my career, and individuals with serious mental illness to shift in such

37

irmportant ways during my involvement with this particular clinic. The experiences I had
at this CMH clinic, as well as the experiences I have had with other community-based
mental health agencies more recently, have contributed tremendously to my current
values, biases, and assumptions about the work I believe is left to be done with and for
this particular population.

I spent almost two years at the CMH clinic as an intern in many different arenas:
prevocational progam counselor, co-facilitator of a weekly dual diagrosis psychotherapy
goup and assisting with the organizing and operation of the weekend progam. Although
I was basically considered and treated as a volunteer, I was also responsible for assisting
in the delivery of client services to a wide variety of their forensic clients living with
mental illness. Being an unpaid intern who was relatively free to explore my position as I
saw ﬁt, it was easy for me to see through the medical model inherent in the business of
CMH. My job did not depend on it. I believe that this is the reason why I was able to
view the clients in ways that my paid co-workers could not. My position there allowed
me to look closely at the needs of the clients and see how the community services, and
the everyday community environment, was enriching or hindering their ability to grow,
and ultimately survive.

Through my experiences at the CMH clinic I got the chance to know the clients
not as clients, but as individuals with strengths, weaknesses, interests, hobbies, concerns,
and very interesting world-views. I spent almost every weekend working on the weekend
goup at the clinic, and it was there that I was free to know the clients as people. On the
weekends clients were not there because they had to see doctors or case workers, they

were there to relax and enjoy the casual company of others who would not look down on

38

them. Prior to this intimate exposure, I had many preconceptions regarding the
capabilities of people who experience mental illness. I soon carme to realize that these
preconceptions were a result of social conditioning and igrorance. Upon this realization I
wondered how many other people adopt similar views based on the same learning
process. I wondered about how this process could be remedied. I came to the conclusions
that this population is in need of respect and acceptance and that further unexplored
community action was in order. I was fortunate to have had the opportunity to work with
some amazing people, both staff and clientele, who have helped me to understand that
pathology is simply part of every life and should be accepted, if not embraced as essential
to the ecosystem of soul. This experience has been the critical catalyst in the discovery of
my professional endeavors and has led me to where I am today.

Based on my experiences in working with people who experience mental illness
in San Francisco, and my natural aversion to the more dominant medical model
philosophies on mental illness, I sought entry into a gaduate progam in Community
Psychology at Michigan State University. I chose this area of study at this particular
school because the focus was on valuing diversity, community—based ﬁeld work,
empowerment and social change. Upon entry into my gaduate progam I wondered if
people with mental illness experienced the same struggles in this area of the country. In
an effort to learn more about the needs of people who experience mental illnesses in this
new state, I began working with the Michigan Consumer Evaluation Team (MCET).
MCET is a consumer-staffed non-proﬁt evaluation service that seeks to improve
Community Mental Health Services (CMHS) in the state of Michigan. MCET interviews

consumers of mental health services, using consumer interviewers, and providing

39

feedback to the providers. I worked as a data consultant for MCET for almost 2 years and
through the analyzing of their data I learned much about how the mental health services
in Michigan are utilized and experienced by clients. Although much of my interaction
with the consumer staff was casual and brief, their voices were my primary interest. It
was through my relationships with these consumer staff persons that I learned about the
NIMBY response against the clubhouse I speak about in this study today.

I have been working with the clubhouse of interest in this study for the last 2
years. My interest in knowing this clubhouse began when I learned of the discrimination
they were experiencing through the NIMBY phenomenon in March of 2004. I was
surprised to hear of such a huge public display of discrimination. I gradually became
more closely connected to the members and staff of this clubhouse nearing the start of
our collaborative relationship on this research study. With the philosophy of clubhouses
being focused on valuing consurmer voice and empowerment, and the context of this
speciﬁc clubhouse to stay wholeheartedly committed to that philosophy, it was easy for
me to become intimately connected with this particular clubhouse over time. Throughout
the process of this research study I have come to work even more collaboratively with
this clubhouse. Over the last month we have been working together on a presentation of
this study’s ﬁndings, along with the personal stories of members’ experiences, which was
just presented at the Michigan Consumer Conference 2006.

The focus of my work, my professional goals, my values, biases, and attitudes
have all been inﬂuenced by the above experiences. I learned from my internship at the
CMH clinic that there needs to be less focus placed on the views of professionals and

more focus placed on the needs of the client. It was clear to me through that experience

40

that working within the philosophy of the medical model would not accomplish such a
task. I learned from my colleagues in community psychology that there are alternative
philosophies to work within in order to better focus on and address the needs of people
with mental illness and that social change is needed for many underserved populations in
this country; that a cultural shift is necessary. I learned from my experience with MCET
how difﬁcult it is to make progess in opposition to the medical model when all mental
health services and dominant beliefs and attitudes are based within that philosophy. I
learned from my working relationship with the clubhouse that discrimination against
people with mental illness is alive and well today, that the right context can support
healthy recovery for people who experience mental illness, and that it is time that people
with mental illnesses become active participants in the social change that is possible
tomorrow. I have learned many lessons, and I hope to learn many more, that will continue
to contribute to the focus of my work as an advocate for people who experience mental
illness, and more generally as a social change agent for all other underserved and
oppressed populations.
Setting Description

The setting of this study was the current location of the clubhouse described
above. This clubhouse was established in 1991 and was built based on the Fountain
House Clubhouse Model, which started in 1948. This clubhouse is also accredited by
CARF as a Psychosocial Rehabilitation Program. This clubhouse has the support of their
auspice agency and their local Community Mental Health Authority. This clubhouse has

73 members and 10 staff, 5 of which are consumer staff (July 18, 2005). The mission of

41

this particular member-driven clubhouse is to provide support, instill a sense of
belonging, and increase independence for persons diagrosed with SMI.
Participants

Table 1 on page 47 summarizes all of the demographic characteristics across all
of the participants as well as within their prescribed goups (N IMBY active and
Clubhouse involved). In total, there were twelve members of the clubhouse that agreed to
participate in the study. Six members were actively involved in the NIMBY case
(N IMBY active = 50%) and six members were involved with the NIMBY case only
through the clubhouse (Clubhouse involved = 50%). In the total sample, 42% (5/ 12) are
male and 58% (7/12) are female. There are 33% (4/12) who identiﬁed as Caucasian, 17%
(2/12) as Aﬁicam American, and 42% (5/12) who identify as being of European descent.
Participants represent a range of serious mental illnesses: 17% (2/12) have clinical
depression, 33% (4/12) have bipolar disorder, and 42% (5/12) have schizophrenia. One
participant did not feel comfortable disclosing their diagrosis. Participants have an
average age of 52 (range 30 to 56 years old) and a little under half of them have
completed some college or trade school (42%, 5/12) with a few that have completed a
college degee (25%, 3/12). The employment status of the participants included 42%
(5/12) employed part-time, 50% (6/12) unemployed, and 8% (1/12) utilizing the

clubhouse’s Supported Employment prograrm.

42

Table 1

Participant Demographics

 

NIMBY Clubhouse

 

 

Characteristic Category Active (6) Involved (6) Total (12)
% g % pk % 11

Gender Male 33.3 2 50 3 42 5
Female 66.6 4 50 3 58 7

Age Range in years 34-53 30-56 30-56
Mean 46.666 49.666 48.16
SD 6.420 9.031 7.977

Ethnicity/Race Caucasian/ White 33.3 2 33.3 2 33 4
Aﬁican American/ Black 16.6 1 16.6 1 17 2
European 33.3 2 50 3 42 5
Other 16.6 1 O O 8.3 1

Education Some High School 0 0 16.6 1 8.3 1
High School Graduate 33.3 2 16.6 1 25 3
Some College 66.6 4 16.6 1 42 5
Associates Degree 0 0 16.6 1 8.3 1
Bachelors Degree 0 O 33.3 2 l7 2

Employment Not Employed 33.3 2 66.6 4 50 6
Part-time Employed 66.6 4 16.6 1 42 5
Transrtronal/ Supported 0 O 16.6 1 8. 3 1
Employment

Marital Status Never Married 16.6 1 33.3 2 25 3
Partnered 16.6 1 0 O 8.3 1
Divorced 33.3 2 33.3 2 33 4
Widowed 16.6 1 O 0 8.3 1
Single 26.6 1 33.3 2 25 3

Housing Independent 66.6 4 16.6 1 42 5
With Roommate 16.6 1 16.6 1 17 2
House with F armily 16.6 1 50 3 33 4
Silltemsed “mum” o 0 16.6 1 8.3 1
Lrvrng

Diagrosis Schizophrenia 50 3 33.3 2 42 5
Clinical Depression 16.6 1 16.6 1 17 2
Bipolar Disorder 16.6 1 50 3 33 4
Not willing to disclose 16.6 1 O 0 8.3 1

43

Design and Use of Qualitative Methods

We know little about the experience of stigma and discrirrrination in the lives and
recovery of members of Clubhouses, therefore this issue was explored using qualitative
interviewing methods. Qualitative interviews are useful in this case because it allows us
to understand participants’ experiences by providing a ﬁrm grasp of the issues at hand,
while also providing the ability to move beyond preconceived notions (O’Day, 2002).
Moreover, Stein and Mankowski (2004) argue that using qualitative research methods
with underserved populations (such as people with SMI) has the potential to further the
efforts of needed social change:

In asking those who are marginalized to be the focus of qualitative study,

researchers seek to understand and legitimate participants ’ points of view to a

larger social audience or to empower those who have previously been silent or
excluded ﬁ'om society. (Stein and Mankowski, 2004; p 23)

Thus, to gain an understanding of how people with SMI experienced a NIMBY response,
individual interviews were used to bring together and accentuate the personal stories of
these members (Patton, 2002).
Measurement: Semi-structured open-ended interviews

Clubhouse members that were experiencing the later stages of a NIMBY protest
case were interviewed using a semi-structured, open-ended interview protocol (See
Appendix A). The two staff members who were interviewed were also interviewed using
a semi-structured, open-ended protocol (See Appendix B). This method of interviewing is
purposeful in exposing each member’s individual and unique experience of the NIMBY
response. The interview protocol consisted of 5 areas of inquiry: l) the story of their
involvement with the clubhouse, 2) the impact of the NIMBY response on members in

the process of recovery from SMI, 3) the impact of the NIMBY case on members’

44

feelings about the clubhouse, 4) ways in which the clubhouse has assisted members in
dealing with the NIMBY response and throughout the case, and 5) Dernogaphics.

All interviews were transcribed verbatim and were examined for accuracy by
comparing them with their original recordings. Any and all identifying information was
removed ﬁom the transcripts to ensure conﬁdentiality. Recorded tapes and transcripts
from the interviews were stored in a locked cabinet.

Procedures
Recruitment

An informational meeting was held at the clubhouse to explain to all members
what the study was about and who has been asked to participate. Two separate goups of
participants were selected: 1) those members actively involved publicly to the NIMBY
case, and 2) those members involved in the clubhouse but not publicly involved in the
NIMBY case. For those members that were publicly involved in the NIMBY case, a list
was compiled by recording which mermbers were named for making public comments in
newspapers, and by recommendation from a key informant (the director of the clubhouse)
as to who was publicly involved. This list identiﬁed 9 members. Three members from
this list were not interviewed because they no longer attended the clubhouse. One had
moved out of the area. Based on information ﬁ'om the key inforrmant it was deterrmined
that the other two members had not stopped attending the clubhouse because of NIMBY
response. They were no longer attending the clubhouse because they had other
responsibilities (e. g., job/ family commitments) that were requiring more of their time
and attention. The six members who met inclusion criterion received a letter from the

director of the clubhouse asking them if they would like to participate (See Appendix C).

45

All six contacted the investigator directly through mail, e-mail or by phone to set an
interview time.

For the second goup of participants, consisting of members involved in the
clubhouse, but not publicly involved in the NIMBY case, potential participants were
identiﬁed using the following procedure. A list of all members who were either active or
inactive members of the clubhouse at three points in time was compiled by the director.
The clubhouse director used the clubhouse data base to identify all members of the
clubhouse who had active and inactive member status in the clubhouse at the following
three points in time: (1) six months prior to the NIMBY response (September/2003), (2)
during the initial NIMBY response (March/2004), and at the time of recruitment
(October/2005). Active status in the clubhouse means that the member has attended the
clubhouse in the last 90 days a minimum of 4 times per month. Inactive member status in
the clubhouse means that the member has attended the clubhouse a minimum of once
I every 90 days.

This list included 58 members. All members with guardians were then withdrawn
from the list leaving a total of 40 members. The second goup of participants were
randomly selected from this goup. The clubhouse director sent a letter to the ﬁrst 10
selected members of this second goup describing the study and inviting them to contact
the researcher if they would like more information about the study or would like to
participate (See Appendix D). A follow up letter was sent two weeks later. Those
members interested in participating were asked to contact the investigator by mail, phone,
or e-mail to set a date for an interview. Five members responded to this second set of

letters.

46

Letters were then sent to 5 more randomly selected members. Although 2
members responded, two of them ultimately declined to participate in interviews. One
member decided at the interview that he no longer wanted to participate and another
member would only provide some information about his NIMBY experience through an
email. Recruitment of the second goup ceased at this point for several reasons: 1)
response rates were low (6/15), 2) as interviews continued, it became clear that members
from this goup had little to say about the NIMBY response, and 3) the NIMBY case was
resolved legally which changed the context of the study. A total of 6 members were
recruited for this goup.

Two staff members of the clubhouse were also interviewed for this study to get
another perspective as a source of triangulation of the experience. The director was
invited to be interviewed and chose to participate. She was asked to recommend another
staff member who had been involved with and close to the members throughout the
NIMBY case who she believed was well aware of the member’s experience and the
clubhouse response. This staff member was invited to participate and ageed to be
interviewed. Interviews were set up based on their availability.

Interviewing

Interviews took place at the current location of the clubhouse in private ofﬁce
spaces. All interviews ranged from 25 minutes to 98 minutes and all were tape recorded.
All questions followed an interview protocol. At the time of the interview, an explanation
of the project was given and an opportunity where the participant could choose not to
participate. The member was reminded that the interview would be recorded, should take

no longer than 90 minutes and that conﬁdentiality would be ensured. The consent forrm

47

was explained and asked to be sigred (See Appendix E and F). Participants were paid a
small fee for their participation. An amount of $15 was deemed appropriate as an
incentive but not so much that it would be coercive, as outline in section 8.06 of the APA
Ethical Principles of Psychologists Code of Conduct (2003). All participants were
compensated in cash upon completion of their interview. Four interviews with the
NIMBY involved members took place before the ﬁnal court decision was made. The
remaining eight interviews, with both NIMBY active and clubhouse involved members,
took place in the two months following the ﬁnal decision.
Methods of Analysis and Interpretation

Due to the exploratory nature of this proposed study, where no prior literature or
hypotheses exist, inductive analysis was used. Inductive content analysis is an approach
that is used in qualitative analysis to identify underlying themes across participants and
underlying stories within participants (Patton, 2002). In order to explore each members’
individual experience of the NIMBY response, it’s overall impact on members, and ways
in which the clubhouse may have assisted members in dealing with the NIMBY response,
two methods of qualitative analysis was used: cross-case analysis and within-case
analysis.

Cross-case Analysis

Using a cross-case strategy of analysis entails identifying themes across
individual cases within sirmilar areas of inquiry. This strategy was used to examine the
research questions to identify any common themes across participants. First, all
interviews were transcribed, read, cleaned and organized. Coding was started before all

of the interviews were completed. Coding was done separately for the two groups (i.e.,

48

NIMBY active and Clubhouse involved). For the NIMBY active members, the ﬁrst step
of the analysis process was open coding all the transcripts and checking those codes by
discussing therm individually with the chair of this project. Based on these discussions,
and ﬁrrther coding of the transcripts, reﬁnements to the initial open coding framework
were made (See Appendix G). The interviews coded earlier in the process were recoded
as necessary. The second step involved thematic coding of the open codes. Themes of
sirmilar content were sought across the NIMBY active member interviews; this is called
content analysis (Patton, 2002). These patterns in thermes were examined to see if they
could be made into larger categories. Categories were then considered and judged for
meaningfulness (See Appendix H). After development of the initial ﬁ'amework, there
were several additional versions that reﬂected minor adjustments. Many of these
adjustrments concerned codes and themes related to meaningful roles within the
clubhouse. There were two more major reconceptualizations in this iterative process: the
decision to add coding of members’ relationship to the clubhouse (See Appendix I), and
the reorganization of codes after coding the clubhouse involved members data in order to
make the themes and meta-themes across the two goups more consistent when
appropriate (See Appendix I).

A parallel coding process was used for the clubhouse involved goup of members.
The ﬁrst step of the analysis process for this goup was open coding all the transcripts
around the members’ relationship to clubhouse (See Appendix K). Codes were checked
by discussing them individually with the chair of this project. The second step involved
thermatic coding of the open codes. Thermes of similar content were sought across the

clubhouse involved member interviews using NIMBY active ﬁamework as a reference

49

for its organization (See Appendix L). Based on discussions with the chair, a major shift
in this framework occurred. The decision was made that the framework developed for the
NIMBY active members was not helpﬁrl in organizing the codes for this goup. Thematic
coding was then conducted based only on the open codes. After a thematic framework
was created, minor reﬁnements continued until a ﬁnal frarmework was ageed upon for
the clubhouse involved members (See Appendix M). In order to asses the impact of the
NIMBY response on the clubhouse involved members, summaries of each mermber was
created. Due to the fact that 4/6 reported no impact from their experience of the NIMBY
response; 1/6 reported a little negative feelings around the NIMBY response in the
beginning, but no lasting impact; and 1/6 described a process that ﬁt with more with
thematic coding for goup 1, no additional frarmework was developed for this goup.
After discussing the ﬁnal ﬁ'amework with the chair, a ﬁnal analysis included further
analyzing the identiﬁed themes of empowerment (See Appendix N).

Within-case Analysis

Within-case analysis was used to exarrrine each of the member’s individual
experiences of the NIMBY response over time. This part of the analysis brought to light
the stories of the members’ lives and their personal experience of being involved in a
NIMBY response, which was irmportant in looking for commonalities and consistencies
across stories. For the clubhouse involved members, a case surmmary of each person’s
story was written that highlighted the member’s experience of the NIMBY response,
recovery, and engagement with the clubhouse before and during the NIMBY experience.
Across all members’ interviews, individual within-case timeline ﬁgures were drawn that

described the stories of each member. Stories were examined for differences and

50

similarities across participants. Consistencies across the NIMBY active member’s stories
were so great, that one timeline ﬁgure effectively captured the stories of all ﬁve
participants. The clubhouse involved members, on the other hand, experienced three
varying paths that were quite different from the NIMBY active goup: little response to
NIMBY, no response, and no negative response to NIMBY but increased involvement in
the clubhouse over time.

Authentication of the Data

Authenticating the data refers to the validity, credibility, or correctness of the data
collected, including the description, explanation, and interpretation of the ﬁndings
(Maxwell, 1996). Validity and credibility is necessary in all methods be it quantitative or
qualitative. For qualitative methods speciﬁcally, Guba and Lincoln (1989) refer to this as
the “trustworthiness criteria” (Guba ad Lincoln, 1989) which includes: internal validity,
external validity, reliability, and objectivity. The proposed study sought to address and
minimize any and all threats to the validity and credibility of its ﬁndings using ﬁve
criteria: 1) prolonged engagement, 2) member checks, 3) negative case analysis, 4) peer
debrieﬁng, and 5) assessing the non-generalizability/ transferability of the ﬁndings.

Since the beginning of the NIMBY response against the clubhouse, there has been
prolonged engagement with the director of the clubhouse, its auspice agency, and its
members on a monthly basis, which has brought rise to the proposed study. This criterion
is irmportant to ensure that there has not been misinformation about what has been
happening at the clubhouse, to establish a trusting relationship with the members and
staff of the clubhouse, and to build a more comprehensive understanding of the

clubhouse’s culture. Member checks were used to ensure that the interpretation of the

51

ﬁndings were consistent with the intended meaning of the participants’. For this criterion,
the ﬁndings were taken back to the participants for conﬁrmation and further
understanding. Individual meetings were set up with seven of the twelve participants
across both NIMBY active members and Clubhouse involved members, but once the
investigator was at the clubhouse, the members decided that they wanted to discuss the
ﬁndings as a group. The members discussed together how the ﬁndings very clearly
demonstrated their individual experiences. After this meeting, a few of the mermbers
expressed an interest in presenting the data at an up and coming conference. The data
from this study was then presented at that conference with the members who volunteered
to participate in the presentation.

To ensure that the investigator is viewing all the many experiences of the
members and not merely just trying to prove hypotheses, negative case analysis was
conducted. This included examining cases that did not follow a usual theme. In this
study, there was a story of a clubhouse involved member that did not follow the usual
tlrermes of that group. This case was given considerable attention in the analysis and in the
discussion of the ﬁndings. In fact, thorough and careful consideration of this member’s
experience as a negative case further highlighted the implications of the ﬁndings.

Peer debrieﬁng with the chair of the study is another way that credibility was
accomplished and this involved having extensive conversations around conclusions of the
data where various possible ﬁndings were discussed. The data was coded by the
investigator and those codes were discussed with the chair to reduce possibilities of
researcher bias. To address the issue of generalizability and transferability, a full

description of the case context, scenario, and participants was provided. This description

52

will clearly show that the ﬁndings are not necessarily generalizable, or transferable, but
may be found to be generalizable if other similar studies are conducted.

Saturation

The proposed study sought to understand the impact of stigma and discrimination
experienced as a result of a NIMBY protest case on recovery of members of a consumer-
driven Psychosocial Clubhouse. This was accomplished by looking speciﬁcally at how it
has impacted their recovery, their views about the clubhouse and their involvement with
it. It was expected that the questions created for the interview protocol would bring us to
this understanding, and that saturation would be reached through a hill inquiry of how
NIMBY has made members feel about themselves and the clubhouse. For the NIMBY
active members, all of the NIMBY active members who were still involved in the
clubhouse were interviewed. These interviews were enough to reach saturation, yielding
a very consistent story of how the NIMBY response impacted members, as well as a
consistent story of how they were affected by the NIMBY case over time. By the ﬁnal
interview, there was no new information emerging around the ﬁrst two research questions
(Lincoln and Guba, 1985).

For the clubhouse involved members who were not actively involved in the
NIMBY case, it was expected that the stories of NIMBY impact would be far more
varied. We did not anticipate necessarily being able to interview enough people to reach
saturation, but were interested in whether or not these members were impacted similarly
to those who were involved. As anticipated, saturation, as deﬁned above, was not reached
for the clubhouse involved members. Recruitrment efforts ceased once it was clear that the

clubhouse involved mermbers were consistently less impacted by the experience than

53

those who were NIMBY involved. Their experiences are informative in terms of how

they contrast with those who were actively involved.

RESULTS
How the NIMBY Case impacted Members and How the Clubhouse Assisted
Members through the Case over Time: Summary of Main Findings
Members who were actively involved in the NIMBY case (N IMBY active
members) were more empowered by the end of the NIMBY case than those members
who were not (clubhouse involved members). NIMBY active members were more
negatively impacted by the NIMBY response early in the case than clubhouse involved
members. The level of exposure to the negativity of the NIMBY response and member’s
relationship with the clubhouse may explain why the NIMBY active members were so
negatively irmpacted in the beginning. Although NIMBY active members were devastated
in the early stages of the NIMBY response, over time and through active engagement in
the NIMBY case within the clubhouse, these members described feelings of
empowerment in the end. The clubhouse acted as an empowered organization throughout

the NIMBY case and appears to have played a large role in the member’s experiences of

the NIMBY case overall.

Impact of the NIMBY Response on Members’ Recovery: In the Beginning
In the end the clubhouse won their lawsuit against the city, so it is not surprising
that members spoke very positively about the ending stages of the NIMBY case in their

interviews. While keeping this information about the context of this study in mind, results

54

show that NIMBY active members demonstrated a more empowering stage of recovery
than clubhouse involved members in the end, but NIMBY active members were also
more devastated by the NIMBY response in the beginning.
Impact on NIMBY Active Members in the Beginning

In the very early stages of the NIMBY case where the negative response from the
community was at its height, NIMBY active‘ members were more negatively impacted by
the NIMBY response in the beginning than clubhouse involved members. NIMBY active
members varied in what they were exposed to, but all described experiencing very strong
negative feelings and having very negative reactions to the NIMBY response from the
community (See Figure l). Across all of the NIMBY active members, a) all of them
expressed feeling overwhelmingly bad in some way, and b) some of them discussed
having a mental health breakdown, and c) some experienced an impact on their clubhouse
attendance.

Feeling Overwhelmingly Bad

NIMBY active mermbers discussed having varying bad feelings that ranged ﬁ'om
feeling hurt, upset, sad, devastated, angry, shocked, degraded, and disappointed:

I was devastated by what they thought of us, ya know, murderers, child molesters,

and we’re gonna break in their houses, I was really devastated because that ’s not
our people. 3

Well, I was proud to be a member of [the clubhouse] and after the [ the city of the
new clubhouse location] thing, they made me feel like, you know, very insecure
and like maybe there is something wrong with me sort of thing. Um, inferior, they
made me feel inferior...those people were so agitated and you know, they, they
glared at you and just, I felt like a second class citizen is what I felt like.

 

3 Two direct quotes are included in the written results section to demonstrate themes but a minirmum of
three quotes were necessary to identify a theme. Indicators of other quotes that ﬁt each theme can be
referenced in the ﬁnal coding ﬁ'amework in the appendix.

55

Having a Mental Health Breakdown

There were members that were so negatively affected by the NIMBY response
that they had a mental health breakdown, where they had to go into the hospital, or felt
close to going back into the hospital.

Yes, it did effect me because I had to go into the hospital because it was effecting

me because I had to get my feelings together, what was going on really, and what

was going to happen. .There are people that are not giving us a chance. That ’s

not right. That ’s what made me sick

You can call it a psychiatric break or I just call it falling out where you ’re, your

illness is very bad and require, I mean, it was just, it was to the point where I was
almost killing myself so, it was that bad so...

Impact on Clubhouse Attendance

Depending on how members felt about what they were experiencing, members
began increasing or decreasing their involverment in the clubhouse accordingly. Early on
in the development of the NIMBY process there were members that decreased their time

spent in the clubhouse.

Yeah [I stopped attending the clubhouse] because it ’s like a, it ’s a put down. And
I thought that ’s not the way to go so I changed... Ifelt, that was the kind of person
that I really, I thought I, that ’s the kind of person I was. But I ’m not... I put myself
down because they were. And it didn ’t make me any better.

A member, who eventually increased her involvement in the clubhouse, attended a
planning commission meeting early in the NIMBY process where residents were treating
her badly. She had decided not to be involved in the NIMBY response anymore because
they were acting so horribly:
Yeah, yeah, I guess I just, I was curious is what I was and then after [attending
the planning commission meeting] I said forget it. I 'm not coming back. I said I

can ’t handle it, you know? All these bad vibes... I can only take so much stress
and you know, they were seething with anger.

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Regardless of the reaction of members to reduce their involvement in the clubhouse and
avoid the NIMBY response as much as possible, these NIMBY active members went
back to their regular involvement in the clubhouse where they were able to regain
strength and conﬁdence over time.
Impact on Clubhouse Involved Members in the Beginning

In contrast to the experiences of the NIMBY active members, for the most part,
clubhouse involved members were not similarly impacted by the NIMBY response in the
beginning. The irmpact experienced by the clubhouse involved members ranged from
little irmpact, to no irmpact at all (See Figures 2 and 3). The one member who experienced
a little irmpact ﬁom the NIMBY response had felt somewhat negatively upon exposure to
the NIMBY inforrmation. This member was the only member ﬁ'om the clubhouse
involved goup that experienced any negative feelings about NIMBY. She4 discussed
how she felt upset by the community response and felt more alone in the world:

Well, it basically tells me that a lot of people still have the same belieﬁs and

feelings about the mentally ill as they did back in the 1960 ’s. Nothing has really

changed in forty years... [It makes me feel like] a loner. It makes you a real loner.

The 5% that are mentally ill, that makes everyone of those people a loner.
The comment above was the most negative response that was heard from the clubhouse
involved goup. All the rest of the clubhouse involved members felt no impact from their
exposure to NIMBY. One member stated that she “didn ’t really think anything about it

Another member who also felt no irmpact upon exposure discussed how he had felt

simply that reality was being spoken through the newspapers:

 

" In an effort to conceal the identity of the participants in this study, gender identiﬁable terms may have
been altered. The terms “he” and “she” will be used interchangeably and randomly throughout the paper.

57

It was just reality coming out in the newspaper. Reality being spoke of where

nobody else would talk about it. It was just really being spoke. Because that ’s

what ’s real out there. It really is. On the, on the newspaper it was reality. People

that were aﬁ'aid their, their fears were like, ok, we don ’t wanna admit this but no

way, not them in out backyard. Because this is going too far.

Possible Reasons Why Differential Experiences of NIMBY in the Beginning

Some notable differences between the NIMBY active members and the clubhouse
involved members that may help explain why NIMBY active mermbers were more
negatively irmpacted by NIMBY in the beginning are: a) the level of direct or indirect
exposure members had to the NIMBY response, and b) members’ individual relationships
with the clubhouse; prior to the NIMBY case. These two elements were explored due to
their saliency across the interviews and because they may help to explain the different
experiences of the NIMBY case by both goups of members.
Direct and Indirect Exposure to the NIMBY Response

NIMBY active members and clubhouse members had different levels of exposure
to the NIMBY response in the beginning. Given the highly negatively charged nature of
the NIMBY response in the beginning, it is possible that those members who had direct
exposure to the NIMBY response could have been more negatively impacted by such
displays of hatred disdain by the community because they were directly attacked. Overall,
NIMBY active members had more direct exposure to the NIMBY response than
clubhouse involved members.

All of the NIMBY active members experienced some level of exposure to the
NIMBY response directly or indirectly. Direct exposure to the NIMBY response would

include those members that attended the ﬁrst planning commission meeting or had seen

and felt the negative response by the community ﬁrst hand. It was at the ﬁrst planning

58

commission meeting that community residents brutally protested the move of the
clubhouse. Indirect exposure to the NIMBY response would include those members that
heard about that meeting through the media or through the clubhouse. Although the level
of exposure that NIMBY active members experienced varied (5/6 had some direct
exposure to the NIMBY response), all of them had strong negative feelings about the
community response.

In contrast to the NIMBY active members, the clubhouse involved members all
reported that they had heard about NIMBY response indirectly and they expressed little
to no irmpact upon exposure to the NIMBY information. Three of the six members
learned about NIMBY at clubhouse meetings,

It was a sporadic meeting, or a spontaneous meeting. We were being ﬁlled in,

what was being said, you know, by the local community and uh, basically we were

told it was a, just a few trouble makers causing a big scene.
and one member had not heard anything until much later.

[I ﬁrst heard] that we 're going to move in. And then about a month later they

said, [the director] said that they were in legalities with [the protesting

community].
Members ’ Individual Relationships with the Clubhouse Prior to NIMB Y

Although the interviews took place very late in the NIMBY case, all members
were asked to reﬂect on their feelings about the clubhouse and their involvement with it
prior to hearing about the NIMBY response. It was not hypothesized that these goups of
members would differ on this dimension but it was clear from the cross case analysis that

the NIMBY active members had deeper and more personal individual relationships with

the clubhouse than the clubhouse involved members prior to the NIMBY response. Both

59

goups of mermbers felt that the clubhouse provided them with varying opportunities to be
social, to learn, and to have meaningful roles, but NIMBY active members described the
clubhouse in ways that the clubhouse involved members did not. NIMBY active
members described the clubhouse additionally as a supportive place of safety and
acceptance. The fact that NIMBY active members had deeper connections with the
clubhouse prior to the NIMBY response could provide some insight into why the
NIMBY active mermbers were more negatively irmpacted by the NIMBY response against
the clubhouse in the beginning. It might also be the reason why those particular members
become involved in the NIMBY case at all.
What the Clubhouse Means to NIMBY Active Members

In order to understand the impact of the NIMBY response on the NIMBY active
members, it is irmportant to ﬁrst explore members’ perceived relationships with the
clubhouse prior to, and at the beginning stages of the NIMBY response. All of the
NIMBY active members reported feeling strongly that the clubhouse was: 1) a supportive
place of safety and acceptance that 2) provided them with varying opportunities to be
social, to learn, and to have meaningful roles.

The Clubhouse is a Supportive Place of Safety and Acceptance

NIMBY active members were all in ageement regarding what being a member of
the clubhouse meant to them. A nurmber of themes were identiﬁed that created a common
ﬁamework across all of the NIMBY active members. All of these members’ very
personal connections to the clubhouse were based on the belief that the clubhouse was a
supportive place of safety and acceptance. More speciﬁcally, NIMBY active members

identiﬁed the clubhouse as: a) a place of support, b) like a family, and c) as a safe space.

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Clubhouse as a Place of Support
Support can be received and given in many places in people’s lives, and these
NIMBY active members discussed how the clubhouse was a source of social support for
them in a variety of ways. One member described very nicely how support works for her5
and how irmportant and helpful that support can be in people’s lives:
...not only [the clubhouse], my family, my church, people, when I was down to my
lowest point, someone helped bring me, liﬁ me back up and I want to do the same
thing and [the clubhouse] is a great plus for this in society. I know that for a
fact... Well, when they tried to, when they really sympathize, empathize with how I
felt and tried to be supportive. It was the support system that really got it, you
know? ...it ’s the support system. We all need supports whether it ’s religion or
whatever. We need that support system to go on and, you know what I ’m saying?
NIMBY active members talked about how three aspects of support, including: a)
receiving support from the clubhouse, b) giving support to others, and c) the importance
of having staff that believe in their potential.
Receiving support
It is not surprising that members would feel that the clubhouse is a place to
receive support, because that is one of the primary roles of a clubhouse. A clubhouse
environment is desigred to be understanding and help facilitate the process of recovery
for people with SMI, and it appears that, from what these members state, this clubhouse
has done just that. Members described receiving support in a number of ways: feeling
understood, feeling that people at the clubhouse cared and were kind, feeling that the
clubhouse pushes them to reach their goals, and that the clubhouses notices when they are

not there and will reach out to her to bring them back in.

Um, you know, if I ’m having a bad day, you know, they understand and there ’s
like, you know, a really great feeling knowing that when you ’re having a bad day,

 

61

that people aren ’t looking at you saying oh, you know, you ’re just, you know, get
out of the depression and that sort of thing and they understand here and they ’re
supportive and if I have a problem I can go to any staﬂ and they ’11 sit and talk to
me so...

When we get here we get support... I like to keep progressing and moving and

[ the clubhouse] has helped me. They push me too. When I ’m not here, believe me,
I get many calls, they say [name of interviewee] please come home, please, we
miss you and that makes me really feel good.

Giving support

Some of the NIMBY active members described ways in which they would
frequently give support to others at the clubhouse and how doing so made them feel
good. Giving support was discussed in different ways: by being there to talk with
members and by being there to help others when necessary.

I call it leadership. When I help someone else it ’s making me feel like I
accomplished that. It makes me feel good too, to help another person.

One member described that she was involved in both giving and receiving support at the
clubhouse as needed.

When I was sent here, really, it helped me start to focus more, not so much on
myself not on myself but more on others because a lot of people, it ’s not just to
seeing my face that makes them feel good about themselves, I really appreciate
the talking to these people, these members we have here...1nformation I give,
where ever I go as a seminar, newspaper, doctor, where ever, that ’s pertinent to
the mental health system, anything, any facet of life I try to pass it on. This is my
purpose at this clubhouse because they basically share just about everything
they ’ve got. You know? They try to lift someone up when they 're down, we try to
lift their spirit and bring em up to the same level as everybody else, because I
was doing it and this time now people are helping me because every time, some
times you have a down spell and you need someone ’s help as well and I
understand...

Staffs belief in members

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A couple of members explained that having the support of the director of the
clubhouse was an important element of support. They felt that the director of the
clubhouse was a true believer in people with mental illnesses, who was committed to
them, and who has cared for them. A couple of members expressed their appreciation for
the position that the director had chosen to take in support of people with mental
illnesses:

Well, no, [the club director] is a true believer. She ’s been here from the

beginning. And there hasn ’t been any really true believers. No one ever

committed to the length that she has been here. They come here and then they go
some where else. They ’re not true believers. True believers go with the ﬂow and
accept what ’s given them for their pay, and you know, so...

I saw the caring of lawyers and [the clubhouse auspice agency] and [the

director], who ’s been fighting for us ever since, since she got in the business of

this, caring for us. I mean, I saw a real commitment that you don 't see unless you
really do care about what you believe in.

Being a Part of a Clubhouse is being Part of a Family

In addition to the clubhouse being described as a place of support, NIMBY active
members also referred to the clubhouse as a family. Although the description of the
clubhouse as a farmily has somewhat varied meaning for each of these members, it seems
clear that by describing a clubhouse as a family, members expressed that being a member
of the clubhouse is something that was essential to them; something that sustained them
in some ways.

[I come to the clubhouse] for support and a feeling of family and we have um,

there 's some members, where [the club director] is the mother and there ’s

[another clubhouse member], myself [another club member] and [another club

member]. We ’re all sisters and we 're all, basically we ’re children of mom, so,

yeah. We have a good time with that. I feel it ’s my family. I tried to stay away and
withdrawal ﬁom [the clubhouse] and I found that 1 couldn ’t so...I came back. So

it '3 my family...I couldn ’t exist without the clubhouse, I mean it was like I was
totally on my own and that wasn ’t working. I mean I have a roommate but I mean

63

aaah I don ’t know...I just needed to come back to the family and I needed the
warmth of the clubhouse.

...it ’s like we ’re a family. Every one here is like a family. We look out for each
other and try to uh, if something ’s wrong we try to...ﬁnd out what ’s wrong. It’s
the connection and the love that they show toward one another...and willingness
to help show people things can be better...And that 's a feeling I love about this
place.

The Clubhouse is a Safe Space
NIMBY active members discussed that they have come to feel that their
clubhouse is a safe space where they feel accepted for who they are:

Well, basically, it was the ﬁrst place on the face of the earth that had accepted my
[being gay] along with my mental health. It was the ﬁrst place on the earth I
wasn ’t any diﬂerent then anybody else inside the walls of the Clubhouse...
Acceptance, yeah, you know. I like being able to come to the clubhouse and not
feel threatened, ya know. Being gay is a threatening experience in the United
States so, aaah, everyday I don ’t end up dead I ’m happy. (laughs) I come to the
clubhouse to shut the door. On the waves of the pond, ya know, when you throw a
stone in and it makes ripples you just come in and you shut the door and the
waves stop...I come here because I have permission to keep anything and
everything outside that door. If I don ’t want any, if I don ’t want society in, to
come in that door they don ’t. If I don ’t want my doctor to come in that door, they
don ’t. My case worker doesn ’t come inside that door. My mother won ’t be able to
come inside that door. [My girlﬁ'iend] won ’t be able to come inside that door.
Nobody can come inside that door unless they have my permission to do so and

it 's my space.

I feel diﬁ'erentﬁ'om other people sometimes but then here ’3 like a place to let

myself be normal, and not that I ’m not normal, I 'm not any diﬂerent when I ’m out

in public but I just, I don ’t know, don ’t feel as safe sometimes. Mmmmmm... safer.

Yeah, I feel safe at certain areas too, just it 's safer. I mean it ’s, I want people to

treat me the way that they want me to treat them, ya know. You ’re supposed to

treat one another the way you want to be treated and that ’s what I believe...
Being Part of a Clubhouse Provides Many Opportunities

NIMBY active members not only felt that the clubhouse was a space where

mermbers felt supported, where they felt like part of a family, or where they felt safe; they

64

also described that the clubhouse provided members with various opportunities. The
clubhouse environment was such a space where opportunities were provided, where they
could explore their options, and work towards personal goals. NIMBY active members
pointed out that they felt that the clubhouse provided for them opportunities to: a) be
social and have ﬁiends, b) to learn, and c) to have meaningful roles.

The Clubhouse is a Place to be Social and Have Friends

Clubhouses have many opportunities for members to be social with one another in
all aspects of the work order day as well as the many social activities that occur weekly.
These NIMBY active members discussed how they felt about the social opportunities
provided to them and the ﬁiends they acquired.

Yes...it feels like I have, like I ’ve got a lot of friends here because, ya know, I just

think that this pace is a wonderful place to be, to be together and do things

together and have friends. (1040-4)

Some would even come there and help me clean and so forth, take me out and go

to the movies and so forth, that kind of thing. They might have an activity and I ’1]

meet them at the mall, drive to the mall, and go up there and socialize with them.

Oh yeah. They like that they work here. They were so glad to see me. I ain ’t even

out of the car, ‘here comes your pal ’, like oh god, they ’re really there. (103a-12)

The Clubhouse is a Place to Learn

The clubhouse’s supportive environment provides an opportunity for these
NIMBY active members to learn and apply skills everyday.

[My life is] better...I ’ve been getting new skills here like computer skills. You can

pay a bundle of money to take a computer class but I can come here for ﬁ'ee and,

also, other members that are very well versed and can help me as well. There ’s

um, a couple of members that, if I ’m in a bind on the computer that will bail me

out.

[The clubhouse] has been a very good help to me and it ’s been a learning

experience for me. Things I wasn ’t sure of I ﬁnd myself being able to understand
and apply it to my day to day as well as being a help to someone out there.

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The Clubhouse is a Place to Have Meaningful Roles

For these NIMBY active members, the clubhouse has provided them with, not
only the role of being member of a clubhouse, but a space where they could create more
speciﬁc roles for thermselves that have personal meaning and value to them. Everyday
members are provided opportunities to be a part of social events, contribute to a work
order day, and attend groups. All of these opportunities that are provided by the
clubhouse are what provides members with the potential to have roles in whatever it is
that is meaningful to them. For some mermbers, it is important to them to simply know
that they contribute to the daily functioning of the clubhouse:

Before it was like going to classes now as members we run the clubhouse. So, that

gives us the opportunity to really say wow we should be proud of ourselves for

doing that. Running the clubhouse.

. [Being a part of the clubhouse makes me] feel accomplished. That I, yeah, that I

did something worthwhile. I ’m participating in the functioning of the clubhouse.

NIMBY active members also described that they saw themselves having more
speciﬁc roles in the clubhouse besides that of merely a clubhouse member. The roles they
discussed meant very personal things to them, roles that they may claim as part of their
personal identity. These more personal and meaningful roles that members talked about
ranged from: being the one who runs and maintains the clubhouse library, to feeling that
they were a leader in the clubhouse, to feeling a responsibility in maintaining the
computer systems in the clubhouse, to feeling that their life has in some way set an

example of what is possible for others with SMI.

Well, I ’ve contributed to our library. I have the books; for the most part they ’re in
the different categories and... Yeah and I ’ve been working in the library so that’s

66

my contribution and if people want to know how to work in the library, I train

them and I teach people how to alphabetize and stuﬂ like that so that’s my

accomplishment.

My responsibility is to try to take care of and keep the up keep on the computers.

Cuz I have 25 years of computer experience.

It was quite clear that these NIMBY active members had very special and
personal ties with the clubhouse by the way they viewed the clubhouse as a supportive
place of safety and acceptance. This clubhouse was not merely a mental health facility
where people with mental problems went to get services. All of these members viewed
the clubhouse as an essential part of their lives in some way and so when the NIMBY
response occurred against the clubhouse, it’s easy to see why these particular members
became actively involved in it. Becoming involved in the NIMBY response seems as
though it was a natural response for these members; to speak up on behalf of a place they
considered to be a second home, their family.

What the Clubhouse Means to Clubhouse Involved Members

In contrast to the importance of the clubhouse for NIMBY active members as a
family and a safe space, the clubhouse involved members generally focused on how the
clubhouse provides them with the chance to take part in various opportunities.

The clubhouse provides many opportunities within the clubhouse

Much like the NIMBY active members, many of the clubhouse involved members
felt that the clubhouse provided them with various opportunities for meaningful
involvement, including opportunities: a) to be social and have ﬁiends, b) to be with

others like therm, c) to learn needed skills, and d) to have meaningful roles.

The clubhou_se is a place to be social and have friends

67

Clubhouses are places where members have many opportunities to be socially
involved and this also allows for opportunities for members to create ﬁiendships.
Clubhouse involved members reported that the clubhouse was a place for socializing,
talking, and bonding with others.

I like to socialize. This is the place to socialize at... Yeah, I have uh, enjoy

personal contact with clients and talking to them and uh, having some meaningful

discussions... Well, it makes me not so isolated, you know? It gives me a place to
go to you know? So, I don ’t become a hermit, you know? I can talk to people.
Some members talked about the irmportance of having friends at the clubhouse:

I consider most of the memberships here ﬁiends. Most of them. Like I say about

myself [the clubhouse] is good for me. Ah, my goal, my next goal I 'm gonna be

working on, when I get the diet and everything right, is umm, to make friends on
the outside. I am workin on that.

The clubhouse is a place to be with others like them

Clubhouse involved members describe how being with others like them was
helpful for them: it helped them to see how best to deal with their illnesses, it helped
them to not feel alone with their illnesses, and it helped them to become accepting of
their illnesses, because they learned to accept each other.

[being a member of the clubhouse] changed the experience of my illness. I think

it uh, sheds light on the fact that I can deal with my illness because uh, I ’m with a

group of people all with similar illnesses dealing with their problems as best they

can as I ’m trying to deal with my illness best I can.

Yes. [Before joining the clubhouse I was] very withdrawn, I really, the clubhouse

has helped me to accept others as well as myself To accept others with mental

illness, cuz I was just as much a judge as society, I ’m ashamed to say. And that
means of myself too. And I just wanted to crawl in a hole and die somewhere.

The clubhouse is a place to learn needed skills

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Much like the NIMBY active members, clubhouse involved members felt that the
clubhouse provided opportunities for them to learn needed skills. The variety of tasks and
activities that compose the work ordered day in the clubhouse provided members with
opportunities to learn varying skills. Having a variety of tasks and activities available to
members, as well as ﬂexibility in the assigrment of tasks and activities also provided
mermbers with the ability to choose activities that they enjoyed and wanted to master.
Clubhouse involved members reported that being a part of the clubhouse helped therm to
learn how to work with others, how to maneuver through varying tasks, and how to learn
responsibility through commitment to the clubhouse over time.

It teaches [us] how to work with other people. And not be isolated, and to feel

good about their self because they ’re doing something. Ya know...their learning

how to cook a meal. Or they ’re learning umm, sanitation even, about in the
kitchen. Like bleaching the cupboards the counters. Or, or washing their hands,
or how to cook a meal or how to um, do laundry, or how to bleach the whites, or

all kinds a things we do here. It ’s like running a house. *

I gotta learn to commit to some things, and really its me that ’s going through

some personal things that I need to learn how do deal with it, but I gotta learn

commitment, I gotta learn trust, I gotta learn a lot of things that I just thought of
that I need to start learning how to do. I think if I get up in the morning and do
something about it, it ’s like I get up to go to work everyday, I just ﬁgure I gotta

try and get used to doing things, so that ’s the reason I come here everyday, it ’s a

way for me to practice getting to work on time, to get here on time, you know, if I

get here on time in the morning and you know, if I pick up on the little things, I

might be ready by the time I leave. To you know, get a real job and hopefully

they ’11 say, ‘Well, he ok. ’ Ya know?

The clubhouse is a place to have meaningpr roles

Much like the NIMBY active members, clubhouse involved members reported
that the clubhouse is a place where they can have meaningful roles. For most clubhouse

involved mermbers, their descriptions of these roles were more task oriented than the

NIMBY active members’ descriptions, which focused more on their roles and

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responsibilities within the clubhouse. Clubhouse involved mermbers felt that the
clubhouse provided them with activities and some felt good about being part of an
organization. Few members felt they had more personally meaningful roles and
responsibilities in the clubhouse.

Having things to do. Some of the clubhouse involved members described their
participation or role with the clubhouse very simply. These clubhouse involved members
did not refer to the overall functioning of a clubhouse, they described the activities that
they took part in and for them that was it. Some of these members described various
activities and tasks of the work ordered day that they took part in while others reported
participating in very speciﬁc tasks on a regular basis. Either way, these members made it
very clear that the clubhouse gave them things to do.

I answer phones, uh, regularly, uh, Mondays and Tuesdays, or whenever I’m in. I

like uh, typing articles, various articles for their newsletter. I ’ve been doing that

for a long time.

I work on the clerical unit, like when they ’re doing attendance and stuﬂ like that.

I type the bulletin up for em’, I clean up sometimes, answer phones, work in the

snack room where they sell all the stujf at, and that ’s about it really. I might

vacuum every once in a while or take the trash out...or I’ll help with certain
things like if they need someone to go to the grocery store, I ’11 go to the grocery
store with them. That ’s about it.

Being a member of an organization. Clubhouse philosophy stresses that their job
as a member is to contribute to a work ordered day that is set up to maintain the everyday
functioning of the clubhouse. It is explained that if they do not do certain things in the

club that those things will not get done. This places a certain level of ownership and

responsibility in the hands of the members by just being a member. Given this fact it is

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not surprising that some of clubhouse involved mermbers described feeling that they
personally contribute to the successful functioning of the clubhouse.
I think my role here is like anybody else here, to mingle amongst each other, work
with each other, and like even taking attendance here, there ’s a number of us that
get together to do that. Together. So it ’s not all one person. And we send it to the

[clubhouse auspice agency], but they send it to the government. It’s we run the
club house all of us do. Not one person.

I like being a part of things actually being worked on and being completed, tasks
being completed... When I work the Snack Shack, just seeing products go out and
counting the till and, you know, [mowing that you ’re responsible to increase the
proceeds of the clubhouse in one area.

Personally meaningful roles or responsibilities. There were two clubhouse
involved members who described having personally meaningful roles and
responsibilities. One was a member of the advisory board, who also described himself as
feeling responsible for educating members about the importance of voting. The other ran
a self-help group at the clubhouse. Interestingly, both of these individuals saw their
primary role as involvement in activities that go outside the reahm of the basics of a
clubhouse’s work ordered day. For these members it seems that the clubhouse was a
space where they could provide support or infonmation to others that was outside of the
clubhouse’s primary mission.

I like to, ya know, help educate uh, various members about the importance of uh,

voting during election time. Because uh, that really, that 's the place where it ’s

gonna hopefully make the difference. I mean if you, you want, when you vote for

someone, you want hope, how do you hope, you wanna, ya know, read about that
person. Get to know that person, uh, somewhat. And get to know what their goals
are, so that uh, you stand a better chance of voting for someone who ’s gonna
make a diﬂerence instead of someone who ’s gonna show favoritism to the rich

and wealthy.

...I do a [self help] group here [at a speciﬁc day and time] and if I come in during
the week, then I ’11 have a meeting then too... When I 'm not here I ask people to do

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a group, like yesterday, I asked [another member] to do a group. I talked to him
Tuesday aﬁemoon, he said sure. He wasn ’t, he didn ’t show up.

The clubhouse involved members had seemingly different personal ties with the
clubhouse than the NIMBY active members. The NIMBY active members described
feeling strongly that the clubhouse was a supportive place of safety and acceptance that is
like a family, but the clubhouse involved mermbers did not describe feeling that way at
all. Although the clubhouse involved members felt similarly to the NIMBY active
members, when they reported that the clubhouse provides them with many opportunities
to be social, to learn skills, and to have meaningful roles, most of the clubhouse involved
members described roles that were more task oriented and less personal in nature than the
NIMBY active members. In contrast to the NIMBY active members, clubhouse involved
members talked about how the clubhouse was important because they were able to be
around others who have mental illnesses; others like them. Overall, the clubhouse seems
to be important to clubhouse involved members, but these mermbers do not seem to have
the depth of personal ties or sense of responsibility that were expressed by the NIMBY
active members.

Overall, clubhouse involved members did not have the depth of personal
connections to the clubhouse as the NIMBY active members and they did not have the
same level of direct exposure to the NIMBY response when it’s negativity was at it’s
height. These elements could be considered explanations for why there were such

dramatic differences in the impact of the NIMBY case on members in the beginning.
These factors may also provide some explanation for why there were also such

differences in how members were impacted by the NIMBY case in the end.

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The Irmpact of the NIMBY Case on Members in the End

By the end of the NIMBY case, NIMBY active members reported feelings that
were consistent with empowerment as cited in the academic literature. This was in stark
contrast to the experiences reported by the clubhouse involved members who did not
describe any changes in their recovery, their feelings about themselves, or their
involverment with the clubhouse, in the end.
Impact of the NIMBY Case on NIMBY Active members in the End

NIMBY active members were negatively irmpacted by the NIMBY response in the
beginning of the NIMBY case but in the end, they experienced a complete turn around in
their feelings about themselves and the clubhouse (See Figure 1). NIMBY active
members reported that: a) they still felt good about themselves, b) they felt better about
themselves, and 0) they felt better about the clubhouse. Interestingly, the transformation
among these members in moving from devastation to feeling it is important to take a
stand is consistent with the academic literature on empowerrment. (Linhorst, 2006;
Rappaport, 1987; Zimmerman, 1990; Zimmerman and Rappaport, 1988).

Still Feel Good About Self

Regardless of the negative feelings that members experienced at the start of the
NIMBY process, NIMBY active members felt strongly that the NIMBY response did not
have any lasting negative impacts on their process of recovery or their feelings about
themselves in the end.

No, [NIMBﬂ hasn ’t [aﬂected me]. I know my capabilities and I know my

strengths and I know that I’m not what they say that I was or am. Nope. I ’m still
me. I know what the truth is and the truth will set you ﬁ'ee. Sorry.

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One member talked about how the NIMBY response reinforced the idea that she just
needs to go and show people that she can do things and that her illness is not a disability:
...oh it ’s made me realize, I’m, uh, it’s not going to cause me to think about it one
way or the other because my whole point is just to go out there and do what, don ’t
let this, my illness clog what I ’m doing, to show you I CAN DO, you know? Uh,
that ’s not going to be an issue for me at all, no...
Feel Better about Self
Although initially, NIMBY active members said that the NIMBY response did not
change the way they felt about themselves, many of them mentioned later in their
interviews that they felt noticeably better about themselves than they did before the
NIMBY case. Members learned a geat deal from the NIMBY situation, about themselves
and the community and some mermbers seemed to gain a better understanding of the
world around them. Members reported feeling stronger, more hopeful, happier, proud,
and more motivated. Some felt proud for being a part of something that achieved
something so geat, and some felt more motivated to go out and ﬁght in other ways.
Uh-huh. I ’m still, matter of fact it made me a better person. Well, it did. It made
me really hopeful and I ’m gonna start showin ’ and sharin ’ and being a strong
force again, in this, like I told [the clubhouse director], I ’m going to be the
strong, same strong person, the person that ’s going to ﬁght for the members but
I’m going to do it a better way.
I feel really proud of myself now. I feel like I ’ve achieved something like a goal in
our life that can make us all feel like ‘hey we did it’.
Feel Better About the Clubhouse
NIMBY active members felt good about the clubhouse before the NIMBY

response but in the end they felt even more proud of the clubhouse and how they dealt

with the NIMBY situation. Members felt the clubhouse did the better thing by “taking the

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high road”, they felt proud of the clubhouse for not giving up, and that nothing had

changed for some members because they will continue to support the clubhouse.
Actually, um, I ’m more proud of being a member of the Clubhouse because we
weathered the storm and weathered all the negative comments and we took the
higher ground. We did not respond with anger and we did not respond with
unkind words so we are the better people...we did not stoop and we did not call
them all these names. We could have called them a whole bunch of names and we

didn ’t. Oh yeah, we didn ’t say a damn thing. We just let them beat their own
shield.

Um, I guess when we found out we won, I took a lot of pride in the clubhouse

because we worked relentlessly with [the auspice agency] and it was a long haul

and I ’m really proud of the clubhouse for sticking with it because I think anybody

else would have said forget it and just given up and we didn 't give up. I didn ’t. I

hoped and then when I heard that the department of justice was involved, then I

knew that it was going to happen but urn, for awhile I was not optimistic.

Feeling Stronger & Motivated to Act in the End

In the end, NIMBY active members were feeling much better, but members had
also reported feeling more conﬁdent and stronger than they had before experiencing the
NIMBY case. NIMBY active members reported that they not only felt better, they felt: a)
better able to deal with having a mental illness, and now see that it is b) important to take
a stand for their rights and the rights of others.

Better able to Deal with Having a Mental Illness

Some NIMBY active members felt that after they experienced NIMBY they were
now more able to deal with their mental illness. There are things that that members have
had to avoid or dismiss in their lives because of their mental illnesses, but members have
gained a lot ﬁ'om what they’ve learned and experienced throughout the NIMBY process.

This experience has helped them become more open, and conﬁdent, and willing to take

on certain challenges. One thing they learned throughout this case is that they do not have

75

to be ashamed of their illness. Members reported feeling that they have come more to
terrms with their illness, that they feel more comfortable talking with others about their
illness, and that they overcame some fears in experiencing the process.

So gradually, over the years, I ’ve gotten better and better but um, just in the last
couple of years, I ’ve kind of come to terms with my illness and um, you know, I
don 't go around proclaiming it but you know, people like, especially in my
building. People, new people come in, they want to know why I live there so I just
say I have a disability. I’m not so much afraid to tell people I have an illness. I
don ’t want to tell people speciﬁcs but basically I ’m not afraid to tell someone I
have a disability. Before, I um, I had a lot of trouble doing that, you lcnow?

I feel better in the sense that now I, now when I go to my apartment I can talk, I

mean, the people there know about [the clubhouse] in the paper and I always kept

[quiet] of what my outside life was, what I was doing on the outside. But now I ’m

not and I opened up a little bit.

Feel it is Important to Take a Stand

Members talked about how they felt that it is important that people stand up for
their rights and help to end stigma of mental illness. Winning the lawsuit meant more to
members than just being able to move to a new location, and these NIMBY active
members are not going to let this lesson go urrlearned. Mermbers acknowledged the power
of voice and how important it is for people with mental illnesses to speak out to end the
stigma of mental illness; some vowed to continue to ﬁght for their rights, and others
reported learning to never let go of what they believe in.

And you know, the stigma that people ﬁ‘om [the city of the new clubhouse

location], you know, were thinking, that is not going to be erased if people don ’t

step up and, you know, say this is, I have a mental illness and I ’m functioning and

I work and this, that, and the other, you know? I guess I feel like you know,

when we do move to [the city of the new clubhouse location] that I, I would like

to, you know, be a part of whatever it is we can do to get the community involved

with the clubhouse.

...it has taught me how to never let um, go of what you believe in and what you ’re
striving for because that shows weakness in yourself and you know, you ’ve got to

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be strong or more of a balance...I ’11 continue this ﬁght for the mental health

system myself to promote it, to understand it, and to help people to

understand ...Oh yeah...It really, encourages me because, you know, there was a

time where you couldn ’t see what was going to happen; whether we were going to

have a clubhouse [or not].
NIMBY Active Members ’ Experiences in the End: From the Empowerment Perspective

Many of the feelings that NIMBY active members reported at the end of the
NIMBY case were consistent with the academic literature on Psychological
Empowerment (PE). Empowerment is “a process by which people, organizations, and
communities gain mastery over issues of concern to them” (Rappaport, 1987). PE is
when an individual person feels empowerment (Zimmerman, 1990). Empowerment is
described as both a process and an outcome but “empowered outcomes are one
consequence of empowering processes.” (Zimmerrman, 1995; p. 585). Feeling
empowered can involve having an understanding of ones socio-political environment,
having an awareness of resources and factors that can enhance or hinder efforts to
achieve goals, having a sense of motivation to control, believing that goals can be
achieved, or having the decision-making and problem-solving skills necessary to actively
engage in one’s community (Zimmerman, 1990). From the empowerment perspective,
NIMBY active member’s responses at the end of the NIMBY case reﬂected feelings of
empowerment by: 1) being aware of the factors that inﬂuence achieving their goals, 2)
believing that goals can be achieved, and 3) having the motivation to take control and act.

Awareness of the Factors that Inﬂuence Achieving Goals

Throughout the NIMBY case, NIMBY active members learned about the socio-

Political environment in which they live and its potential irmpact on their lives. They

gained an awareness of the various factors that contribute to achieving their goals, as well

77

as the factors that hinder their ability to reach their goals. Understanding the way in
which stigma can irmpact people’s perceptions of others and the irmportance of setting a
positive example for other people with SMI are just two of the ways in which NIMBY
active members demonstrated becoming more aware and empowered in the end.

I now have an understanding if what this is and occasionally I do have the same
stigma that they do, the NIMB Y stuﬁf on certain issues, but once I get more
information I can work through it and that ’s what I think needs to be done with
the people in [our new location].

...the stigma that people from [our new neighborhood] are showing, is not going
to be erased if people don ’t step up and say...I have a mental illness and I am
functioning and I work, and this and that and the other, you know?

Believing that Goals can be Achieved
In addition to what members learned about the factors that can inﬂuence reaching

their goals and the larger issues in the socio-political environment, they learned through
the clubhouse’s response to the NIMBY case how to work with those factors. NIMBY
active members had experiences throughout the NIMBY case that brought them to
believe that the goal of moving to their new neighborhood could be achieved. As an
empowered organization, the clubhouse contributed to mermbers’ beliefs that what they
hoped to achieve could and would actually happen through their efforts. Believing that
moving to the new location was possible was an important aspect of ermpowerment '
experienced by NIMBY active members.

[My transportation] driver would ask me ‘are you moving yet? ’. They always
said that to me, and I said ‘not yet but we will be ’. I says ‘I believe that we ’re
going to go there '.

...it has taught me how to never let go of what you believe in and what you ’re

striving for because that shows weakness in yourself and you know, you ’ve got to
be strong or more of a balance...

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Motivation to T ake Control & Act

An important aspect of PE is feeling motivated to control the factors that
inﬂuence meeting ones goals. Once a person can identify the factors that inﬂuence
reaching their goals, they can then begin to identify how to go about removing any
barriers to achieving their goals. Although believing that a goal can be achieved is not
always enough to motivate someone to act, sometimes seeing it happen is motivating. In
this case, the clubhouse set quite an example of how to win over discrimination by
winning the lawsuit, and this created some motivation within the NIMBY active
members. In the end of this NIMBY case, NIMBY active members expressed how they
wanted to become more active against discrimination in the future.

...when we do move to [the new neighborhood] I would like to be a part of
whatever it is we can do to get the community involved with the clubhouse.

I 'm gonna start showin ’ and sharin ’ and being a strong force again, in this, like I
told [the clubhouse director], I ’m going to be the strong, same strong person,
the person that ’s going to ﬁght for the members but I ’m going to do it a better
way.

Although the NIMBY active members were devastated by the NIMBY response,
and should not have had to experience such discriminatory reactions from their new
neighbors, it seems they have gained something ﬁ'om the experience in the end. The
literature on empowerment is quite consistent with what the members have reported by
the end of the NIMBY case, and these are irmportamt ﬁndings to consider in contrast to

the experiences of the clubhouse involved members. Experiences of the NIMBY case by

the end of it was expressed quite differently by the clubhouse involved members.

Impact of the NIMBY Case on Clubhouse Involved Members in the End

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In contrast to the experiences of NIMBY active members, clubhouse involved
members were not only less impacted by the NIMBY response in the beginning, they
reported no change in their feelings about themselves and the clubhouse by the end of the
NIMBY case. Almost all of the clubhouse involved members were fairly unaffected by
the NIMBY response overall (See Figures 2 and 3). In the end, all but one member stated
that the NIMBY response did not affect them personally and had no affect on how they
felt about being a part of the clubhouse:

No [impact].

I don ’t see what the big deal is about moving in there but I guess if they really

want it.

As was mentioned earlier, the level of exposure that the clubhouse involved members had
to the NIMBY response and the personal connections that they had with the clubhouse
prior to the NIMBY case may have had something to do with why these members were
virtually unaffected in the end.

Across all of the NIMBY active members there is clear pattern of change,
transformation, and redeﬁnition. All of these NIMBY active members experienced
negative feelings about the NIMBY response in the beginning and then began feeling
more positive and stronger as individuals and as part of a clubhouse in the end. The
clubhouse involved members had experiences that were quite different ﬁom the NIMBY
active members in that they underwent no changes in their feelings about themselves or
the clubhouse by the end of the NIMBY case. It is speculated that the differences
between these two goups of members (personal connections with the clubhouse prior to

NIMBY, level of exposure to the initial NIMBY response) could be the reasons for these

80

differences of experiences. Although those differences are quite interesting in and of
themselves, an examination of what mermbers experienced with the clubhouse over time,
between the initial NIMBY response and winning the NIMBY case in the end, is another
important aspect of the NIMBY case that sheds some light on the differences of
experiences. It might be that NIMBY active members were more empowered in the end

because of how they were actively engaged in the NIMBY case over time.

How the Clubhouse Assisted Members through the NIMBY Case over Time

To place into context how mermbers who were actively involved in the NIMBY
case becarme more positive and stronger by the end of the case, it is critical to examine: a)
how the clubhouse reacted to the NIMBY response, and b) how the clubhouse assisted
members through the NIMBY case over time. Due to the distinctly different experiences
between the NIMBY active members and the clubhouse involved members, special focus
will be placed on the experiences of the NIMBY active members in order to understand
what exactly occurred over time that brought therm to experience a positive
transformation consistent with the later stages of recovery and empowerrment. The
experiences of the clubhouse involved members will be discussed in contrast with them
at the end.
How the Clubhouse reacted to the NIMBY Response: An Empowered Organization

In understanding the experiences of members with the clubhouse over time, it is
essential to have some information about the context and background of how the

clubhouse reacted to the NIMBY response and continued case over times. The clubhouse

 

6 The contextual information was provided through an interview with the clubhouse director and consumer
staff, discussions with auspice agency staff, and reviews of newspaper articles.

81

as an organization had knowledge of, and good relations with, their networks, and based
on that quickly identiﬁed and mobilized their existing resources in order to be able to
take legal action as advised. Over time the clubhouse reached out to all of their
organizational networks where they requested and received their support. The lawsuit
gained such a vast armount of recognition that the United States goverrrrmemt learned of it
and chose to become involved in their efforts. By the end of the NIMBY case they had
won their lawsuit against the city under the ADA and their case has been logged in a
report titled “Enforcing the ADA: A Status Report from the Department of Justice”.

It could be said that this clubhouse reacted as an empowered organization would.
Empowered organizations are known to effectively compete for resources, network with
other organizations, inﬂuence policy decisions, or offer effective alternatives for service
provision (Zimmerman, 2000). The ability of this clubhouse to respond so
comprehensively to the NIMBY response, and be successful in its aims, provides some
evidence of its status as an empowered organization. Aside ﬁom how the clubhouse
responded to the NIMBY response as an organization ﬁ'om an outsider’s perspective,
they also responded to the needs of their mermbers internally.

In the beginning stages of the NIMBY response, the clubhouse staff decided they
wanted to work very closely with their auspice agency. An auspice agency is a
sponsoring agency that some clubhouses are afﬁliated with. Some clubhouses have an
auspice agency in order to work collaboratively with them to increase their effectiveness
in the community. The auspice agency had been supportive of the clubhouse’s choice of
relocation and was with them at every step to ensure a successful move (i.e. assisted with

permit authorizations and building plans, provided gant funding for materials, provided

82

legal representation). This particular auspice agency had experienced a similar NIMBY
response from another area in the state just three years prior to this case. This history
provided them with an understanding of what could happen in this case and how to
approach and prepare for what was yet to come.

The auspice agency was tremendously supportive to the clubhouse and its
members. The CEO of the auspice agency viewed himself as an advocate for the
mermbers and was personally invested in worked closely with the clubhouse. He involved
their marketing representative to ensure that a positive frame would be placed on the
NIMBY response as it was portrayed in the media. He frequenﬂy met with clubhouse
members to keep them informed about what was happening with the NIMBY case. He
also made his counseling staff available for members if they felt they needed to speak
with someone about feelings they might be having about the very negative NIMBY
response.

Once the use of a special land use permit becarme an issue, one of the auspice
agency’s staff, who was also an attorney, was brought onto the scene. When the planning
commissioner asked that the clubhouse provide answers to almost 50 questions asked by
the neighbors (illegal questions asking for members’ personal medical information), in
addition to their special land use permit request so that the request could be “better
evaluated”, the attorney advised them that they should seek legal advice on zoning and
discrimination issues. They were again supported by the auspice agency in gaining legal
advice and this marked the basis of the lawsuit held against the city.

How the Clubhouse Assisted NIMB Y Active Members over Time

83

Although NIMBY active mermbers all described being very negatively effected by
what they had experienced or witnessed initially during the NIMBY response, they
described going through a similar process of feeling better over time. In describing their
transformation, members described a variety of ways in which their participation with the
clubhouse helped them to cope with their negative feelings. The clubhouse: a) Provided
opportunities for action in response to NIMBY, b) provided support to members, c) kept
members informed about the NIMBY case, d) maintained clubhouse business as usual,
and e) kept members focused on the positives. After considering how the clubhouse
assisted and supported NIMBY active members over time, it is quite clear how their
active participation with the clubhouse contributed to their feelings of empowerment in
the end (See Figure 1).

Provided Opportunities for Action in Response to NIMB Y

For those members who decided they wanted to actively participate in the
NIMBY case, the clubhouse environment was such that members felt they had the choice
to be active in various ways. In fact, in an interview with the clubhouse director, he
explicitly stated the clubhouse’s standpoint on member participation in response to the
NIMBY case:

[Staﬂ and members] told the truth of the meetings to the members and the

members decided for themselves if they wanted to become involved in anything

personally. They knew ahead of time what might happen, and we did not
encourage participation for that reason, but we didn ’t discourage it either.

Members chose to speak out publicly, talk with others at the clubhouse about NIMBY,

and or participate in clubhouse board meetings.

Speaking out

84

Mermbers spoke out in different ways. Some members went to planning
commission meetings and some made comments in newspapers. Regardless of how they
spoke out, all of them reported feeling better as a result of that action.

I just, just know that when we came out there all grouped together and talked and

the county told us, we’re going to ﬁght em ’, we’re taking em, this is not going to

happen if we can help it...it was more calming.

“[ The newspapers] talked to me more than one time but I didn ’t think I was going

to be in the paper (laughs). I thought wooow this is something exciting, I had said

something about it, ya know. I felt good. It was a good feeling. Everybody 's

reading it; everybody ’s going to know what ’s up, what ’s happening. "

Talking with other members

Talking with other clubhouse members about the NIMBY case was an important
way for members to engage in the clubhouse dialogue about the NIMBY case and to
come to an understanding of it for themselves. Some members felt they were contributing
to a positive dialogue about the NIMBY casein the clubhouse through discussion, and
others reported that talking with members helped them to feel better and to get over their
negative feelings.

Yes we [talked about NIMBI7 because how else are we gonna learn something

ﬁ'om it? We have meetings like in the afternoon, and we talked a lot about stujf

like that then too so all the members know what ’s happening. We can give
response. We were involved because we were watching the newspapers all the
time and seeing what people are saying. We would talk about it to see how each
individual member...how they felt and that we all just decided that we ’re not

giving up, we ’re gonna go for it...I get the [local newspaper] for [staﬁ] now and I

help bring extra clippings for the clubhouse and then we talk about it so that ’s

something good too.

Talking about it here with the members has also been good.

Participation in clubhouse board meetings

85

Clubhouse board meetings were places where members could go once a month to
keep informed about new updates on the status of the NIMBY case. Some of the NIMBY
active members talked about how being at the board meetings was good for them because
it helped to clear up any confusion they had about what was going to happen:

And we talked about the [the new clubhouse location] too. So that kept you

informed about things and I wanted to know what was going on because I wanted

to make sure that we 're not going to give up and keep ﬁghting and I learned that
the more you hear about [the new clubhouse location] the more you really realize
what ’s going to happen, ya know. We ’re ready.

Because I 'm involved in the board meeting every month I get an update that way

so that really helps me keep informed but otherwise I don ’t hear a lot about it and

I know that the minute we hear something, especially if it ’s good news, it ’s going

to be...(laughs) everyone ’s gonna know.

Provided Support to Members

Members who reported feeling support ﬁom others described how irmportant it
was to them to feel that support. Support seemed to bring for members a variety of firings,
such as: feeling understood, feeling that someone cared about them, feeling nurtured and
comforted, feeling accepted for who they are, a feeling of trust, and feeling a sense of
validation. Members discussed feeling support from a few different sources: ﬁ'om a)
inside the clubhouse and auspice agency, and b) ﬁom outside the clubhouse from the
media to the federal government. Their experience of support throughout the NIMBY
process brought a growing sense of validation; that they were right, that they have rights,
and that a line had deﬁnitely been crossed by the community protestors.

It made me feel calm and better knowing that we ’re not in this alone. It ’s no

longer stigmatized mental illness it ’s umm human beings looking out for each
other. Ok, besides the mental illness in us...

Support from the clubhouse and auspice agency

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Much of the social support that was experienced initially was support ﬁ'om the
clubhouse staff and members, as well as the club’s auspice agency. In the clubhouse
members saw and felt the support of the staff and discussed how much it meant to therm.
At some point in the NIMBY process the clubhouse and the auspice agency had decided
that they were not going to give up on this, and for one member, that was all it took to
make him begin to feel better about it:

The way they went after that point, I felt that way but then by the [clubhouse

auspice agency] and [the clubhouse] not giving up, the weight actually was being

lifted and I knew it was in good hands so, and I was supportive and I was having
good thoughts, you know?... Um, there ’s power in, uh, what made me feel better is
not giving up. Don 't give up because they become a loser. A quitter never wins

and a winner never loses. And I was certain we were gonna come out on top just
keep up that determination and never let them cloud your thinking, your vision.

One member talked about how nice it was to feel support speciﬁcally from the auspice
agency:
They have been there if we need them and a couple of the case managers have
come over and talked to us individually here about what ’s going on and how
we ’re feeling, and stuff like that. Yes, oh [an auspice agency staﬂ person] and
others have asked me how I was doing.
The clubhouse and the auspice agency were all doing such a good job of working on the
variety of issues that they were faced with that one member stated that he had at some
point stopped worrying about it; had begun to feel more comfortable with the NIMBY
issues:
I don ’t let it bother me right now because right now I feel that we are doing the
best that we can do with the help of the lawyers that we have and I have seen in
the background, ya know, [a staff member] going over to [street where the new
club will reside] and everybody else going over there and working on things

trying to ﬁgure out how we ’re going to make this work. Make the building work
for us if we get, if we win the case. Umm so I have seen that.

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Outside supp_o_rt

Support within the clubhouse and from the auspice agency was just the beginning.
The clubhouse did not learn until later the extent at which they would eventually receive
outside support. Once the local newspapers began tracking the NIMBY story, the
clubhouse began receiving a lot of attention. When the newspapers reported accurate and
factual information about the clubhouse, and on the side of the clubhouse, members
began to feel that they were being further validated and supported by the media. One
member actually referred to a particular author who wrote an uplifting article in a
newspaper:
She ’s one of the most inspiring contributors of [the clubhouse] that I ’ve known
anybody could give to anybody, because in the [local newspaper] oh golly, it was
nice. It was short but it was nice and very well written. Her name was [a woman ’s
name]. Uh-huh. And I really, that really, that really lifted my spirits up...One
thing about it I really appreciate, somebody saying some good about this
clubhouse because we ’re getting backing from good agencies and corporations
out of this world, you know, and it really is, it really, it ’s good for the morale of
the members, it really is. Someone got their back and you know, and I really
appreciate that...
As time went on members began to see other people and goups becoming involved from
everywhere that were interested in their NIMBY case of discrimination, like other
clubhouses, advocacy organizations, Community Mental Health, and the International
Center for Clubhouse Development (ICCD). The support that really seemed to encourage
members the most was that of the United States Government’s Departrment of Justice.
Once they heard that the United States was going to back them up in their lawsuit against
the city they knew that they had won. They learned that they had this support ﬁ'om the

government approximately one month before the interviews with members too place. One

member talked about how good she had felt about this news:

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Well look at that one article, I can ’t remember who said it, who they say is on our
side, the United States in on our side. Yeah, that ’s the good part about the whole
thing too, having that. I mean on our side that is really gonna help out. Especially
for what [the people ﬁom the new clubhouse location] are saying ‘bla blah ’

(laughs).

Another member talked about how he felt that winning the case with the US. was
something much bigger than just a NIMBY protest against the movement of a mental
health service facility; that this had the potential to contribute to making changes in the
Americans with Disabilities Act (ADA):

And this has been a very sensitive topic but however it works out I think all the

members are going to be better of because it ’s...now I understand that there ’s

some US. congressmen who are looking at this and looking to draft up some

legislation to add onto the ADA [law]. That a couple of them are looking at, cuz a

lot of us are not congressmen and legislators, and the lawyers are looking at it

and looking to see if they can draft something up into the ADA.

Seeing the clubhouse and the auspice agency work together to stand up for the
rights of the members, and not give up over such a long period of time, showed these
NIMBY active mermbers how important it is to stand up for their rights. Seeing the
clubhouse win the lawsuit and all the organizations and people support them showed
members that they were not alone and that they deserve to be treated equally. Overall, the
numerous types of supports that the clubhouse received were critical in developing a
more conﬁdent and validated sense of self among the mermbers. The varying levels of
support that members experienced over tirme were reported by these members to be
important elements in members’ processes of coming to feel better about thermselves and

the clubhouse.

Kept Members Informed About the NIMBY Case

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The clubhouse staff was consistent about keeping members informed about what
was happening with the NIMBY case. Keeping infonmed was irmportant to the members
because they were able to understand the NIMBY issues in more depth. Members kept
informed by attending board meetings, being at club meetings, reading newspapers, or
talking with others about the NIMBY issues. Keeping informed about the NIMBY
response brought about many different thoughts and feelings for members. Members
reported that keeping informed made them feel they were better able to understand what
was happening, made them learn some things about themselves, and that it was
encouraging and uplifting when they heard positive updates.

I think it ’s a positive if anything because I understand what this is and

occasionally I do have that same stigma that they do. The NIMB Y. On certain

issues but when I get more information I can work through it and that ’s what I

think needs to be done with the people in [the city of the new clubhouse
location]. ”

Well, I stood back and I listened to [staﬁj and the lawyers and stuﬂ talk and I felt

more conﬁdent knowing that we were going to take them to court over it I felt a

lot more relieved that we ’re not going to let them try and get away with it if we

can.

Maintained Clubhouse Business as Usual

Maintaining the daily functioning of the clubhouse and staying on task with
business as usual was helpful for NIMBY active members in different ways. Some
members seemed to take their cues from the paid clubhouse staff to continue to work in
the clubhouse as usual because it is a business. Others felt that keeping busy with daily
tasks not only helped them not to dwell on the NIMBY problems themselves, but that

doing so also contributed to the well-being of the clubhouse membership.

I mean, we a do our daily tasks and we keep focused on what needs to be done in
the clubhouse to make it run. I mean, it hasn ’t eﬂ’ected the operation of the

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clubhouse at all because we ’ve been focused on what needs to be done to keep us

running, ya know, like doing daily attendance, MESH, and answering the phones.

Cuz we ’re a business so...I think that [the director] told me that we can 't let

what ’s going on aﬂect the clubhouse, the daily participation of the members, ya

know.

We just going on like this dang thing never happened. We know the problem but

we ain ’t going to let it stop us...I think its business as usual. In fact I haven ’t seen

no diﬁérences. Like I said, I have seen better things. I ’ve seen that things have

gotten a whole lot better. It ’s good; it 's going the right way. It 's going the right

way. It ’s going up, it ’s not going down.

Kept members focused on the Positives

In a variety of ways members described the ways in which they stayed focused on
the positives in spite of the negative messages they were getting from the community.
The clubhouse created an alternative narrative that focused on the positives to counteract
the stigmatizing views the members were being exposed to. The NIMBY active members
had become part of the public conversation that took place about them not only in the
clubhouse but also in the public media and this alternative community narrative helped
guide their behaviors, thoughts, and discussions about the NIMBY response. Members
described a positive focus in the following ways: a) we took the high road, b) they’re
wrong and we’re right, 0) we can have a wonderful impact on them, and d) we can
continue to make changes.

“We took the higl_r road”

The part of the narrative that discussed how the clubhouse “took the high road”
brings to light the fact that the clubhouse did not stoop to the level of the protesting

community. The protesting community was acting out their hatred by calling members

narmes and accusing members of being terrible people but the clubhouse chose not to

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respond to those remarks. Members discussed how the clubhouse chose to address the
NIMBY response in a more digriﬁed manner.

I think that the way that we responded and the way that we did not act to all the
negativity, it ’s like, ya know, I mean, basically we were quiet, I mean there were
no comments or no, we didn ’t respond to everything that was, ya know, said and
in the paper and we were basically letting the neighborhood shoot itself in the
foot. We just let them go on and they kept going and they kept showing their
hatred and bigotry, so we just sat and were quiet, ya know, and just shook our
heads and (shaking her head and laughs). So they had stuff in the newspaper and
I’d say, ‘can you believe they said that? ’ but we ’ve been very quiet. Basically we
haven ’t beaten our shield...[we ’ve acted through a] code of honor and a code of
respect...so it 's like the clubhouse has taken at knee, when you ’re not threatening
you go to your knee and you put your sword pointing to the ground to show em ’
that you ’re not hostile and so that ’s what I think the clubhouse has done. It has
taken at knee and just let everybody else go...

I held in a lot of what I had to say but I was really devastated and I just wanted to
go see what it was about, why we weren ’t being permitted. And I wanted to see
ummm, ya know, was it as bad as they said? And sure enough it was.

“They’re wrongand we’re riglL”

The piece of the alternative narrative that states “they’re wrong and we’re right”
speaks to the fact that the protesting community was wrong for responding to the
clubhouse in such a discriminatory way and that the clubhouse is right for ﬁghting for
their right to go anywhere they want to. This piece of narrative brought some members to

feel that they were upholding truth and justice.

We have the right to be...just because we ’re mentally ill shouldn ’t... we shouldn 't
be excluded from a community, ya know.

I feel very uncomfortable about that, the long time to move, because I feel they ’re
doing the wrong thing and we want to do the right thing, ya know, and it ’s

hard ...I just feel that it ’s discrimination. I really do. That ’s like taking our rights
away, ya know, of who we really are, ya know, cuz we wouldn ’t treat them like
that.

“We can have a wonderful impact on them”

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The piece of the narrative that stated that “We can have a wonderful impact on
them” is based in the belief that the members of the clubhouse are good people. It also
points out that the people of that protesting community will need to wait and see over
time that they are good people that can make a positive contribution to the community,
and that this will, in turn, reduce the negative stigma that these people have of people
with mental illnesses.

I feel I ’11 just treat them like I ’ll treat everyone else. No matter what they say to
me I ’m just gonna not let it bother me because we ’re ok, ya know, like I said, they
don ’t know what they ’re talking about. I feel it will be great to be there. Fix the
place up for ourselves, it could be wonderful.

I think once were in there and we 're settled and we 're doing things, I think they ’11
realize that we ’re a beneﬁt to their community, so in that respect, it is worth every
penny that we ’ve spent because they in turn passed on to other people, you know,
how they...the stigma, and how they feel about people with mental illnesses, you
know? Generation to generation.

6

‘Continue to make changes”

The piece of the narrative that states that they are going to “continue to make
changes” refers to the fact that they plan to continue to challenge the dominant cultural
narratives that exist about people with mental illnesses. One way that they have begun
this mission is by ﬁghting and winning this NIMBY case, because they are potentially
setting a precedent for others in need of human service programs.

It ’s a stepping stone and it ’s set the precedent for other lawsuits you know, um,
about, you know, the American ’s with Disabilities Act and zoning, so , yeah...and
you know, the stigma that people ﬁ'om [the protesting community] were thinking,
that is not going to be erased if people don 't step up and, ya know, say this is...I
have a mental illness and I 'mﬁmctioning and I work and this, that, and the other,
ya know? Um, I mean, I don ’t go around telling everybody my mental illness but I
still think it ’s important that, you know, we beat the stigma. I think we really
stepped up to the plate and tried to educate people about us.

9

Anyways...we make the pathways. Or like we used to say...we ’ve bent the grass. ’

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When the clubhouse was faced with new developments from the NIMBY
response, it maintained an enviromnent where they could comfortably discuss their
concerns, vent about their thoughts and feelings, and participate in responding however
they felt necessary (within the conﬁnes of the lawsuit). The adoption of the alternative
community narrative about the NIMBY response that was created within the clubhouse
helped maintain the fundamental belief system of the clubhouse, while also assisting
members in making sense of the NIMBY response for themselves.

The Important Role of the Visionary

It became even clearer that these NIMBY active members had adopted and
internalized an alternative community narrative once it was summarized in full in the
interview with the director. The following quote ﬁ'om the director surmmarizes the
alternative community narrative that was accepted and exempliﬁed throughout the
NIMBY active members’ interviews:

We pretty much processed everything as a group. And so they would speak up in

those meetings too and they would share what was, you know, in their thoughts

and what their experience was, and whatever, and uh, we just kept the theme of
we ’re gonna take the high road. You know. We ’re not gonna lower ourselves to
um, the way that they ’re, you know, treating us. That, you know, we 're going to
just continue on our, you know, path. And um, they they 're wrong and we ’re right.
(Laughs) you know, that kind of a thing. That we ’re just gonna stay strong as a
group and um, that the CEO or no one else is ever gonna let anything happen to
us... Time will heal all, and so just give us a chance, we ’11 get in there and I think
we can have a wonderful impact on them and continue to make changes.
Since the interview with the clubhouse director took place after all of the member’s
interviews had been analyzed, the director was asked how this narrative originated within

the clubhouse. The director explained that he was the one to start some of this narrative

but that it was the choice of the members to accept it or not. The director explained that it

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is part of his role as the director to be a visionary for the clubhouse. The following
excerpt is a description of the formal role of the director of a clubhouse:

They need to develop and keep a vision for the growth and ongoing success of
the clubhouse. The director needs to be thinking ahead, to know where the
clubhouse is going and what it will take to get there. Directors need to foster a
sense of community within the clubhouse among members, staﬂ and board
members. In addition, they must also work to create a positive place for the
clubhouse in the city or town and the neighborhood where it is located. (Jack
Yatsko, ICCD Director of Training, and former Director of Friendship House,
Hawaii; 12’h International Clubhouse Seminar excerpt from his speech)

The Clubhouse as an Empowering Organization

Somewhat different ﬁom being an empowered organization is being an
empowering organization, and according to how members described the clubhouse
assisting them throughout the NIMBY case, it appears that this clubhouse is an
empowering organization as well. According to Zimmerman (2000), empowering
organizations are known to provide the structure needed for people to gain control over
their lives. This adequately describes the structures provided by this clubhouse, which
included: encouraging people to participate in decision making processes, and providing
opportunities for shared responsibility and leadership. Additionally, empowering
organizations are known to be settings where people with similar interests can share
information and experiences and develop a sense of identity with other members
(Zimmerman, 2000).

Maton and Salerm (1995) identiﬁed 4 characteristics of empowering organizations
that are similar in content to Zimmerman (2000). They state that empowering
organizations provide: 1) a culture of gowth and community building, 2) opportunities

for members to take on meaningful and multiple roles, 3) foster a peer based support

system that helps members develop a social identity, and 4) shared leadership with a

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commitrment to membership and the organization. By either of these criteria, this
clubhouse could be said to have functioned as an empowering organization.
Experiences of Clubhouse Involved Members over T ime: A Contrast

Although clubhouse involved members were involved in the clubhouse
throughout the NIMBY case, they did not take part in the clubhouse to the extent that
NIMBY active members did in the NIMBY case (See Figures 2 and 3). After the initial
exposure to the NIMBY response there was a long period of time where the clubhouse
experienced a variety of events that were associated with the NIMBY case: media
coming into the clubhouse, regular conversations about the NIMBY case at clubhouse
meetings, news articles written about the clubhouse and members, and visits from the
auspice agency in relation to the NIMBY case. In spite of the activity happening in the
clubhouse regarding NIMBY, clubhouse involved members did not become involved in
the NIMBY case activities and reported: a) continuing their involvement in the clubhouse
as usual, and b) being exposed to the NIMBY case minimally. As discussed earlier,
clubhouse involved members were mostly unaffected by the NIMBY case overall, with
the exception of an anomalous case. .

Clubhouse Involvement Unchanged

Quite differently from the NIMBY active members, with the exception of one
clubhouse involved member, all of them continued to participate in the clubhouse as
usual, attending between one and three times per week. Their involvement in the
clubhouse underwent no change as a result of the NIMBY response against the
clubhouse.

Well, I ’m still here, ya know?

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No. No, sure didn’t [have any impact on my involvement in the clubhouse].
Although the clubhouse involved members were not as impacted by the NIMBY
response as the NIMBY active members, some of these members did notice how the
clubhouse was assisting other members in dealing with the NIMBY response.
Staﬂ help[ ed] build conﬁdence that things are going to work out. [The director] is
real supportive. She gives us updates. There ’s the blueprint of our new place.
She ’s right up there and involved and real conﬁdent. She 's been real enthusiastic
and that ’s been real good.
An Anomalous Case
There was one exceptional case from the clubhouse involved members who
exermpliﬁed no impact ﬁom the NIMBY response information in the beginning yet had
reported sirmilar experiences to NIMBY active members in the end (See Figure 4). She
described becoming more involved with the clubhouse and clubhouse activities over the
time that the NIMBY case was occurring. She credited the clubhouse discussions about
the NIMBY case with helping her to see errors in her own thinking about mental illness
and with becoming more involved in the clubhouse. This member discussed how talking
through her personal thoughts and feelings with others in the clubhouse brought her to
certain realizations about herself:
There was one group I was in here in the clubhouse, and I admitted I did feel the
same way [the opposing community] feels. With the members I told them that. I
used to think oh I ’m psychotic well I ’m hopeless. I’m dangerous, put me away.
And I really did wanna be put in the hospital and left therefor the rest of my
life. Because I thought I was hopeless. And, I could see in the other members
there hearing me say this, they would go (deep breaths) getting defensive, ya
know, like woah. And I thought I was just like [the opposing community
members]. I was the same way... Well one, one of the workers there said, why
were you like that [interviewee 's name]? I said cuz I didn ’t know. I didn 't

understand mental illness. I didn 't know that I had nothing to be afraid of I didn’t
know there ’s nobody that ’s hopeless. I was unaware of what I was talking about.

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And it ’s just, and it ’s made me more compassionate to the people here, and how
they ’ve dealt with it too. That ’s just me. And members have really helped me.

This member described being personally affected by the NIMBY case in the end. She

described feeling more able to accept her mental illness, a willingress to move into the

new community in order to show them that they’re wrong about people with SMI, and

she also stated how important ﬁghting this case has been for her personally:

I can ’t wait to go to [the city of the new clubhouse location] and, I 'm um, I 'm not
afraid to meet [the residents of the opposing community]. I ’m not afraid of them.
They 're gonna realize how harmless we are... What I really have learned ﬁ'om this
debate between [the opposing community] and [clubhouse auspice agency], or
[the clubhouse], is that you don ’t haﬂa back away and run away. You don ’t have
to. And that you don ’t, that it ’s not the cave man days, you don ’t have ta lock
yourself up. And its not, its just totally misunderstanding and fear that people
don ’t know what mental illness is...It ’s made a big diﬂerence to me that we have
won. I didn ’t realize how important it was. I even mailed little news printings
about [the opposing community] not letting us in...I mailed it to my mother and I
mailed it to uh, oh I gave one to my son ta look at. I said this is really important to
me, read it. And I really took a personal opinion of myself about it. I really did...
[If something like this happened to the clubhouse again] I ’d probably speak up
then. I probably would. Because I don ’t feel, I’m not as afraid of myself as I used
to be. It has to do with my doctor too, going to her. But I 'm not as afraid. I was
terriﬁed of myself I wanted, my belief in god, kept me from killing myself
Because I thought I ’d be in hell forever, an eternity. And if this is bad, then it ’s
really gonna be bad cuz your never gonna get out. And, I was very suicidal, but
that ’s why I was catatonic. I just sat there stationary. I was so aﬁaid. I was afraid
of who I was.

This anomalous case brings to light implications that being quite actively involved in the

NIMBY case through the clubhouse over the span of the case in certain ways can be a

critical element in personal development a person reaching later stages of recovery and

empowerrmemt.

The experience of these clubhouse involved members, aside from the anomalous

case, differs sigriﬁcantly from that of the NIMBY active members. Only one clubhouse

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involved member reported feeling any negative feeling about the NIMBY response and
that was in no way close to the responses of devastation reported by the NIMBY active
members. Although the involvement of clubhouse involved members did not change over
the span of time during the NIMBY case, they were at least exposed to hearing about
NIMBY in the clubhouse; all but one of these members did not report feeling any
differently about themselves or the clubhouse in the end; unlike the NIMBY active goup.
The one clubhouse involved member that did feel better about herself and the clubhouse
in the end seems to have exhibited similar traits as the NIMBY active goup and by the
end of the NIMBY case. That particular member described the clubhouse as a family and
talked about the change in her perceptions of self through continuous and increased
clubhouse involvement over time.
DISCUSSION

Despite the vast amount of negative stigma that exists about people with mental
illness, it is possible that settings that foster empowering processes can sigriﬁcantly
buffer it’s affects on people’s lives. The experience of stigma related events can have
very negative effects of pe0ple with SMI and this NIMBY event had devastating effects
on all of those participants who were directly exposed to the negativity and active in
addressing it. While the results of this study clearly demonstrate that the NIMBY
response was a stigma response that negatively affected the personal recovery of NIMBY
active members, the results also reveal that these same clubhouse members who were
actively involved were empowered by the end of the NIMBY case.

Members who were actively involved in the NIMBY case (NIMBY active

members) were more empowered by the end of the NIMBY case than those members

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who were not (clubhouse involved members). NIMBY active members were more
negatively impacted by the NIMBY response early in the case than clubhouse involved
members. The level of exposure to the negativity of the NIMBY response and member’s
relationship with the clubhouse may explain some of the reasons why the NIMBY active
members were so negatively impacted in the beginning.

Although NIMBY active members were devastated in the early stages of the
NIMBY response, over time and through active engagement in the NIMBY case within
the clubhouse, these members described feelings of empowerment in the end. The
clubhouse acted as an empowered and empowering organization throughout the NIMBY
case and this appears to have played a large role in the member’s experiences of the

NIMBY case overall.

The hmpact of NIMBY on Members in Recovery in the Beginning

All of the NIMBY active members were devastated at the outset of the NIMBY
response. They all described feeling personally degraded. Clubhouse involved members,
on the other hand, did not experience the same devastation. It was once thought that self
stigma was an automatic response to being a part of a stigmatized goup (Allport,
1954/1979; Erikson, 1956; Jones et al., 1984), but it was later found that self-stigma
occurs only when a person agees with and internalizes the stereotypes associated with
the stigmatized goup (Crocker & Major, 1989). Moreover, Corrigan (2005) found that
both the degee to which a person agrees with the stereotypes of the group and a high
level of identiﬁcation with a stigmatized goup play a huge role in whether a person is

affected by a stigma related event. It might be that clubhouse involved members were not

100

as affected by the NIMBY response because they did not identify with the clubhouse as
much as the NIMBY active members and so did not internalize the negativity associated
with the NIMBY response.

Interestingly, the NIMBY active members were more personally connected with
the clubhouse than clubhouse involved members. While all of the study participants were
actively involved in the clubhouse, the two goups differed in their personal connections
with the clubhouse and the armount of time they spent at the clubhouse each week. These
members were not chosen based on these characteristics yet were revealed upon within-
case analysis. Given that they were not as impacted by the NIMBY response as the
NIMBY active members, it is interesting to ﬁnd that this goup of members was less
personally connected to the clubhouse and spent less time there. In contrast to the
clubhouse involved members, NIMBY active members reported that they received a
sense of family from the clubhouse and that the clubhouse provided them with the
opportunity to have very personal meaningful roles. NIMBY active members were likely
devastated by the NIMBY response because they identify more personally with the
clubhouse at which it was targeted.

Another possible reason why the clubhouse involved members were not as
negatively impacted by the NIMBY response might have been that they were not directly
exposed to the NIMBY response, but the active members were. The ﬁnding that all of the
clubhouse involved members were aware of the NIMBY response in the beginning, yet
had no devastatingly negative reaction to it, rrright also be explained by the ﬁndings of
Crocker and Major (1989). They found that awareness of stigma does not mean that a

person will internalize the stigma and automatically feel negatively about themselves. In

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fact, Corrigan (2005) points out from the empowerrment literature that there are some
“persons with psychiatric disability who, despite this disability, have positive self-esteem
and are not sigriﬁcantly encumbered by the stigmatizing community” (p. 27). Corrigan
(2005) also points out that “those who do not identify with [the stigmatized] goup will
be indifferent to stigma”. Additionally, some studies have found that people who strongly
identify with the stigmatized goup will react with righteous anger (Corrigan et al., 1999,
Chamberlain, Ellison, & Cream, 1997).

NIMBY active members may have identiﬁed more with the clubhouse and so had
more personal connections with the clubhouse. Since they identiﬁed more with the
clubhouse, or stigmatized goup, the NIMBY active members were more impacted by the
NIMBY response and becarme active once they becarme aware of their ability to ﬁght it.
For those who did not become actively involved, it could be that the level of threat to
their sense of self was different since they did not have the same level of investment in
the clubhouse. It is therefore not surprising the clubhouse involvement of those members
who were not actively involved in NIMBY underwent little to no change. Although, these
members were not necessarily more empowered in the end, they did express some
thoughts and feelings about the NIMBY response similar to the NIMBY active members.
They also often expressed some indifference to the NIMBY response in that they often

referred to NIMBY as “just stigma”.
The Impact of the NIMBY Case on Member’s Recovery in the End

Despite the devastating impact that the NIMBY response had on the NIMBY

active members, these members reported feelings associated with empowerrment by the

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end of the NIMBY case. This was also not the experiences of the clubhouse involved
members, with the exception of the one anomalous case. There was one clubhouse
involved member who increased his involvement in the clubhouse over time and was
ermpowered in the end, and that member’s experience may shed some light on the
possible reasons why these clubhouse involved members did not have similar experiences
to the NIMBY active goup. This anomalous case may also provide more support for the
clubhouse acting as an empowering setting.

By the time the NIMBY response had nearly been resolved legally, actively
involved members reported feeling better about themselves and the clubhouse and
described feelings that are consistent with Psychological Empowerment (PE). It is clear
from their stories that experiences both in and outside of the clubhouse, where members
were more personally active, helped facilitate a sense of empowerment in the end. More
speciﬁcally, members discussed feeling stronger because they were better able to deal
with having a mental illness and felt that it was important that they take a stand for their
rights in the future. From an empowerment perspective, by the end of the NIMBY case,
members had developed an awareness of the factors that inﬂuence achieving their goals,
believed that their goals could be achieved, and became motivated to take control and act
against any displays of discrimination in the ﬁrture.

It appears that NIMBY active members gained conﬁdence through their
experiences with the NIMBY case and transformed some of their feelings about
themselves and their illnesses to be more positive. They also gained much information
about their socio-cultural environment throughout their involvement in the NIMBY case.

This shift in their thinking about thermselves and their capabilities, along with new

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knowledge about the social system in which they live, seem to have assisted in them
ﬁrrther developing a desire to ﬁght discrimination and advocate for themselves in the
future. Through their active involvement with an empowered and empowering setting
that won a lawsuit against discrimination, members learned from their clubhouse how to
advocate for their rights, mobilize resources, and overcome injustice.
The Anomalous Clubhouse Involved Member

The one clubhouse involved member who increased his involvement in the
clubhouse over tirme, and who became more ermpowered in the end, highlights the
sigriﬁcance of identiﬁcation with a stigmatized goup. This member discussed that he
identiﬁed with the stigmatized goup and, in the beginning of the NIMBY response, was
not surprised by the NIMBY response. In fact, he ageed with the members of the
protesting community. He was often ashamed of his membership in the clubhouse
because it was afﬁliated with people with SMI. He did not want to further sharme himself
or his family because of his diagrosis. Through participation in the clubhouse over time
(i.e. infonmal discussions, formal discussions, gaining inforrmatiom), he began to
understand more about himself and the origins of the NIMBY response. In the end, he
was eager to become further involved in anti-stigma efforts and to tell his personal story
of discovering the truth about the stigma against people with SMI. From close
examination of this speciﬁc case, it appears that the clubhouse played a key role in
supporting the personal discovery process and empowerment of this particular member

over the span of the NIMBY response.

How the Clubhouse Assisted Members throughout the NIMBY Case

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Active participation in the NIMBY response was critical to the empowered
experiences of NIMBY active members by the end of the NIMBY case. Active
involvement could not have been possible had the clubhouse not reacted to the event in a
manner that reﬂected their beliefs and values. Members’ reports of the environment and
processes of this clubhouse are indicative of an empowered and empowering context. By
effectively mobilizing resources, encouraging participation of members, providing
necessary supports, and providing resources and information, this clubhouse was
successful at meeting its goals as a clubhouse. Additionally, the reinforcement of
clubhouse beliefs and values through an alternative community narrative was helpﬁrl in
creating ermpowered members.

This study identiﬁed various aspects about the clubhouse that made it an
empowered and empowering organization. One way that this clubhouse exempliﬁed its
status as an empowered organization is that upon realization that action was necessary
against the NIMBY response; it mobilized existing resources and took legal action
against it. They worked with their auspice agency and legal representation to manage the
situation as well as possible. The ability of this clubhouse to respond so comprehensively
to the NIMBY response, and be successful in its aims, provides some evidence of its
status as an empowered organization.

The Clubhouse as an Empowering Organization

According to the ﬁndings of this study, in addition to being an empowered
organization, it appears that this clubhouse is also an empowering organization.
Participants describe their clubhouse in ways that demonstrate its ability to function as an

empowering organization. Part of the context that facilitated empowerment armong

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members was the empowering processes of the clubhouse in which members participated.
NIMBY active members reported various experiences in the clubhouse that contributed
to these points. These included: 1) making active participation against the NIMBY
response possible for members, 2) providing members with a needed sense of support, 3)
providing information and resources to members, and 4) creating an alternative
community narrative in response to NIMBY that kept them focusing on positives.

Made Active Participation Possible

Making active participation against the NIMBY response possible for the
members of the clubhouse was done by creating a sense of personal responsibility within
the membership to ﬁght the stigma. It was also made possible through the creation of
opportunities for mermbers to act as they felt necessary. The clubhouse created a sense of
personal responsibility among the membership by reminding members that the lawsuit
was being fought on their behalf. Opportunities were created for members to act as
leaders by the clubhouse welcoming the media and inviting the media to talk with
members about the reality of clubhouses. The combination of placing personal
responsibility on the membership to ﬁght the stigma, and then giving them opportunities
to educate the public on the truth about clubhouses and people with SMI, led members to
participate and become engaged.

The ﬁndings indicate that these members became more empowered through
engagement and active participation in the NIMBY is consistent with the literature that
discusses the role of active participation in the empowerment process. Itzhaky and York
(2002) found that citizen participation leads to increases in self esteem, mastery, and an

increased sense of control. Zimmerman and Rappaport (1988) found, in their studies with

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students and community residents of the relationship between empowerment and
participation, that “more involved participants reported a greater sense of political
efﬁcacy, competence and mastery, a geater desire for control, more civic duty, and a
general belief that their success is a result of internal rather than external factors” than
those who participated less (p. 746). These studies certainly resonate with the ﬁndings of
the study conducted here in that those members of the clubhouse who actively
participated in anti-stigma activities reported gaining strength and a sense of personal
control over their lives.

Active participation has also been found to be related to collective efﬁcacy
(Chavis et a1, 1987). Collective efﬁcacy is the belief that people can work together and
intervene to maintain social control (W andersman & Florin, 2000). Collective efﬁcacy
was clearly at play in the experiences of the NIMBY active members. They discussed the
importance of feeling support both in and outside of the clubhouse. Knowing that other
organizations and people who do not have mental illnesses were behind their efforts to
contest the NIMBY response brought a sense of power and capability to the members.
The support and the determination of the clubhouse and other organizations to ﬁght the
discrirrrination they were experiencing were critical in the process of empowerment that
NIMBY active members achieved.

Provided Members with Support

The clubhouse provided members with a lot of needed support. They did this by
inviting supporting agencies to assist them in their ﬁght against the NIMBY response and
by continually discussing their support. They received the support of their auspice

agency, other clubhouses, the ICCD, CMH, legal representation, and the US.

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Government. The clubhouse continued to discuss the involvement of all the various
supporters as the information became available; such as letters of support or public
comments being made. Support was also experienced on an individual level where
members were able to speak to each other about their thoughts and feelings as needed.
Much of the conﬁdence of the NIMBY active members came from realizing that they
were not alone; that they were working with multiple supportive individuals and
organizations at varying levels.

Provided Information and Resources

The clubhouse continually provided information and resources to the membership
through weekly meetings and informal conversations. As new information about the
NIMBY response was gained it was quickly shared with the entire membership (e. g.,
newspaper articles, meeting updates). Although the weekly meetings were a venue where
inforrmation could be shared, they also provided a place for mermbers and staff to voice
opinions about updates and new information. These meetings provided a place where
questions could be asked, concerns could be expressed, decisions would be made, and
action on the part of both the members and the staff could be taken. All decisions within
the clubhouse were made at the weekly meetings with the input of the membership and
staff. Informal conversations among staff and members were going on at any point in
time. The informal conversations were reported as ways that members could gain deeper
understandings of what was happening and learn more about themselves and each other.

Created an Alternative Community Narrative

The clubhouse also created an alternative community narrative about the NIMBY

experience that kept the members and staff focusing on the positives. Across the

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members who were actively involved in NIMBY, themes were identiﬁed that clearly
demonstrated a conrrmon narrative. Alternative community narratives are stories that
attach meaning to life events and they often are in opposition to more dominant
stigmatizing narratives (Rappaport, 2002). This narrative seemed to be their guiding light,
a driving voice for how they each made sense of the NIMBY response. The narrative
entailed the themes: 1) taking the high road, 2) they’re wrong, we’re right, 3) we can
have a wonderful irmpact on them, and 4) we can continue to make changes. The creation
and acceptance of a positive alternative narrative in the clubhouse helped NMBY active
members to understand NIMBY through a personally afﬁrming lens. In this situation, the
use of an alternative narrative to combat the more dominant and stigmatizing narratives
coming through the media and public arenas was extremely helpful in assisting the
NIMBY active members in making sense of the NIMBY response.

The alternative narrative assisted members in creating positive views of
themselves. This helped to remind members that they are good people, and that the
protesting that took place against them was wrong. As the members gained more positive
views of themselves over time they were less encumbered by the stigmatizing NIMBY
response and instead more empowered. The internalization of the alternative narrative as
a goup was critical in providing therm with a stronger voice because it was accepted and
used by all. This ﬁnding supports the work of Sampson & Raudenbush (1999) who found
that alternative narratives contribute to “the linkage of cohesion and mutual trust with
shared expectations for intervening in support of neighborhood social control” (pp. 612—

613).

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Through the voices of these NIMBY active members it is easy to recogrize that
this clubhouse is a case example of an empowered and empowering organization.
Clubhouses can be empowering organizations and can be effective when they adhere to
their values and beliefs and utilize their resources. By the clubhouse acting as an
empowering context, as well as an empowered organization, this produced a very positive
and winning feeling over the span of the NIMBY case that contributed to the end result of
empowerment experienced by some members. These ﬁndings also support Wandersman
and Florin’s (2000) statement that organizational characteristics, structure and
effectiveness can inﬂuence the nature of citizen participation. Without the supportive and
empowering environment of this clubhouse, active participation in response to this
NIMBY case may not have occurred and empowerment, as a result, might have been
unlikely. This also supports the ﬁndings of McMillan and colleagues (1995) who state
that there is a strong relationship between psychological empowerment and the
perception of oneself as part of an inclusive and focused group effort with which one
identiﬁes and to which one commits.

The Irmportance of Closely Examining NIMBY Protests against Clubhouses

NIMBY against human service facilities is an act of discrimination, and NIMBY
against clubhouses is individual and personalized discrimination. It is reasonable that
people will exercise their democratic rights in order to protest things they do not want in
their neighborhoods, but protesting a clubhouse is not like protesting a garbage dump or
an airport. Garbage dumps and airports are not afﬁliated with any social goups or
individual people. Clubhouses, on the other hand, involve members who have mental

illness that help to create the clubhouse, and are lifetime owners of their clubhouse. The

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ﬁndings of this study stress the importance of closely examining NIMBY responses that
are created to protest clubhouses and other consumer oriented settings, and the
importance of understanding the supports necessary to assist their members through them
when they occur.

As the ﬁndings of this study show, clubhouses, for their own membership, are
more then just service facilities. This particular clubhouse was identiﬁed by members as a
place where members are provided with many opportunities to have ﬁiends, to learn new
things, and to have meaningﬁrl roles. Members have many opportunities to be social in
the clubhouse and to have ﬁiends, but just having a space to be with others who are also
living with mental illnesses is an important aspect of what members feel they get from
being involved in the clubhouse; in and of itself. There are not many places in society
where people with SMI’s are welcomed and encouraged to hang out together, and there
are few places especially desigred to focus on their strengths and abilities. Clubhouses
are places where mermbers can be assisted in meeting their personal goals and are very
special places for some members.

This clubhouse was identiﬁed by many of the members in this study as a place
where members can feel a sense of farrrily and safety. This is crucial given that the
members of a clubhouse, and all people with mental illnesses, to some extent, all have to
deal with feeling stigmatized and ostracized for their clinical diagroses (Corrigan, 2005).
They have a clear understanding that they are not accepted by others, and this comes
from their experiences with community mermbers, ﬁiends, family, and maybe even
themselves. Some are keenly aware of the socio-cultural history connected to them and

have come to expect nothing less than to be viewed in a negative light. It is for these

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reasons that clubhouses are intended to play such a supportive and encouraging role in
the lives of their members; in an effort to combat all the negativity that exists everywhere
in the world.

Clubhouses are composed of the interests and characteristics of the individuals
who make up its mermbership. Members feel a strong personal connection. It is for this
reason, and the reasons listed above, that protesting a clubhouse is an act of protest
against individuals living with mental illness and is a highly discriminatory act. This is
precisely why clubhouses and other supporting agencies need to be aware of the
potentially negative impact such issues can have on their members. This case study can
be a good example of how clubhouses can support their members through such situations
in the future.

This NIMBY case was handled well by the clubhouse and its supporters. Not only
did they win the lawsuit they held against the city, it turned out to be an empowering
experience for members who engaged in active participation in the end. Needless to say,
although the experiences that these members underwent helped to built strength armong
some of these members, there are better ways of doing this and it would have been better
if it had never happened. It is hoped (by both the investigator and the members of the
participating clubhouse) that the stories of these members will be studied in order to
assist other clubhouses and human service facilities through such turmoil if and when
they are faced with such adversity.

Limitations
The ﬁndings of this study are not generalizable to all clubhouses or all people

with mental illnesses and these ﬁndings cannot be generalized for the participating

112'

members in all contexts. These same people rrright have had a very different experience
being active in another context that did provide the support and alternative narrative
necessary to ﬁnd that involvement empowering. Generalizability to other settings was not
the goal of this qualitative study. However, the goal of some qualitative research is to
identify potentially generalizable constructs, and in this study, we were able to identify
important relationships authentic to this setting. The application of the applicability of
these ﬁndings to other settings and circumstances is an irmportant next step.

Although we found that this was an empowering experience for all members
actively involved in the NIMBY response, this should also not be generalized to all
possible members. The active participation of these members in the NIMBY response
turned out to be a positive thing for these individual members, but it is not implied that all
members of clubhouses, or all people with mental illness, should engage in such activities
in order to be empowered. Although this was an empowering experience for these
actively involved members, we do not know any details about their stage of recovery at
the time that the NIMBY response happened and therefore cannot make generalizations
about the need for people with SMI to become actively involved. Not everyone would be
able to move through devastation to empowenment such as these members did. We also
do not know how the timing of when the interviews were conducted may have irmpacted
members’ responses. Although feelings of empowerment were expressed by NIMBY
active members in the end, we cannot be sure of how much winning the court case might
have inﬂuenced members’ responses and feelings.

The ﬁndings of the clubhouse involved goup provide a good comparison to the

active goup because their experiences were very different ﬁom the active members.

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Although the stories of these members do not ﬁrlly represent the experiences of everyone
in the clubhouse, the experiences of these members helped to authenticate that the active
involvement in the NIMBY response was key in the process of empowenment. It is
irmportant to note that we did not reach saturation for this group. We do not know why
some individuals chose to participate in the study and others did not. We also do not
know if any members not actively involved in the NIMBY response left the clubhouse or
decreased their involvement as a result of the NIMBY response.

It is clear, without a doubt, that the clubhouse played an important role in these
members’ lives. This particular clubhouse was an empowered and empowering setting
that handled the NIMBY response effectively, both for the clubhouse and the members.
The impact of this NIMBY response could have been far more devastating if the
clubhouse had not been able to handle it so well and if they had not won the lawsuit in
the end.

Irmplicatioms for Settings and Future Research

NIMBY responses will not simply go away just because they have the potential to
be discriminatory, and peoples attitudes and beliefs about certain goups of people will
not likely change over night. Due to the nature of our society, human service agencies of
all sorts have the potential of experiencing a NIMBY response. The fact of the matter is
that many human services serve unappreciated populations (Dear & Gleeson, 1991; Dear
& Taylor, 1982; Gale, Ns, & Rosenblood, 1988; Kastrrer, L. A, Reppucci, N. D. &
Pezzoli, 1979; Klein, 1968; Page 1989; Piat, 2000; National Coalition for the Homeless,
1987; National Carnpaigr to End Hunger and Homelessness in America,1988; Robert

Wood Johnson Foundation, Progam on Chronic Mental Illness,1990; Solomon & Davis,

114

1984). It is for this reason that human service agencies should anticipate the possibility
that their consurmers may need safe spaces that can help them to deal with stigma related
experiences; in addition to providing needed services. This study suggests that settings
can provide opportunities for meaningful involvement, support, and positive alternatives
to more dominant negative socio-cultural predispositions. The ﬁndings of this study can
be used by some organizations, such as clubhouses, to improve their capacity to turn
stigmatizing events into empowering experiences.

First, for people who experience mental illness, recovery can be highly affected
by stigmatizing acts and beliefs. These ﬁndings support the existing literature and make
clearer the fact that stigma related experiences prove to be detrimental to the process of
recovery experienced by people with mental illness. This ﬁnding is consistent with the
more current efforts being made to eliminate the negative stigma and to de-criminalize
mental illness. Although attempts are being made to decrease the stigma of mental
illness, it will most deﬁnitely take some time for that to happen. Until then, it is important
that services that work with people with mental illness, like clubhouses, have the supports
in place to deal with such issues in the lives of their members.

Second, empowering contexts need to be developed in order to foster a sense of
empowerment among people with mental illness. Empowerment will ultimately lead to a
positive sense of self, a clear understanding of the potential effects of stigma on their
recovery, and the ability to advocate effectively for themselves and each other through
participation in the world around them. Given the beneﬁts of empowenment for people
with mental illness (or any underappreciated goup for that matter) and the inability of the

natural environment of our society to foster it, empowering contexts need to be

115

developed. The NIMBY active members that participated in this study have explained
individually how the clubhouse has fostered a sense of empowenment in them. It is
through their stories that we have been able to identify key elements of empowering
contexts and it is up to future research efforts, interventions, and service centers to move
forward and create such safe spaces.

Third, the empowering context that was fostered by the participating clubhouse
facilitated a level of awareness, strength, and understanding on the part of the members
consistent with the literature on empowenment. The way that this clubhouse functioned
was in accordance with the Fountain House Model standards and philosophies inherent in
certiﬁed clubhouses. Those standards were brought to life through the stories of these
members and proved to meet their goals of producing a context conducive to
empowerment, competency, and recovery. This ﬁnding has implications for the
certiﬁcation and ﬁdelity requirements of existing clubhouses because not all clubhouses
are required to function in such similar ways.

Fourth, creating alternative narratives that create positive life stories for people
with mental illness are helpful in facilitating recovery. The more dominant beliefs and
attitudes that exist in society are often negative and potentially detrimental to the
recovery of people with mental illness. It is therefore important that settings create more
positive and afﬁnming alternative narratives so that people can continue on their path of
recovery. In an ideal world, replacing the more dominant cultural narratives that currently
exist about people with mental illness with the elements of the alternative community
narratives that are being created would be a more all encompassing way of creating more

positive life stories for people with mental illnesses.

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These ﬁndings were not expected to be generalizable to all settings but it is clear
from the stories of these members that in moving ﬁ'om devastation to empowerment,
certain processes, narratives, and clubhouse supports were crucial. It may well be true
that in the absence of these processes, these members may have stayed at devastation.
The fact of the matter is that clubhouses vary in their ability to provide these elements,
and it is important that we identify what key elements are necessary to have in an
effective context that hopes to promote empowenment, competency and recovery from
mental illness. This study has been able to further identify some of those key points.
Although human services oﬁen function in their own individualized ways, it is possible
that all human service agencies may learn something from they ways in which this
clubhouse context successfully buffered the negative effects of this NIMBY response on
their members. Future research should work to identify prevention interventions for
people with mental illness that build understanding of themselves and their illness, focus
on their strengths, build capacities, and create opportunities for active participation in
ones community that will lead to decreased stigmatizing attitudes imbedded in local
communities and society as a whole.

This NIMBY response was started over a clubhouse that needed to move and
wanted to be in a more convenient location, closer to member’s neighborhoods and
locations. Although it is common knowledge that the members have a right to fulﬁll these
needs, policy change was needed to make it possible. Now the challenge for these
members comes in building relationships with the local neighbors in the community. This
is key if there can be any hope of altering the negative dominant cultural narratives about

people with mental illness (Corrigan, 2005). Until the day comes where all people are

117

comfortably and successfully integated into a society that can accept them, creating
contexts that can build strength, foster understanding, and facilitate leadership will be

central to the movement towards equality and the survival of many.

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APPENDIX A
Interview Protocol: Members

You are being asked to participate in this study because you were an active member of
the Clubhouse when the NIMBY response occurred against, the relocation of the
clubhouse last year. I arm very interested in hearing about your perspective and
experiences as a member of a clubhouse that has experienced this type of community
response. I have some questions planned; however I’d like them to serve as more of a
guide. I hope that you will feel free to discuss any way that this NIMBY issue has
affected you and your role as a member of this clubhouse. My goal is to obtain a
complete picture of your experience.

Do you have any questions before we begin?

 

INTERVIEW QUESTIONS:

 

 

1. Demographics
First I would like to ask you some simple demographic questions about yourself:
1. What year were you born?

2. What racial/ethnic background do you most closely identify with?
__ Black/African American

_ Aﬁican

__ Asian/Paciﬁc Islander

__ White/Caucasian

__ Native American/Aleut

Hispanic

Latino/a

Middle Eastern
Indian

South American
Other (what is it?)

 

3. Do you belong to any organized religion?
_ No

__ Catholic

_ Christian
Islamic/Muslim
Jewish

Protestant

Other (what is it?)

 

 

 

119

 

 

INTERVIEW QUESTIONS:
1. Demographics (Cont’d)

4. What is the last grade you completed in school?
Did not complete high school Demogaphics
High school gaduate/GED
Some college or trade school after high school (describe)

 

Associates degee
Bachelors degee
Masters, or Post-graduate degee

5. Are you currently in school?
No
Yes, part-time student
Yes, full-time student

6. What is your current marital status?
never manied
currently married
separated
divorced
widowed

7. What is your current employment situation?
not employed
supported employment or job training
part-time job (less than 30 hrs/wk)
full-time job (30 hours/wk or more)
retired

8. Do you receive disability beneﬁts (SSI, SSDI, VA disability beneﬁts, etc)?
no
yes
9. How are your mental health services paid for?
private insurance
Medicaid/Medicare
Free (through CMH or community health clinic, etc.)
Out-of-pocket
None received
Other: (what is it?)

 

120

 

 

INTERVIEW QUESTIONS:
1. Demographics (Cont’d)

10. What is your current living situation?
my own house or apartment (can be w/roommate)
live with my parents
supported apartrment
goup home
Other: (what is it?)

 

11. What is your primary diagrosis, if known?
Schizophrenia (including paranoid schizophrenia)
Schizo-Affective Disorder

Major Depression

Bipolar Disorder

Obsessive Compulsive Disorder

Personality Disorder

Anxiety/Panic Disorder

Other: (what is it?)

 

12. How many times have you been hospitalized for psychiatric reasons in your
lifetime?
times

13. What was your approxirmate age of your ﬁrst admission to a hospital for
psychiatric
reasons? years old

 

 

II. Clubhouse Involvement (Present time)
14. How long have you been a member of clubhouse?

15. How often do you come to the clubhouse?
every day

few times a week

once a week

less then once a week
other (describe)

 

16. What are you involved in at the clubhouse?

Team activities

Social activities

ﬁnding a job

Attending seminars

Attending Board Meetings

Reporting to the clubhouse about my job position

 

121

 

 

INTERVIEW QUESTIONS:
II. Clubhouse Involvement (Present Time Cont’d)

17. What do you feel responsible for as a member of this clubhouse? What is your
role?

 

III. Clubhouse Involvement (before NIMBY)

I am interested in how you became involved in the clubhouse and what that
involvement has been like for you. Can you tell me the story of your involvement in
the clubhouse?

18. Tell me how you ﬁrst becarme involved in the clubhouse?
P1. How long ago was that?
P2. Why did you decide to come?
P3. What made you keep coming?

19. How has the clubhouse helped you?
P]. What do you like most about coming here?
P2. Do you feel that the clubhouse has assisted you in your
recovery? How?

20. Are there things that have been difﬁcult about being a member of the clubhouse?
What?
P1. What do you feel that you have contributed to the clubhouse?

21. Since you’ve been a member of the clubhouse, have you ever had a reason to
stop conring to the clubhouse?
P1. Why? (work, school, medical, other)

22. Before the attempt to move to [the new city], how did you feel about being a
member of the clubhouse?
Pl. What do you like about being a member?

 

 

IV. N IMBY Response (Impact on recovery during N IMBY)

I would like to ask you some questions about the ﬁrst time that community members
protested the relocation of the clubhouse into the [new city] location.

23. Were you at the planning commission meeting on March 9th of last year that was
held at the [new street] Location in [the new city] where the protests against the
relocation of the clubhouse occurred?

 

122

 

 

INTERVIEW QUESTIONS:
IV. NIMBY Response (Impact on recovery during N IMBY Cont’d)

YES:
Y24. Can you tell me about that meeting- what happened and what is
was like for you to be there.
Pl. Can you tell me what happened at this meeting?
P2. What was your initial reaction?
P3. What were you feeling at that time?
P4. What did you do at that meeting? (make public comments,
respond to neighbors)
P5. How did you feel after you left?

Y25. Since then, how have you been involved in responding to the
negative response from the community?

 

NO:
N24. Can you tell me about when you ﬁrst heard about the protests by
the people in [the new city]?

P1. What was the ﬁrst you heard about it?

P2. How did you hear about it?

P3. Did you get a sense of what actually happened at the meeting
from your source? (newspaper, ﬁiend)

P4. What was your initial reaction?

P5. What were you feeling at that time?

P6. What did you do after you heard about it? (make public
comments, respond to neighbors)

N25. Since them, How have you been involved in responding to the
negative response from the community?

 

V. NIMBY Response (Impact On recovery presently)

The negative stigma response from [the new city] has been going on for almost a
year now, and has now taken a more quite and legal route. I would now like to ask
you some questions about how this community response has impacted you:

26. Can you tell me about how the negative community response has
impacted you over the last 8 months?
Pl. How has it made you feel?
P2. What, if anything, have you done in response?

IF RECOVERY MENTIONED:
P3. How has it impacted your recovery?

27. How has it impacted your feelings about the clubhouse?

 

28. How has it impacted your involvement with the clubhouse?

 

123

 

 

 

INTERVIEW QUESTIONS:
VI. NIMBY Response (Impact on the clubhouse)

29. How has this negative community response affected the clubhouse in
general?
P 1. How have members reacted to the community response?
P2. How has the staff reacted to the community response?
P3. Have there been any changes made in the function of the
clubhouse?
P4. What, if any, changes have you noticed?

 

124

 

APPENDIX B
Interview Protocol: Staff

Thank you for taking the time to meet with me. I am interested in interviewing you
because of your involvement in the Clubhouse during the time that it experienced the
NIMBY community response. As you have played a very central role in this
NIMBY response. In order for me to fully understand the impact of NIMBY on the
clubhouse and the members, it is critical that I understand certain aspects of the NIMBY
process from your perspective. I arm mainly interested in knowing how the clubhouse has
dealt with the NIMBY response and what you have observed happening with the
members over that time. I am speciﬁcally interested in how members were affected by
the NIMBY response.

 

Do you have any questions before we begin?

First, I would like to know some things about you and your relationship with the
clubhouse:

1. How long have you worked at the clubhouse?

2. What is your role with the clubhouse?
P1. What do members come to you for?
P2. Do you work closely with members? All, or some? If so, how?

Now, I would like to know how the NIMBY response unfolded for the clubhouse,
starting from the beginning. I am particularly interested in how the NIMB Y response
aﬂected the members:

3. Can you tell me the story of how NIMBY impacted the clubhouse, beginning ﬁ'om the
moment you planned to invite the community to the ﬁrst planning meeting?

IF Expectations mentioned:
P1. Did you expect that the residents would respond in this way?

P2. If so, what was done in preparation?

P3. How were actions decided upon?

P4. How did you think the announcement of NIMBY at the club would affect
members?

IF publicity mentioned:
P1. How did the club decide how to deal with newspapers and t.v.?
P2. How did members become involved in the press?
P3. How do you think mermbers felt about the press being in/around the club?

IF a plan/strategy Mentioned:
P1. How did implermenting the strategy/plan play out?

125

P2. Did you ask members to conduct themselves in certain ways? If so, how?

IF member reactions/changes mentioned:

P1. How did members/ staff respond to news of NIMBY?

P2. How did the club deal with concerns of the members?

P3. Why do you think you noticed differences in members?

P4. Why do you think you saw changes in members’ participation in the club?

IF member Mcipation mentioned:

P1. How did members participate in the NIMBY issue?
P2. Did you create any opportunities for them to be more involved?

IF the Board is mentioned:

P 1. What happens at the board meetings?

P2. How many members are on the board?

P3. What are members involved in on the board?

P4. Were there changes in the members on the board when NIMBY began?
P5. Did you see changes in board members over time? If so, what?

Now that the case has been won and you 're mainly working out the moving details, I ’d
like to know how you think NIMB Y has impacted the members:

4. What do you think that NIMBY has meant for members over the last year?

P1. How did this community response affect the members personally?
P2. How did it affect their involvement in the club?

P3. How did it affect their personal recovery?

P4. What did the club do to help them deal with it?

PS. Were you worried about it? Why?

P6. Did you have a speciﬁc strategy? What?

P7. What if anything did other people or organizations do to help them?

5. Do you think that NIMBY would have impacted members differently had the case not
been won?

P1. How might they be different?

126

APPENDIX C
Recruitment Letter to NIMBY active members
Dear [Insert name of clubhouse member]:

Tiffeny Jimenez ﬁom Michigan State University (MSU) is working with XXXXXX
XXXXXXXXX Clubhouse (XXX) to gain a deeper understanding of how the negative
community response to our relocation (sometimes called NIMBY or “Not in My
Backyar ”) has affected the members of our clubhouse. Tiffeny would like to interview
members who have been publicly involved in the NIMBY response against [the
clubhouse] and highly involved in the clubhouse. She is very interested in hearing your
views and experiences.

This study will increase our understanding of the impact that NIMBY can have on members
of clubhouses and how clubhouses can help members to deal with this negative public
response. By participating you will be contributing to this understanding. Participation will
include taking part in a conﬁdential, 9O nrinute interview that will be audio-taped. You will
be paid $15 for your participation.

If you would like to participate in this study, or would like to learn more about it, please
contact Tiffeny Jimenez in the way that is most convenient for you. You can ﬁll out the
attached form and return it in the enclosed envelope. You can also contact Tiffeny by phone,
(WW—##1##) or email ()O(XXXXXX@,msu.edu).

Your participation in this research is voluntary. The staff and other members of [the
clubhouse] will not know whether or not you chose to participate.

Sincerely,

XXXXX XXXX, Director

XXXXXX XXXXXXXXX Clubhouse
W XXX XXXX blvd.,

XXX XXXX, MI W—W
W-W—W

127

CONSENT TO CONTACT FORM

I am interested in hearing more about this study. Please call me to discuss an
appointment at the following number:

My Name (PLEASE PRINT):

 

My Phone Number:

 

Best times to reach me:

 

SEND RESPONSE TO:
Tiffeny R. Jimenez

Michigan State University
Psychology Building, Rm. ##1##
East Lansing, MI 48824
XXXXXXXX@msu.edu
WWW ofﬁce

4° You may also choose to call or email.

128

APPENDIX D
Recruitment Letter to Clubhouse Involved Members
Dear [Insert name of clubhouse member]:

Tiffeny Jimenez from Michigan State University (MSU) is working with XXXXXX
XXXXXXXXX Clubhouse (XXX) to gain a deeper understanding of how the negative
community response to our relocation (sometimes called NIMBY or “Not in My

Backyar ”) has affected the members of our clubhouse. Tiffeny would like to interview
members who are highly involved in the clubhouse. She is very interested in hearing your
views and experiences.

This study will increase our understanding of the impact that NIMBY can have on members
of clubhouses and how clubhouses can help members to deal with this negative public
response. By participating you will be contributing to this understanding. Participation will
include taking part in a conﬁdential, 90 minute interview that will be audio-taped. You will
be paid $15 for your participation.

If you would like to participate in this study, or would like to learn more about it, please
contact Tiffeny Jimenez in the way that is most convenient for you. You can ﬁll out the
attached form and return it in the enclosed envelope. You can also contact Tiffeny by
phone, (###-###-###) or email (XXXXXXXX@msu.edu).

Your participation in this research is voluntary. The staff and other members of [the
clubhouse] will not know whether or not you chose to participate.

Sincerely,

XXXXX XXXX, Director

XXXXXX XXXXXXXXX Clubhouse
W XXX XXXX blvd.,

XXX XXXX, MI Mimi-W
WWW

129

CONSENT TO CONTACT FORM

1 am interested in hearing more about this study. Please call me to discuss an
appointment at the following number:

My Name (PLEASE PRINT):

 

My Phone Number:

 

Best times to reach me:

 

SEND RESPONSE TO:
Tiffeny R. Jimenez

Michigan State University
Psychology Building, Rm. ##it
East Lansing, MI 48824
XXXXXXXX@msu.edu
WWW ofﬁce

02° You may also choose to call or email.

130

APPENDIX E

Community Response to a Psychosocial Clubhouse
Study Consent Form

Purpose: This study aims to gain a deeper understanding of your experience as a member of
a clubhouse that has experienced a negative community (or NIMBY) response.

Procedures: If you decide to participate in this study you will be asked to participate in an
interview that will last approximately 90 minutes and will be audio taped. The interview will
cover demo gaphic information, mental health history, mental health service utilization, and
the impact of the NIMBY response on you and your clubhouse. At the end of the interview
you will be given $15.00 in cash for participating.

Confidentiality: The interview is conﬁdential. Information obtained from you will n_o_t be
shared with other clubhouse members or staff. Interview data, in the form of tapes and
transcripts, will not have your name on them. They will be identiﬁed by only a numeric
code. The audio tapes and transcripts will only be used by the research team. The tapes
will be destroyed when the research study has ended. If ﬁndings are published, only
pseudonyms or roles will be used. Your privacy will be protected to the maximum extent
allowable by law.

Withdrawal: Participation in this study is voluntary. You have the right to discontinue
participation in the study at any time. There are no penalties to you if you choose not to
participate in this study or if you choose to withdraw or discontinue your participation

Benefits: By participating you will be contributing to our understanding of the impact that
NIMBY can have on clubhouse members and how clubhouses can help members to deal with
this negative public response.

Risks: There are no physical, legal or economic risks to participating in the study. It is
possible that you might feel somewhat uncomfortable discussing your experiences If this
happens, you may stop the interview at any time. It should be pointed out that, although
pseudonyms will be used, we cannot guarantee that your identity might be recogrized by
someone in your clubhouse. It is also possible that your identity might be recogrized by
others if you express a position to us for which you are publicly known.

If you have any questions about this study, please contact either the investigator (Deborah
Salem, (###) W-W. XXXXX@msu.edu, or by regular mail: ##A Psychology
Department, East Lansing, MI, 48824) or the co-investigator- Tiffeny Jimenez, (###) ##9#-
W, XXXXXXXX@msu.edu. or by regular mail at: Psychology Departrment, East Lansing,
MI 48824.

If you have questions or concerns regarding your rights as a study participant, or are
dissatisﬁed at any time with any aspect of this study, you may contact — anonymously, if you
wish —Peter Vasilemko, Ph.D., Chair of the University Committee on Research Involving

131

 

 

 

 

 

 

 

 

Human Subjects (UCRIHS) by phone: (517) 355-2180, fax: (517) 432-4503, e-mail:
ucrihs@msu.edu, or regular mail: 202 Olds Hall, East Lansing, MI 48824.

CONSENT

By checking this box and sigring below you are indicating that you voluntarily agree to
participate in this study. You will receive a sigred copy of this consent forrm.

 

Participant’s Printed name

 

 

 

 

/ /
Participant’s Signature Date
/ /
Signature of Investigator Date

By checking this box and sigring below you agree to have your interview audio taped.

 

Participant’s Printed name

 

Participant’s Signature

132

APPENDIX F

Community Response to a Psychosocial Clubhouse
Staff Study Consent Form

Purpose: This study aims to gain a deeper understanding of your experience as a staff
member of a clubhouse that has experienced a negative community (or NIMBY) response.

Procedures: If you decide to participate in this study you will be asked to participate in an
interview that will last approximately 90 nrinutes and will be audio taped. The interview will
cover demographic information, history with the clubhouse, and the impact of the NIMBY
response on you and the clubhouse.

Confidentiality: The interview is conﬁdential. Information obtained ﬁom you will M be
shared with clubhouse members or staff. Interview data, in the form of tapes and
transcripts, will not have your name on them. They will be identiﬁed by only a numeric
code. The audio tapes and transcripts will only be used by the research team. The tapes
will be destroyed when the research study has ended. If ﬁndings are published, only
pseudonyrms or roles will be used. Your privacy will be protected to the maximum extent
allowable by law.

Withdrawal: Participation in this study is voluntary. You have the right to discontinue
participation in the study at any time. There are no penalties to you if you choose not to
participate in this study or if you choose to withdraw or discontinue your participation

Benefits: By participating you will be contributing to our understanding of the impact that
NIMBY can have on clubhouse members and how clubhouses can help members to deal with
this negative public response.

Risks: There are no physical, legal or economic risks to participating in the study. It is
possible that you might feel somewhat uncomfortable discussing your experiences. If this
happens, you may stop the interview at any time. It should be pointed out that, although
pseudonyms will be used, we cannot guarantee that your identity might be recogrized by
someone in your clubhouse. It is also possible that your identity might be recogrized by
others if you express a position to us for which you are publicly known.

If you have any questions about this study, please contact either the investigator (Deborah
Salem, (##1##) W-W. W@msu.edu. or by regular mail: WA Psychology
Departrment, East Lansing, MI, 48824) or the co-investigator- Tiffeny Jimenez, (#39!) ##1##-
W, XXXXXXXX@m§1.edu, or by regular mail at: Psychology Department, East Lansing,
MI 48824.

If you have questions or concerns regarding your rights as a study participant, or are
dissatisﬁed at any time with any aspect of this study, you may contact — anonymously, if
you wish —Peter Vasilemko, Ph.D., If you have questions or concerns regarding your
rights as a study participant, or are dissatisﬁed at any time with any aspect of this study,
you may contact - anonymously, if you wish - Peter Vasilemko, Ph.D., Director of Human
Research Protections, (517)355-2180, fax (517)432-4503, e-mail irb@msu.edu, mail: 202
Olds Hall, Michigan State University, East Lansing, MI 48824-1047.

133

 

 

 

 

 

 

 

 

CONSENT

By checking this box and sigring below you are indicating that you voluntarily agree to
participate in this study. You will receive a signed copy of this consent form.

 

Participant’s Printed name

 

 

 

 

/ /
Participant’s Sigrature Date
/ /
Sigrature of Investigator Date

By checking this box and sigring below you agree to have your interview audio taped.

 

Participant’s Printed narme

 

Participant’s Signature

134

APPENDIX G
NIMBY Active Members: Initial Open Coding of Transcripts

1M1.

Felt devastated 101-3, 101b-18

fell out 101-6

demeaned 101-7

wanted to harm self 101-7

sometimes get anxious 101-9

had a psychiatric break 10 1b-7

almost suicidal 101b-7

bad day can cause suicide lOlb—ll

now more proud to be a member 101b-l6
now more committed to the clubhouse 101b-18
did not change feeling about self 101b-19
truth will set you free lOlb-l9

kept wanting to speak out lOlb-20

#_1_92

felt devastated 102-1 8

held in what she wanted to say 102-1 8

felt upset 102-21

felt more conﬁdent going to court 102-22
ﬁghting was calming 102-22

felt better knowing not alone 102-23

meant a lot to see caring and nurturing in clubhouse 102-23
being able to talk about illness feels good 102-23
don’t let it bother me now 102-26

trying to live in the present 102-28

felt amazed at community response 102-30

5.193

felt angry 103-l7

felt upset and disoriented 103-1 7

the lowest I’d ever been 103-17

felt shocked and hurt 103b-10

newspaper article lifted my spirits 103-22 & lO3b-10
not giving up helped lift the weight 103b-11

trying to look up a lot as a member 103-22

trying to keep feelings in on the board 103-22

felt hopeless and lost 103-23

went to a depressed state 103-23

caused me to have a stomach problem 103-23

wasn’t coming here everyday 103-23

now conscious of cruel people 103-26

taught me to never let go of what you believe in 103-27
you’ve got to wait for strength and guidance 103-27
will continue to ﬁght for mental health system 103-27
you have to study a problem to ﬁgure out how to deal with it 103-27
progress is being made 103-28

135

let nothing stop me from being who I am 103-29

not going to let illness get in the way of anything 103b-12
didn’t affect feelings about self 103b-12

seemed like things got worse in the process of the ﬁght lO3b-12
had to take a leave of absence 103b-12

makes me feel better not giving up 103b-17

never give up 103b-18

made me a better person 103b-18

learned a lot 103b-18

EM

Disappointed 104-10,12, 13

Really wanted us to ﬁght for ourselves 104-11

Felt hurt 104-11,12, 13

Had to go into the hospital 104-13

Had to get my feelings together 104-13

Was so sad about it 104-14

Made me feel good to be on the board 104-14

Felt good to be in the newspaper; to let people know what’s happening 104-15
Feel stronger cuz I know we’re gonna make it 104-19

Stopped going to the club cuz thought that’s not the way to go 104-19
Now feel really proud of myself 104-20

Felt unwelcome lO4b-7

Felt what they said about her was true about herself 104b-8, 9
Community response made her sick 104b-9

Stopped going to club b/c thought she caused the response 104b-9
Feeling about club not changed in end 104b-11

£1.06.

Felt insecure 106-11

Felt maybe there’s something wrong with me 106-11
They made me feel inferior 106-11

I know I’m not what they think 106-11

I felt like a second class citizen 106-12

Couldn’t handle all the bad vibes 106-12

Can only take so much stress 106-12

Made me feel really bad 106-13

Took pride in the club 106-1 7

Now not as afraid to tell people has an illness 106-1 7
Need to step up to erase stigma 106-17

Increased time spent in clubhouse 106-18

Have come to terms with my illness recently 106-19
Has had no effect on recovery 106-20

Wants to help get the community involved in the club 106-20

am

Felt depressed 110-13

Felt like going back into hospital 110-13

Feels good now b/c won case 110-13

Felt they ran the meetings illegally 1 10-14

Winning the case gave him a boost to do other things 110-19

136

Overall, a positive experience 110-19

Now feels safe to walk into neighborhood 110-19

Now understands self, stigma, & discrimination better 110-22
Has not changed the way he feels about the clubhouse 110-22
Increased club involvement 110-22

137

APPENDD( H
NIMBY active members: First Framework from thematic coding

I. How the NIMBY response impacted mpmbers Initially
A.) Members had varying negative feelings
1. FELT OVERWHELMINGLY BAD
Felt devastated 101-3, 101b-18 [overwhelm/overpower]
felt devastated 102-1 8
Made me feel really bad 106-13
fell out 101-6
wanted to harm self 101-7
had a psychiatric break 101b-7
almost suicidal 101b-7
the lowest I’d ever been 103-17
felt hopeless and lost 103-23
went to a depressed state 103-23
Was so sad about it 104-14

2. FELT PUT DOWN
Felt demeaned 101-7 [to reduce/put down]
Felt insecure 106-11
Felt maybe there’s something wrong with me 106-11
They made me feel inferior 106-11
I felt like a second class citizen 106-12
Disappointed 104-10,12, 13 [defeated/thwarted]

3. FELT UPSET
felt upset 102-21 [an unhappy and worried mental state]
felt upset and disoriented 103-1 7
Felt hurt 104-11,12, 13 [suffering/emotional anguish]
Had to get my feelings together 104-13
felt shocked and hurt 103b-10

B.) Members had varying physical changes
1. PHYSICAL REACTIONS
caused me to have a stomach problem 103-23
stopped coming to club everyday 103-23
held in what she wanted to say 102-18
Had to go into the hospital 104-13

C.) Other reactions
1. MISCELLANEOUS
Couldn’t handle all the bad vibes 106-12
Really wanted us to ﬁght for ourselves 104-1 I
felt angry 103-17
Can only take so much stress 106-12

H. How the NIMBY response imparted members Over Time

A.) Things members held back on:
1. SPEAKING OUT

138

kept wanting to speak out 101b-20
held in what she wanted to say 102-18
2. FEELINGS
trying to look up a lot as a member 103-22
trying to keep feelings in on the board 103-22

B.) How the club involvement made things better:
1. BEING ON THE BOARD
Made me feel good to be on the board 104-14

2. SPEAKING TRUTH THROUGH MEDIA
Felt good to be in the newspaper; to let people know what’s
happening 104-15
newspaper article lifted my spirits lO3-22& 103b-10

3. BEING A PART OF SOMETHING BIGGER
felt better knowing not alone 102-23
felt more conﬁdent going to court 102-22
ﬁghting was calming 102-22
meant a lot to see caring and nmturing in clubhouse 102-23
Increased time spent in clubhouse 106-18
Now feel really proud of myself 104-20
not giving up helped lift the weight 103b-11
makes me feel better not giving up lO3b—17

4. FEELINGS ABOUT CLUBHOUSE
now more proud to be a member lOlb-16
now more committed to the clubhouse 101b-18
Took pride in the club 106-17
Feel stronger cuz I know we’re gonna make it 104-19

C.) Ramiﬁcations from NIMBY over time:
1. DISTANCING SELF FROM CLUBHOUSE
wasn’t coming here everyday 103-23
Stopped going to club cuz thought that’s not the way to go 104-19
had to take a leave of absence lO3b-12

III. How the NIMBY response impacted members In the end
1. FEELINGS OF SELF INTACT & UNCHANGED
did not change feeling about self lOlb-l9
truth will set you free 101b-l9
let nothing stop me from being who I am 103-29
Has had no effect on recovery 106-20
don’t let it bother me now 102-26
trying to live in the present 102-28
didn’t affect feelings about self lO3b-12
not going to let illness get in the way of anything 103b-12

2. IMPORTANT TO TAKE A STAND

Need to step up to erase stigma 106-17
Wants to help get the community involved in the club 106-20

139

will continue to ﬁght for mental health system 103-27
taught me to never let go of what you believe in 103-27

3. MORE ABLE TO DEAL WITH HAVING A SMI
Now not as afraid to tell people has an illness 106-17
Have come to terms with my illness recently 106-19
being able to talk about illness feels good 102-23

4. AWARE OF HOW CRUEL PEOPLE ARE
now conscious of cruel people 103-26
felt amazed at community response 102-30

5. MISCELLANEOUS
you’ve got to wait for strength and guidance 103-27
you have to study a problem to ﬁgure out how to deal with it 103-
27
progress is being made 103-28
seemed like things got worse in the process of the ﬁght lO3b-12
never give up lO3b—l 8
made me a better person 103b-18
learned a lot 103b-18

140

APPENDIX I

N IMBY active members: Additional coding framework of members’ personal
relationship with the clubhouse

I. Wh_at actively involved members feel the clubhouse does for them
A.) The clubhouse is described as a supportive place of safety & acceptance
1. CLUB IS A PLACE OF SUPPORT (5/5)

- Having a support system is crucial 103b-8

a. Members Receive Support (4/5)
Enjoys the support and kindness of the club members 102-
1 1
Club as been helpful and supportive 103-3
Club provides support 104-7
People in club supportive 106-8

b. Members Give Support (2/5)
Feels good to help others 104-1
Feels purpose at clubhouse to help out others 103-2

c. Staff Believes in Members’ Potential Q/S)
Director has been ﬁghting for members since the beginning
1 02-22
Thinks the director is a true believer 101b-19

2. CLUB IS LIKE A FAMILY (5/5)
Club is a home away from home 102-11
Club is like a family 103-7,103b-9
Club like a second family 104-2
Feels like has a family in the club 106-6
Club is a family lOlb- 15
Would defend the club because it means so much 101b-18

3. CLUB IS A SAFE SPACE (2/5)
Club is a non-threatening place to be 101-5
Club is a place to be normal and safe 102-12
Club is a personal space lOlb-15
Club is a place of acceptance 101b-15

B.) The clubhouse’s supportive & accepting environment provides opportunities
for members
1. TO BE SOCIAL (2/5)
Club is a place of socializing and ﬁiendship 103-12
Club is a place to be with ﬁiends 104-4

2. TO HAVE MEANINGFUL ROLES (2/5)

141

Feels accomplished in participating in club functioning 106-8
Feels proud to help run the club 104-4
Contributes the library to club 106-10

3. TO LEARN (2/5)
Club a place to learn skills 106-9
Club helps her grow each day 104-6
Enjoys constant learning and being with members 104-1,7

C.) MISCELLANEOUS
Irmportant to open doors for future generations 101-9

142

APPENDIX J
NIMBY active members: Final Framework Prior to Revisions

I. What activelv involved members feel the clubhouse is for them
A.) Supportive place of safety & acceptance (6/6)
1. CLUB IS A PLACE OF SUPPORT (6/6)
:1. Members Receive Support (5/6)
People in club supportive 106-18
Enjoys the support and kindness of the club members 102-
11
Club as been helpﬁrl and supportive 103-3
Club provides support 104-7
Club is supportive of him 110-4

b. Members Give Support (2/6)
Appreciates the giving & receiving of support 103-3
Feels good to help others 104-1
Feels purpose at clubhouse to help out others 103 -2
A place to practice leadership 104b-2
A place to feel good about self, to be there for others 104b-
4

c. Staff Believgs in Members’ Potential (3/6)
Thinks the director is a true believer 101b-22
Director has been ﬁghting for members since the beginning
1 02-22
Director of club an important person 104b-2

2. CLUB IS LIKE A FAMILY (5/6)
Club is a family 101b- 15
Club is my family 101a—2
Club like a second farmily 104-2
Club is like a family lO3b-9
Club is a home away from home 102-11
Feels like has a family in the club 106-6

3. CLUB IS A SAFE SPACE (3/6)
Club is a non-threatening place to be 101-5
Club is a personal space lOlb-15
Club is a place to be normal and safe 102-12
Club is a place of acceptance 101b-15
A place of understanding and acceptance 104b-2
A place of comfort and safety 104b-3
Club keeps her from getting sick/going in to hospital 104b-3, 5
Club makes her feel safe b/c not alone 104b-4

143

B.) A place that provides opportunities for members (6/6)
1. TO BE SOCIAL & HAVE FRIENDS (3/6)
Club is a place to be with ﬁiends 104-4
Club is a place of socializing and friendship 1033-12
Likes being on board b/c meets people and learns about issues 110-
5

2. TO LEARN (4/6)
Enjoys constant learning and being with members 104-1,7
Club a place to learn skills 106-9
Being part of the club has been a learning experience 103a-
A place to learn about illness 104b-2
A place to talk and learn about self 104b-4
Club helped him learn how to cope better 110-4

3. TO HAVE MEANINGFUL ROLES (5/6)
af. Being a member of a well-functioning entig/organization (2/6)
Feels accomplished in participating in club functioning
106-8
Feels proud to help run the club 104-4

b. Having responsibilities that are more personally impprtant (5/6)
Contributes the library to club 106-10

Is a leader and wise woman of the club lOla-l
Responsible for taking care of computers 110-5

A role model for what’s possible for others with SMI 102-
14

Likes being on board b/c meets people and learns about
issues 1 10-5

Feel important being on the board 104a-14

 

11. How the NIMBY response impacted “pctively involved” members Initially
A.) Actively involved members had varying initial negative feelings
1. FELT OVERWHELMINGLY BAD (6/6 included here)
Felt devastated 101-3, 101b-18
felt devastated 102-18
felt amazed at community response 102-30
felt upset 102-21
the lowest I’d ever been 103-17
felt angy, upset, and disoriented 103-17
felt shocked and hurt lO3b-10
Was so sad about it 104-14
Felt hurt & disappointed by what residents said 104-11,12, 13
Made me feel really bad 106-l3
Felt depressed 110-13

144

FELT PUT DOWN (4/6 included here) FELT BAD TOO

Felt demeaned 101-7 [intemally- linked to devastated]
Disappointed 104-10, 12, 13[internally- linked to hurt]

Felt insecure 106-11 [internal]

Felt maybe there’s something wrong with me 106-1 1 [internal]
They made me feel inferior 106-ll [external]

I felt like a second class citizen 106-12 [external]

Felt unwelcome 104b-7 [external]

Felt what they said about her was true about herself 104b-8, 9

2. HAD A MENTAL HEALTH BREAKDOWN (4/6 included here)
fell out/ had a psychiatric break lOlb-7, 101-6
wanted to harm self/ almost suicidal 101b-7, 101-7
felt hopeless and lost/ went to a depressed state/ caused me to have
a stomach problem 103-23 103-23
Had to get my feelings together/ Had to go into the hospital 104-13
Community response made her sick 104b-9
Felt like going back into hospital 110-13

3. CHANGE IN LEVEL OF INVOLVEMENT (5/6)

a Decreased (4/6)
Not coming everyday/ had to take a leave of absence 103b-
12, 103-23
Stopped going to club b/c thought that’s not the way to go
104-1 9
Avoided getting involved in NIMBY: Couldn’t handle the
bad vibes/ Can only take so much stress 106-12
Stopped going to club b/c thought she caused the response
1 O4b-9

L Increased (3/6)
Increased time spent in clubhouse 106-18
Increased club involvement 110-22

Went back to club to learn more and feel better about self
104b-10

III. How the NIMBY response impacted NIMBY active members Over Time
A.) Members’ club involverment & what made them feel better:
1. TAKING ACTION IN RESPONSE TO NIMBY (5/6)
a. Speaking out publicly 3/6
Feeling of being heard by others was important 102-22
Felt good to speak out to others through newspaper 104-15
Members wrote rebuttals of editorials & really educated
others 106-21

b. Talking with others at clubhoﬁuse about it (3/6)

145

Being a part of conversations about the move at weekly
club meeﬁngs104-1 5,16

Brought extra newspaper clippings to the club & discuss
them 104-20

Learned a lot from talking about it 104-23

Keeping others focused on the good ﬁrings 103b-1 1
Talking with members was very helpful 1 10-16

c. Beingat board meetings (3/6)

Gets updates on case at board meetings so feels informed
1 02-29

Things got cleared up after a board meeting 103-23

Felt good to be voted onto the board 104-14

Being on the board made her feel needed 104-21

On board b/c feels good to be part of it 104b-10

 

2. FEELING SUPPORT OF OTHERS (5/6)

a. Members & Staff (3/6)
Doesn’t bother her b/c sees staff and lawyers taking care of
everything 102-26
Staff and members keep each other positive, like a family
101 -12
Staff been supportive of member efforts to stay on
task/focused 101b-20
Staff helped members deal with any reactions members had
1 01 b-2 1
Meant a lot to see caring and nurturing in clubhouse 102-23
Sees concern and care for members nearing court dates
1 02-29
Not giving up, seeing it in good hands, lifted the weight
1 O3b-1 1 ,1 7

b. Outside People & Orga. (4/6)
Support ﬁom outside agencies and corporations felt good
103 -23, 27
Feeling support from org outside the club helped feel better
1 04-1 9
Seeing the support of outside agencies in newspapers
helped feel better 104-20
Felt good to feel support ﬁom others outside the club 106-
14
Reading positive newspaper articles about club was helpful
103-22, 103B-10
Auspice agency sent case workers to talk with members
1 10-14

146

0. Everyone (013$. club. ES. members) (2/6)
Felt more calm and relaxed knowing not alone (everyone)
1 02-22,23
Saw caring of the auspice agency, lawyers, and staff
(everyone) 102-22
Feels good to learn that other changes are happening with
ADA law 1 10-20

3. KEEPING INFORMED ABOUT NIMBY (4/6)
Being updated on the situation helpful lOlb-20
Listened to staff & lawyers talk [about ﬁght] felt more conﬁdent
102-22
Seeing progess being made was encouraging for all members 103-
28
Kept informed about move updates 104-14
Board helped her to understand the community response 104b-1 1

4. MAINTAINING BUSINESS AS USUAL (4/6)
Kept focused on daily club functioning 101-11
Stays busy w/daily tasks, job, health so doesn’t dwell on it 102-29
Feels better about the way the club acted like it never
happened] 03 -29
Staff remained professional throughout; kept plugging away 106-
21

5. STAYING FOCUSED ON POSITIVES (4/6)
We took the high road (2: 101-8, 102-18)
They’re wrong and we’re right (2: 101, 104)
We can have a wonderful irmpact on them (2: 104-17, 106)
Continue to make changes (3: 101, 104, 106-17)

IV. How the NIMBY response impacted members In the enal
A.) Actively involved members feel unchanged & more positive (6/6)
1. FEELINGS OF SELF INT ACT (5/6)
did not change feeling about self lOlb-19
truth will set you ﬁee lOlb-19
trying to live in the present 102-28
didn’t affect feelings about self lO3b-12
not going to let illness get in the way of anything 103b-12
let nothing stop me from being who 1 arm 103-29
Has had no effect on recovery 106-20
Has not changed the way he feels about the clubhouse 110-22

2. FEEL BETTER ABOUT THEMSELVES (4/6)

don’t let it bother me now 102-26
made me a better person 103b-l 8

147

Now feel really proud of myself 104-20

Feels proud like she has achieved something now 104-20
Happier now b/c knows more now 104-25

Really wanted us to ﬁght for ourselves 104-11

Now feels better about self b/c can talk about illness 102-23
Feel stronger cuz I know we’re gonna make it 104-19

Feels good now b/c won case 110-13

Winning the case gave him a boost to do other things 110—1 9

3. FEEL BETTER ABOUT CLUBHOUSE (3/6)
now more proud to be a member 101b-16
now more comrrritted to the clubhouse 101b-18
Proud of the club for not responding to the negativity 101b-19
Proud of the club for sticking with the long ﬁght 106-17
Took pride in the club 106-17
Feeling about club not changed in end 104b-11

B.) Actively Involved members feel stronger (4/5)
1. MORE ABLE TO DEAL WITH HAVING A SMI (3/6)
Now not as afraid to tell people has an illness 106-17
Have come to terms with my illness recently 106-19
Now feels better about self b/c can talk about illness 102-23
Now feels safe to walk into neighborhood 110-19
Now understands self, stigma, & discrimination better 110—22

2. IMPORTANT TO TAKE A STAND (2/6)
Need to step up to erase stigma 106-l7
Wants to help get the community involved in the club 106-20
will continue to ﬁght for mental health system 103-27
taught me to never let go of what you believe in 103-27

148

APPENDIX K
Clubhouse Involved Members: Open coding for members’ relationship to clubhouse

#105

Club a place to socialize 105-15

Involvement varies in the club as needed 105-15

Prefers members service work 105-15

Not attending board meetings more recently 105-1 6

Role is to help out clubhouse and pursue job opportunities 105-16
Club gives him a place to go to talk with others 105-16

Likes being a part of an entity that accomplishes things 105-17

Feels a personal connection to members as a goup 105-17

Club helps him realize he can successfully deal with his illness 105-17
Connecting with outgoing people helps him to come out of his shell 105-18

#107

Enjoys the club We can be with others who have similar issues 107-4
Feels that staff are very helpful 107-4

Members turn to her for advice 107-4, 6

Does phone work when there 107-5, 6

Responsible for running SA goup at the club 107-5, 7

Can bond with members through SA goups 107-7

Club helps her realize she is not alone with her illness 107-8

#1 08

Club provides a place to learn how to commit to something, like a job 108-
Involved in a variety of activities as needed in club 108-

Does not feel has a role in club and does not want one 108-

Does not want to get close to members or make friends 108-

Does not feel a personal connection with club 108-

Club a place to be with others who also have SMI 108-

Club helped him to get an apartment 108-

Does not feel equal to those w/o SMI in the club 108-

#109

A place to ﬁnd time for herself where she’s not the boss 109-10
Feel her role is to work with others to help run the clubhouse 109-10
Club teaches members how to work with others 109-10

Club is a place to learn skills 109-10

Feels role is a volunteer who gets a sense of farrrily in return 109-10
Club is a place to have ﬁiends 109-11

Club a place to feel valuable and worth something 109-ll

Club is a place to have personal space 109-11-12

Club helped her to accept self and others with SMI 109-12, 14

Club is a place of acceptance 109-15-16

149

#1 l 1

Part of advisory board and answers phones 111-5

Likes to type articles for the club newsletter 111-7

Likes to educate members on the importance of voting 111-7

Club is a place to have ﬁiends 111-8

Club helped hirm to cope with illness easier be being involved 1 “-9
Club has helped him become a better person 111-9

#112

Club work order day gives her many things to do 112-20:10
Likes the club staff 112-20145

Works in the library with another member 112-20250

Likes the social life of the club 112-21 :40

150

APPENDIX L

Clubhouse involved members: Initial framework for members’ relationship with the
clubhouse from thematic coding

I. Whgnon-activelginvolved members feel the clubhouse is for them
A.) A place that provides opportunities for members (6/6)
1. TO BE SOCIAL & HAVE FRIENDS (5/6)
a. A place to be social (3/6)
Club a place to socialize 105-15
Club gives him a place to go to talk with others 105-16
Connecting w/outgoing ppl helps him come out of his shell 105-18
Likes being a part of an entity that accomplishes things 105-17
Feels a personal connection to members as a goup 105-17
Can bond with members through SA groups 107-7
Likes the social life of the club 112-21:40

b. A place to have ﬁiends (2/6)
Club is a place to have friends 111-8
Club is a place to have ﬁiends 109-11

2. TO LEARN (2/6)
Club teaches members how to work with others 109-10
Club is a place to learn skills 109-10
Club a place to learn how to practice commitrment 108-42:43-44:00

3. TO HAVE MEANINGFUL ROLES (6/6)
a. Being part of the work order day (6/6)
Involved in a variety of activities as needed 108- 47:40-48:25
Involvement varies in the club as needed 105-15
Feel role is to work w/ others to help run the clubhouse 109-10
Club work order day gives her many things to do 112-20:10
F eels role is to be a volunteer that does what needs to be done 109-
10
Does phone work when there (clerical) 107-5, 6
Part of advisory board and answers phones (clerical) 111-6
Likes to type articles for the club newsletter (clerical) 111-7

b. Having other more personally important roles (2/6)
Likes to educate members on the importance of voting 111-7

Responsible for running SA group at the club 107-5, 7

 

4. TO BE WITH OTHERS LIKE THEM (3/6)
Being w/others w/MI helps him realize he can successfully deal
w/his illness 105-17

151

Being w/others w/MI helps her remember she’s not alone w/her
illness 107-8

Being w/others who have sirmilar issues helps him feel good about
himself 108- 52:30-53:50

B.) Miscellaneous
Club is like a big family away ﬁom the farme 109-10
Club helped her to accept herself and other w/SMI 109-12

152

APPENDIX M

Clubhouse involved members: Final framework of members’ relationship with the
clubhouse after further thematic coding prior to revised framework

1. mt clubhouse involved members feel the clubhouse is for them
A.) A place that provides opportunities for members (6/6)
1. TO BE SOCIAL & HAVE FRIENDS (5/6)
a. A place to be social (3/6)
Club a place to socialize 105-15
Club gives him a place to go to talk with others 105-16
Connecting w/outgoing ppl helps him come out of his shell 105-18
Feels a personal connection to members as a goup 105-17
Can bond with members through SA groups 107-7
Likes the social life of the club 112-21 :40

b. A place to give ﬁiends (2/6)
Club is a place to have friends 111-8
Club is a place to have ﬁiends 109-11

2. TO BE WITH OTHERS LIKE THEM (4/6)
Being w/others w/MI helps him realize he can successfully deal
w/his illness 105-17
Being w/others w/MI helps her remember she’s not alone w/her
illness 107-8
Being w/others who have similar issues helps him feel good about
hirmself 108- 52:30-53:50
Club helped her to accept herself and other w/SMI 109-12

3. TO LEARN (2/6)
Club teaches members how to work with others 109-10
Club is a place to learn skills 109-10
Club a place to learn how to practice commitment 108-42:43-44:OO

4. TO HAVE MEANINGFUL ROLES (6/6)
aﬁBeing a member of a well-functioning entity/organization (6/6)
Involved in a variety of activities as needed 108- 47:40-48z25 ??
Involvement varies in the club as needed 105-15
Likes being a part of an entity that accomplishes things 105-17
F eel role is to work w/ others to help run the clubhouse 109-10

F eels role is to be a volunteer that does what needs to be done 109-
1 0

b. Having things to do (3/6)
Club work order day gives her many things to do 112-20:10
Does phone work when there (clerical) 107-5, 6

153

Answers phones (clerical) 1 11-6
Likes to type articles for the club newsletter (clerical) 111-7

c. Having responsibilities that are more persogrlly important (2/6)
Likes to educate members on the importance of voting 111-7
Responsible for running SA group at the club 107-5, 7

Part of the advisory board 111-6

154

APPENDIX N

Final framework of the Results Section after further analysis of the identified
themes of empowerment

1. Impact of the NIMBY Response on Members’ Recovery: In the Beginning
A. Impact on NIMBY Active Members in the Beginning
1. FELT OVERWHELMINGLY BAD (6/6 included here)

Felt devastated 101-3, 101b-18
felt devastated 102-18
felt amazed at community response 102-30
felt upset 102-21
the lowest I’d ever been 103—17
felt angy, upset, and disoriented 103-17
felt shocked and hurt 103b-10
Was so sad about it 104-14
Felt hurt & disappointed by what residents said 104-1 1,12, 13
Made me feel really bad 106-13
Felt depressed 110-13
FELT PUT DOWN (4/6 included here) FELT BAD TOO
Felt demeaned 101-7 [internally- linked to devastated]
Disappointed 104-10, 12, 13[internally- linked to hurt]
Felt insecure 106-11 [internal]
Felt maybe there’s something wrong with me 106-11 [internal]
They made me feel inferior 106-11 [external]
I felt like a second class citizen 106-12 [external]
Felt unwelcome 104b-7 [external]
Felt what they said about her was true about herself 104b-8, 9

2. HAD A MENTAL HEALTH BREAKDOWN (4/ 6 included here)
fell out/ had a psychiatric break 101b-7, 101-6
wanted to harm self/ almost suicidal 101b-7, 101-7
felt hopeless and lost/ went to a depressed state/ caused me to have
a stomach problem 103-23 103-23
Had to get my feelings together/ Had to go into the hospital 104-13
Community response made her sick 104b-9
Felt like going back into hospital 110-13

3. CHANGE IN LEVEL OF INVOLVEMENT (5/6)

a Decreased (4/6)
Not coming everyday/ had to take a leave of absence 103b-
12, 103-23
Stopped going to club b/c thought that’s not the way to go
1 04-19
Avoided getting involved in NIMBY: Couldn’t handle the
bad vibes/ Can only take so much stress 106-12

155

Stopped going to club b/c thought she caused the response
104b-9

1; Increased (3/6)
Increased time spent in clubhouse 106-18
Increased club involvement 110—22

Went back to club to learn more and feel better about self
1 04b-10

B. Impact on Clubhouse Involved Members in the Beginning [In contrast]
1. LITTLE T0 N0 IMPACT
Felt alone and that nothing has changed
Didn’t really think about it
It was just reality, newspapers spoke reality

11. Possible reasons why Differential Experiences of NIMBY in the Beginning
A. Direct & Indirect Exposure to the NIMBY response
1. NIMBY active had mostly direct exposure
2. Clubhouse involved had mostly indirect exposure
B. Members’ Individual Relationships w/ clubhouse prior to NIMBY
C. What the Clubhouse Means to NIMBY active Members
1. Supportive place of safety & acceptance (6/6)
a. CLUB IS A PLACE OF SUPPORT (6/6)
Members Receive Support (5/6)
People in club supportive 106-1 8
Enjoys the support and kindness of the club members 102-
11
Club as been helpful and supportive 103 -3
Club provides support 104-7
Club is supportive of him 110-4

Members Give Support (2/6)

Appreciates the giving & receiving of support 103-3

Feels good to help others 104-l

F eels purpose at clubhouse to help out others 103-2

A place to practice leadership 104b-2

A place to feel good about self, to be there for others 104b-
4

Staff Believes in Mermbers’ Potmﬁﬂ3/6)

Thinks the director is a true believer 101b-22

Director has been ﬁghting for mermbers since the beginning
102-22

Director of club an irmportant person 104b-2

b. CLUB IS LIKE A FAMILY (5/6)

156

Club is a family lOlb- 15

Club is my family 101a-2

Club like a second family 104-2

Club is like a family 103b-9

Club is a home away from home 102-11
Feels like has a farmily in the club 106-6

c. CLUB IS A SAFE SPACE (3/6)
Club is a non-threatening place to be 101-5
Club is a personal space 101b-15
Club is a place to be normal and safe 102-12
Club is a place of acceptance 101b-15
A place of understanding and acceptance 104b-2
A place of comfort and safety 104b-3
Club keeps her from getting sick/going in to hospital 104b-
3, 5
Club makes her feel safe b/c not alone 104b-4

2. A place that provides opportunities for members (6/6)
a. TO BE SOCIAL & HAVE FRIENDS (3/6)
Club is a place to be with ﬁiends 104-4
Club is a place of socializing and friendship 103a-12
Likes being on board b/c meets people and learns about
issues 1 10-5

b. TO LEARN (4/6)
Enjoys constant learning and being with members 104-1,7
Club a place to learn skills 106-9
Being part of the club has been a learning experience 103a-
A place to learn about illness 104b-2
A place to talk and learn about self 104b-4
Club helped him learn how to cope better 110-4

c. TO HAVE MEAN IN GFUL ROLES (5/6)
Beinga member of a well-functioning

entig/organization (2/6)
Feels accomplished in participating in club functioning

106-8
Feels proud to help run the club 104-4

Having resmnsibilities that are more personally

important (5/6)
Contributes the library to club 106-10

Is a leader and wise woman of the club 101a-1
Responsible for taking care of computers 1 10-5

157

A role model for what’s possible for others with SMI 102-
14

Likes being on board b/c meets people and learns about
issues 110-5

Feel important being on the board 1043-14

D. What the Clubhouse Means to Clubhouse Involved Members
1. A place that provides opportunities for members (6/6)
a. TO BE SOCIAL & HAVE FRIENDS (5/6)

A place to be social (3/6)
Club a place to socialize 105-15
Club gives him a place to go to talk with others 105-16
Connecting w/outgoing ppl helps him come out of his shell
105-18
Likes being a part of an entity that accomplishes things
1 05-1 7
Feels a personal connection to members as a goup 105-17
Can bond with members through SA goups 107-7
Likes the social life of the club 112-21z40

 

A place to have ﬁiends (2/6)
Club is a place to have ﬁiends 111-8
Club is a place to have friends 109-11

b. TO BE WITH OTHERS LIKE THEM (3/6)
Being w/others w/MI helps him realize he can successfully
deal w/his illness 105-17
Being w/others w/MI helps her remember she’s not alone
w/her illness 107-8
Being w/others who have similar issues helps him feel
good about himself 108- 52:30-53:50

c. TO LEARN (2/6)
Club teaches members how to work with others 109-10
Club is a place to learn skills 109-10
Club a place to learn how to practice commitment 108-
42:43-44:00

d. TO HAVE MEANINGFUL ROLES (6/6)
Beinga member of an organization (6/6)
Involved in a variety of activities as needed 108- 47:40-
48:25
Involvement varies in the club as needed 105-15
Feel role is to work w/ others to help run the clubhouse
109-10
Club work order day gives her many things to do 112-20:10

158

Feels role is to be a volunteer that does what needs to be
done 109-10
Likes to type articles for the club newsletter (clerical)11 1-7

Having things to do (2/6)
Does phone work when there (clerical) 107-5, 6
Part of advisory board and answers phones (clerical) 111-6

Having other more personally important roles (2/6)
Likes to educate members on importance ofvoting111-7

Responsible for running SA goup at the club 107-5, 7

 

III. The Irmpact of the NIMBY Case on Members in the End
A. Impact of the NIMBY case on NIMBY Active Members in the End (6/6)
1. FEELINGS OF SELF INTACT (5/6)

did not change feeling about self 101b-19
truth will set you free 101b-19
trying to live in the present 102-28
didn’t affect feelings about self 103b-12
not going to let illness get in the way of anything 103b-12
let nothing stop me from being who I am 103-29
Has had no effect on recovery 106-20
Has not changed the way he feels about the clubhouse 110-22

2. FEEL BETTER ABOUT THEMSELVES (4/6)
don’t let it bother me now 102-26
made me a better person 103b-18
Now feel really proud of myself 104-20
Feels proud like she has achieved something now 104-20
Happier now b/c knows more now 104-25
Really wanted us to ﬁght for ourselves 104-11
Now feels better about self b/c can talk about illness 102-23
Feel stronger cuz I know we’re gonna make it 104-19
Feels good now b/c won case 110-13
Winning the case gave him a boost to do other things 110-19

3. FEEL BETTER ABOUT CLUBHOUSE (3/6)
now more proud to be a member 101b-16
now more committed to the clubhouse 101b-18
Proud of the club for not responding to the negativity 101b-19
Proud of the club for sticking with the long ﬁght 106-1 7
Took pride in the club 106-17
Feeling about club not changed in end 104b-11

B. Feeling Stronger in the end: Feeling a Sense of Empowerment (4/5)
1. BETTER ABLE TO DEAL WITH HAVING A MI (3/6)

159

Now not as afraid to tell people has an illness 106-1 7

Have come to terms with my illness recently 106-l9

Now feels better about self b/c can talk about illness 102-23
Now feels safe to walk into neighborhood 110-19

Now understands self, stigma, & discrimination better 110-22

2. IMPORTANT TO TAKE A STAND (2/6)
Need to step up to erase stigma 106-17
Wants to help get the community involved in the club 106-20
will continue to ﬁght for mental health system 103-27
taught me to never let go of what you believe in 103-27

C. Impact of the NIMBY Case on Clubhouse Involved Members in the End
1. NO IMPACT

No irmpact
What’s the big deal

IV. How the Clubhouse Assisted Members Through the NIMBY Case Over Time
A. How the Clubhouse Reacted to the NIMBY response: Some Context
1. The Clubhouse as an Empowered Organization
Case contextual info provided here
B. How the Clubhouse Assisted NIMBY Active Members over Tirme
1. OPPORTUNITIES FOR ACTION IN RESPONSE TO NIMBY (5/6)
a. Speaking out publicly 3/6
Feeling of being heard by others was important 102-22
Felt good to speak out to others through newspaper 104-15
Members wrote rebuttals of editorials & really educated
others 106-21

b. Talking with others at clubhouse about it (3/6)
Being a part of conversations about the move at weekly

club meeﬁngle4-1 5,16

Brought extra newspaper clippings to the club & discuss
them 104-20

Learned a lot ﬁom talking about it 104-23

Keeping others focused on the good things 103b-1 1
Talking with members was very helpful 110-16

0. Participation in board meetings (3/6)

Gets updates on case at board meetings so feels informed
102-29

Things got cleared up after a board meeting 103-23

Felt good to be voted onto the board 104-14

Being on the board made her feel needed 104-2]

On board b/c feels good to be part of it 104b-10

 

160

2. PROVIDED SUPPORT TO MEMBERS (5/6)

a. Clubhouse & Auspice Agency (3/6)
Doesn’t bother her b/c sees staff and lawyers taking care of
everything 102-26
Staff and members keep each other positive, like a family
1 01 -1 2
Staff been supportive of member efforts to stay on
task/focused 101b-20
Staff helped members deal with any reactions members had
1 01b-21
Meant a lot to see caring and nurturing in clubhouse 102-23
Sees concern and care for members nearing court dates
1 02-29
Not giving up, seeing it in good hands, lifted the weight
103b-l 1 ,1 7

 

b. Outside Support (4/6)
Support from outside agencies and corporations felt good
103 -23, 27
Feeling support ﬁom org outside the club helped feel better
1 04-1 9
Seeing the support of outside agencies in newspapers
helped feel better 104-20
Felt good to feel support ﬁom others outside the club 106-
14
Reading positive newspaper articles about club was helpful
103-22, lO3B—10
Auspice agency sent case workers to talk with members
1 10-14
Felt more calm and relaxed knowing not alone (everyone)
1 02-22,23
Saw caring of the auspice agency, lawyers, and staff
(everyone) 102-22
Feels good to learn that other changes are happening with
ADA law 1 10-20

3. KEPT MEMBERS INFORMED ABOUT NIMBY (4/6)
Being updated on the situation helpful 101b-20
Listened to staff & lawyers talk [about ﬁght] felt more conﬁdent
I 02-22
Seeing progess being made was encouraging for all members 103-
28
Kept informed about move updates 104-14
Board helped her to understand the community response 104b-1l

4. MAINTAINED CLUBHOUSE BUSINESS AS USUAL (4/6)

161

Kept focused on daily club functioning 101-11

Stays busy w/daily tasks, job, health so doesn’t dwell on it 102-29
Feels better about the way the club acted like it never

happened] 03-29

Staff remained professional throughout; kept plugging away 106-
21

5. KEPT MEMBERS FOCUSED ON POSITIVES (4/6)
We took the high road (2: 101-8, 102-18)
They’re wrong and we’re right (2: 101, 104)
We can have a wonderful impact on them (2: 104-17, 106)
Continue to make changes (3: 101, 104, 106-17)

6. THE IMPORTANT ROLE OF THE VISIONARY
Summary quote of the above meta-themes
Quote about role of the Director

7. THE CLUBHOUSE AS AN EMPOWERING ORG
Deﬁne elements of an empowering organization

C. Experiences of Clubhouse Involved Members over Time: A Contrast
1. CLUBHOUSE INVOLEMENT UNCHAN GED
No impact
Still here
Staff has been helpful

2. AN ANOMOLOUS CASE
Experiences similar to NIMBY Active members

162

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

  

 

 

 

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