Clubhouses For People with Persistent Mental Illness Fear State Cuts

June 13, 2017 | By Taylor Knopf

Jasmine Thomas boards a van at her group home a couple days a week to visit a special kind of clubhouse tucked away in an East Durham neighborhood.

Threshold is an accredited clubhouse for adults with severe mental illnesses. It’s a place for its members to socialize, eat lunch, build life skills, and find job opportunities.

Research on clubhouses around the country shows that, for a relatively small investment, members are better able to stay out of the hospital, reducing the cost burden to municipalities and states.

But this year, clubhouse directors in North Carolina worry that they could lose some of their state funding if General Assembly lawmakers get their way.

Self-sufficient

Established in 1985, Threshold, located at 609 Gary St. in East Durham, serves about 40 people daily, and some say it’s one of the area’s best-kept secrets. The clubhouse is a resource for people with psychotic disorders such as schizophrenia and bipolar.

“We work together to accomplish a common goal,” said Threshold Associate Director Ali Swiller, who has worked at the facility for two decades. “It’s a prepositional difference. We do things with people, not to and for them.”

She said that many so-called “psycho-social rehabilitation” programs merely keep people busy with tasks that, in the end, are meaningless.

“Arts and crafts are great, but they aren’t a reason to get up every day,” she said. “People can go home at the end of the day and know that if they were not here, lunch wouldn’t have been made, tours wouldn’t have been given, and phones wouldn’t have been answered.”

Threshold’s 11-person staff works alongside members to operate the clubhouse. Community volunteers also help with tasks such as maintaining the garden.

“It makes me feel good and I can encourage others,” Thomas said about working at the clubhouse.

Though she says that was nervous her first few visits, she has been participating for 11 years and has made lots of friends. Thomas said Threshold members attended a prom with Club Nova in Carrboro last month. In her pocket, she carries a Polaroid photo of herself wearing a white feather boa in front of a Hollywood sign from the event.

The members always have a few activities going on. Last month they went on a fishing trip organized by two Durham crisis intervention officers.

Many Durham CIT officers visit Threshold during their initial training. Officers frequently visit the clubhouse in plain clothes just to check in. Swiller said this makes everyone more comfortable with the officers for the times when they have to return in uniform to respond to a mental health crisis.

On the chopping block

As state lawmakers negotiate the budget, both the Senate and House budget aim to decrease annual funding that pays for non-Medicaid services to the seven LME-MCOs (behavioral health management organizations) that manage care in North Carolina.

Legislators also proposed a cut of more than $30 million in one-time funding for the upcoming fiscal year. However, they have ordered the LME-MCOs to maintain the same level of service, by using money the LME-MCOs already have in reserve.

Threshold receives about $60,000 in state money allocated through Alliance, the LME-MCO that serves the Durham area.

“It can’t keep being depleted at the state level,” Swiller said. “The reality is, by setting a budget that doesn’t focus on prevention and community-based services, you are going to pay tenfold in emergency costs on the crisis end with psych hospitalizations, jails and homelessness.”

Swiller said 90 percent of Threshold members reported no rehospitalizations last year, which saves the state’s mental health system money.

Threshold staff also coordinate members’ care with their doctors, social workers and group homes. Because the staff sees members on a regular basis, they can detect emerging issues before they become crises. Or staff can report to the prescribing doctor how a member is doing with a medication change.

“Eliminating a line item from a budget doesn’t dissipate the need,” Swiller said. “I get that if you thought about every dollar you were cutting as a human being, it would be pretty hard to do your job. But it is a face. It is not a dollar.”

The clubhouse’s operating budget is around $800,000. Funds come from the state, individual donations and billing Medicaid for some members. The organization gets some grants, but Swiller noted foundations don’t often want to fund operating expenses.

Due to some Medicaid service exclusions, Swiller said Threshold is unable to bill for about 20 percent of its members.

“We maintained those members,” she said. “The only thing that changed was our ability to be reimbursed for it. Their treatment needs had not changed.”

Getting back to work

A major focus at Threshold is helping members find a job if they would like to work. The clubhouse has relationships with local employers such as Timmons Fabrication, Zaxby’s Chicken Fingers & Buffalo Wings, Durham County Library and Old Navy.

“We don’t say, ‘Can you give this poor mentally ill person a job?’” Swiller said. “We say, ‘Give us an entry-level job that you are having trouble keeping filled and we will provide a service.’ We will fill that position and support the person as long as they need, for six to nine months, at which point they transition off.”

Limiting the term length of the job helps ease members who haven’t had a job or who have trouble keeping a job back into the workforce.

“So this gives light at the end of the tunnel,” Swiller said. “They start at their job and they know it’s six months. We ride it out with them the entire way, and it’s not as overwhelming.”

If a member can’t go to work one day, a Threshold staff member takes the shift for them.

Threshold member James Edgerton, 59, got an entry level custodial job at Angus Barn on Glenwood Avenue. He works three days a week, and the clubhouse organizes his transportation to and from work. Edgerton said he enjoys the extra money and likes to spend it on new clothes.

“James is awesome. He has the best attitude and is one of our favorites,” said Marcia Felton, Angus Barn HR director. “We are happy to have a position to help people who haven’t had a job in a while. We feel this is a way to help people transition into the working world. It’s our way of giving back.”

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