Outcomes-based commissioning and public service transformation in Mosaic Clubhouse Lambeth

Objectives

The Clubhouse Model seeks to address the social isolation, the loss of confidence and skills, and the educational and vocational disadvantages that accompany a diagnosis of mental illness. There is an international network of over 330 Clubhouses in 30 countries.

Specific objectives of the Clubhouse Model are:

• To encourage Clubhouse members to provide mutual support in their journeys towards recovery;
• To assist members to regain self-confidence, self-belief, and self-esteem by identifying their current strengths, as well as developing new skills;
• To enable members to achieve their own personal goals and improve their employability.

In particular, Clubhouses provide opportunities to return to paid employment and voluntary employment through a successful employment programme.  Clubhouses also encourage their members to access basic, further and higher education.

Mosaic Clubhouse was established in Lambeth in 1994 as a partnership between the London Borough of Lambeth and the NHS Lambeth.. At the time of its establishment in Lambeth, the borough was experiencing six times the national average level of psychosis.

The work of Mosaic Clubhouse is based on a non-clinical co-production approach which is a key characteristic of the Clubhouse Model. This means that doctors and psychiatrists don’t visit the premises, and there is no group therapy. Instead, Mosaic Clubhouse provides its members with:

• a place to come
• meaningful work
• meaningful relationships
• a place to return.

In particular, Mosaic Clubhouse aims to bring structure to the lives of its members with an eight hour work day – paralleling typical business hours.  Staff and members work side-by-side to carry out the work of Clubhouse – from administration to cooking meals in the Clubhouse kitchen. The model is deliberately understaffed which means that the work members do is genuinely needed and valued.

In 2010 the business model of Mosaic Clubhouse was challenged when a contract with the London Borough of Lambeth came to an end and the local council asked the Clubhouse to expand its services to the 100 clients of a day-care centre for people with mental health issues. The new service contract was to be based on an outcomes framework. The main outcomes to be achieved included:

• clients leading more productive lives by sharing their talents with a vibrant, inclusive community, resulting in stronger social networks, better mental health and improved skills;
• increased take-up of education and employment opportunities;
• increased self-confidence to make informed choices about their future.

The expectation was that people could be fast tracked through the system in 12 weeks by identifying their own recovery goals and could be supported to meet them quickly. The Clubhouse was also asked to run an information service in partnership with Lambeth Mind for anyone in the borough with any queries and to form partnerships with other organisations who would use the building on a sessional basis to enable people to be seen rapidly for talking therapies, housing advice etc.

Furthermore, the existing building where Mosaic Clubhouse had been based for 16 years was no longer ‘fit-for-purpose’, so a new location was needed as well.