A Belarusian network of centers – grounded in a self-help approach – has transformed the way mental illness is treated in the country.
About three out of a hundred people in Belarus are estimated to have a severe neuropsychiatric disorder. That means that in any movie theater, bar, or supermarket, several people with mental disorders may be present at any given time. Despite their actual proximity to such diseases, a mentally healthy person is familiar at best with only two of them – schizophrenia and psychosis. And they most likely use both terms as an insult.
It is hard to be surprised any longer by “psychophobia” in Belarus. There are no free anonymous centers for psychological assistance, no public advertising against the stigmatization of mental illnesses, virtually no available psychiatrists, and no full-fledged rehabilitation programs in the country. No one tells adults what to do if they or their relatives happen to be mentally ill.
Or almost no one.
Today the only psychiatric rehabilitation service in the country, Clubhouse – based on an international model of helping people with mental illness – is open to all those in need.
The story of the Clubhouse movement originated in New York City in the late 1940s, when several people who were being treated at Rockland Psychiatric Center formed a self-help group to deal with the expected challenges once they were discharged. After leaving the center, they would meet on the steps of the New York City Public Library before donors helped the group buy a building in 1948 and form a non-profit organization. The group began to grow and evolved into a community-based support program for people with psychiatric problems to improve their lives and renew the aspirations they had lost during their illness.
The history of the Belarusian Clubhouse started in December 2011, when the Belarusian Association of Social Workers opened the first Clubhouse in the country with the support of partners in Germany: Aktion-Man, a foundation for the disabled, and the Bavarian Union of Charitable Organizations. The association is a “public organization,” technically an NGO, but one required to coordinate its work with state agencies, receiving a small amount of state funding to pay its employees. Previous to the official launch, the Belarusian Clubhouse staff had spent 10 days at the Munich branch, learning the ropes.
A few years later similar clubs opened in the Belarusian cities of Lida and Brest. Since then more than 326 people have become active members of the Clubhouses in all three cities. These are people with different life stories but united by the desire to overcome the consequences of their disease and to live actively and happily.
Self-Help as an Organizing Principle
The Clubhouse rehabilitation model implies that the employees are not serving people. Rather, they are managers who organize the process and oversee its implementation.
“We call people who come to us ‘members of the Clubhouse’ instead of ‘clients’ to distinguish our work from traditional services where they use a paternalistic approach,” says Alena Stanislavchik, the executive director of the Clubhouse. “A person comes there as a client and is given some ready-made solutions. But here the member is a full participant in the entire process. Therefore, besides rights, members have obligations to their community. They are also responsible for their rehabilitation program, which is drawn up together with a psychologist, a social worker, and a rehabilitation therapist.”
Unlike the government services that have survived in many places in the former Soviet Union, including Belarus, at the Clubhouse responsibility for what happens is passed on to the individual.
The common philosophy of all Clubhouses is the understanding that a person is capable of more than they are doing now – an approach, say Clubhouse staff and members, which aids immensely in the rehabilitation process. If a person just gets help and doesn’t actively participate, they won’t see their own role in the progress they are making toward a better life.
An individual approach also distinguishes Clubhouse from what is usually on offer from the state in Belarus: legal and psychological counseling, as well as minimal financial assistance or benefits, such as a discounted transportation pass. Someone who thinks they need help can request such services, but often they don’t know what they even need. And people who apply cannot count on all types of assistance – it depends on the disease. Those who require consultations with specialists in a psychiatric hospital must wait a very long time for an appointment.
In the Clubhouse, they work on each situation separately, attempting to understand each person’s needs and ranking them in order of priority. They provide crisis help, psychological support, and legal aid; assist in finding employment; work with relatives; help to restore the skills lost because of the illness; and organize various informal educational courses.
Each new member starts by filling in a long questionnaire, a process during which the person builds for themselves an understanding of how to move forward. Their answers help assess the person’s health status, understanding of their illness, financial situation, the attitude of those around them (whether they provide support or consider the individual a burden), and how the member envisions their future.
The organization works on the concept of directed recovery, with an emphasis on the healthy aspects of the person; the staff try to identify members’ strengths and engage them in various activities. Many members of the Clubhouse engage in mentoring and all are encouraged to talk about their experiences with mental illness.
Members themselves can also become employees. Maxim Brashko came to the Minsk Clubhouse in 2014, after undergoing treatment at the Novinki Psychiatric Clinic. Within a year he became a volunteer himself and, after that, a staff member.
“I had an invaluable experience, as I had been ‘on the other side of the barricades’ myself. I began actively counseling other members of the Clubhouse, although I had no special training in psychotherapy. We provide the best services we can for people with mental illness,” Brashko says.
A main priority, he says, is to engage Clubhouse members in the life of their communities through a structured day with meaningful activities.
“People with mental illness are often shut off and isolated. Medications seem to ‘turn them off.’ My job is to turn them on. They have to acquire the qualities of a normal person. They need to incorporate plans into their day, set rational goals. They have to have some kind of schedule for the day, the week, the month – that they don’t just plan, they do. They need accountability – first of all for themselves, but preferably also for their friends and relatives. If you let everything slide, you won’t have a meaningful day. It’s important to have discipline, to pull yourself together and do something, not sit in your room on the bed,” Brashko says.
‘All That is Needed Are the Tools’
This comprehensive treatment strategy has made Clubhouse the only organization of its kind in Belarus. Earlier, the Belarusian branch of the Red Cross had offered a similar service called the Open House. But they recently closed due to financial difficulties. Other services provide selective assistance. (This year the Clubhouse compiled a database of 166 organizations and agencies across Belarus and the services they provide to people with mental illness and their families).
In addition to stigmatization in society, employment is also a common problem for many people with mental illness. Most Clubhouse members, regardless of diagnosis, have difficulty finding a job. Legal restrictions on employment for people with more severe disorders mean they are more likely to work in low-paying jobs such as, for example, janitors. At the same time, the person may have an advanced degree and their smarts and experience would allow them to do other jobs. And difficulty finding a job can lead to financial problems.
“If an employer knows about the diagnosis, they are not willing to hire such a person. It’s a potential risk for them,” Stanislavchik says. “It’s a stereotype, but people prefer to avoid people with mental illnesses just in case – although people diagnosed with schizophrenia are capable of working as professors in universities. There are such examples in the world. The main thing is to understand and believe that people have a chance and potential for recovery. All that is needed are the tools.”
The Clubhouse in Lida, a city west of Minsk, cooperates with the local psychiatric clinic and begins working with people while they are still undergoing treatment, to forestall them sinking into sad thoughts about their illness. First, say Clubhouse staff, you have to convince the person that recovery is possible. Often a diagnosis can sound like a verdict. They don’t think they can do anything else.
“It is very important from the very first stage, as soon as a person enters treatment, to convey that even if the disease remains for life, this life can still be fulfilling. You have to let them believe in themselves and help them plan for the future. An important point in rehabilitation is not to be a passive recipient of services, but to be able to get involved in the process,” Stanislavchik says.
Prospective members learn about the Clubhouse from doctors at psychiatric clinics. Many also arrive by “word of mouth” or after hearing about the organization on the internet. Over the years, the organization has managed to earn itself a positive reputation.
Clubhouses are open to all aged over 18. Becoming a member is quite easy – drop in and express a desire to join. Membership does not bind people to any strict requirements. Members can come at any time and not only for special events, but also just to socialize and have tea.
Someone at the Clubhouse will get in touch with a member they haven’t heard from for a long time, says Brashko of the Minsk branch. “We never put pressure on the person – not everyone reveals their diagnosis right away. People may come several times to look around.”
However, there is a catch to joining outside of Minsk: the Lida and Brest Clubhouses work through the state system, so only people with an official certificate of disability are accepted as members. The authorities need confirmation that the person who receives this state-supported service is entitled to it. Independent of state funding, the Minsk Clubhouse does not require certificates, so anyone can come.
The Power of Community
Practice shows that if you treat a person with trust, sooner or later they also begin to trust you and reveal more about themselves, Brashko says. It is important for a person to feel that this is a safe environment.
“I was diagnosed with paranoid schizophrenia 10 years ago,” Sergei Fetkovich says. “A year ago I came to the Clubhouse and it was very difficult for me to adapt to new people, to open up to them. However, then I developed an emotional connection [with other members] and realized that I was not alone with my problem. I started going to the Clubhouse more often. I came with some treats; it was nice to share [my experiences] with people. I even realized that my case was far from being the worst. They helped me to get involved in social life. I felt I was needed, and I even thought of ways I could help the Clubhouse to develop.”
Currently there are only two employees at each Clubhouse. The organization also employs a full-time lawyer. Psychotherapists, psychiatrists, and other specialists come to each Clubhouse under contract as needed.
The staff in Lida and Brest receive a state salary. That has to be supplemented at the expense of the organization, because the state pays them only minimum wage. Grants fully cover the wages of the staff in Minsk.
Staff members regularly travel to other Clubhouses for internships and online training. There are close ties to the Clubhouses in Munich and Warsaw, and the Russian branches in Moscow and Arkhangelsk.
“We can turn to the international network for help, and they always support us,” Stanislavchik says.
But what is sorely lacking is the ability for staff to consult more regularly with experienced psychologists to talk about their own challenges and engage in personal therapy. The problem of burnout is often acute and they have to cope with it on their own for the time being.
Financial pressures are also omnipresent. The work of the Minsk Clubhouse is supported only by grants, donations, and local businesses. Since the Belarusian government fears foreign funding of independent initiatives, the authorities have made it especially difficult to register grants from abroad, leading to concerns about the future.
“Foreign colleagues are surprised that our Clubhouses work with very limited resources. Many countries have stable funding. We, on the other hand, are always looking for money, so there is no stability of any kind. I cannot say now with certainty that in five years the Clubhouse will still be operating and taking in people,” Stanislavchik says.
Limitations on space cramp the scale of activities in all the Clubhouses.
“The state provides us with premises on favorable terms,” says Yulia, a psychologist and social worker at the Clubhouse in Brest who asked that only her first name be used. “We are happy about that, too, but we have to make do with very little. We have about 70 regular members, 10-15 people come every day, and we don’t have the space to organize big lectures or workshops.”
While the general approach remains the same through the global network of Clubhouses, groups in different countries work under varying conditions, as Stanislavchik found out when she visited colleagues in other countries. Much depends on the history of civic life in the country, as well as the legal framework. In Finland, for example, Clubhouses work within the state system; in Italy they are more family-type clubs, often started by communities of relatives.
“When I was in Germany, I saw that local people are used to the work of various self-help groups – there is some civic activity, volunteering, and initiatives. In Belarus, we have to explain to people who come to the Clubhouse what this form of interaction is. We have to explain what it is for – why we don’t just help them but teach them how to live independently,” she says.
The same is often true for relatives of people with mental illness, who usually don’t understand the “help yourself” format. They are used to going somewhere, getting money or a service and leaving. In addition to the basic work with members, Clubhouse staff try to convince relatives that it is important for them, too, to join one of the support groups specifically for families – something unknown in Belarus until Clubhouse came around.
Employment programs also present specific challenges. In Germany, for example, potential employers allocate certain working places for the disabled, some of which the local Clubhouse reserves for its members; people are then trained and prepared for their future full-time work. In Belarus, where the law does not provide for jobs specifically for disabled people, they must go through the usual competitive process on an equal basis with others.
A Return to Normal Life
Clubhouse staff agree that a major measure of their impact is the number of times members need to be hospitalized.
“We do [annual ]assessments to see if there is a personal change in a person’s life,” says Yulia. “We find out how much their quality of life has improved. The main success for us is when active members do not end up in a psychiatric clinic, although they used to go there three or four times a year.”
Spending less time in hospital is an indication of how people manage to restart their lives, she says. “Even though we work with people with complex diagnoses such as schizophrenia, bipolar disorder, and personality disorder, they are still getting jobs even though they thought it was impossible before. People become more social, more secure in their daily lives. We see constant results: people start romantic relationships, find work, and go out into the world.”
“My diagnosis was paranoid schizophrenia,” says Anna Manenok, an active member of the Clubhouse in Minsk. “The hospital treatment caused a lot of stress and deep psychological trauma. I developed depression because of that.”
She adds, “The Clubhouse played an important role in my rehabilitation and reintegration into society, as there were various meetings, workshops, gatherings, and celebrations. There was honest, friendly human interaction, which I so needed when I had lost many of my social skills. I felt safe there, it felt good, fun and interesting. I have now been off my medication for over a year and am not in the hospital anymore. My life has changed for the better. Now I sometimes hold musical evenings at the Clubhouse. We sing songs and play guitar. Such meetings bring me much joy.”
The numbers for the Clubhouse in Brest, a city of 340,000 in southwest Belarus on the Polish border, show that the demand for the group’s services remains high. The staff log some 5,000 interactions per year, including phone calls, with potential members, their families, or the general public. In 2021, 739 people received assistance through self-help and support groups. Twenty-three awareness-raising and educational events were held in order to improve mental health literacy and acquire skills on how to cope with mental illness. More than 500 people participated. A total of 11 people with mental health issues were able to find employment through the Clubhouse program, and 75% of active members had fewer hospitalizations.
Clubhouse members here participate in various integration programs and projects. Last summer, more than 100 photographs by club members went on show for an exhibition entitled “Invisible.” Other members take English classes, do handicrafts, learn to use computers, make music, cook, and clean together.
“It’s important to note that all of the activities that take place at the Clubhouse are meaningful,” says Yulia. “We offer activities based on the interests of each individual member, taking into account their talents and desires. The main thing is that the activities should bring results and the person should be able to communicate with other people in the process.”
For Clubhouse staff and members everything comes back to self-help. Existential psychologist Vitalina Mazuruk says it’s crucial that people learn to rely on themselves even as they benefit from the assistance of others.
“Once a person has some skills, even if there is no one around, it gives stability and reliability,” she says. “And this has a very strong impact on mental health. Even small steps are important signs [of improvement]. They give joy and meaning. And a joyful person becomes much healthier.”
Mazuruk says this approach can also limit the tendency for members to depend too much on Clubhouse personnel or outside experts, a relationship that can sometimes lead to a desire for greater intimacy.
“It’s important [for members] to direct the love and trust in such people toward themselves,” she says. “People need to be supported, but not to have everything done for them. Teach them to do more for themselves so they can be more stable, have more confidence in themselves. Then the person will have the strength to enjoy life.”
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Tanya Hendzel is a freelance journalist specializing in environmental and social topics. Originally from Belarus, she is currently living in Belgium.
Photos courtesy of Clubhouse.
This article was produced with the support of the International Visegrad Fund.
