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The purpose of this blog is to spread the news of an incredible and under-utilized community mental health model known as the “Fairweather Lodge.”  (The “Lodge” model, sometimes known as the “Community Lodge,” is often referred to as the “Fairweather Lodge” in reference to the late George W. Bill Fairweather, who developed the model in the early 1960s.) 

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Group Autonomy Part 2: How?

A post by John K. Trepp

Getting Group Autonomy to work within a Lodge isn’t easy. Just throwing a small group of people with serious mental illnesses into a house and just telling them to “work it out” would be an interesting experiment, but I don’t know of anyone who has tried it.

In his pioneering work at the V.A. Hospital in Palo Alto, Dr. Fairweather spent a lot of time (many months) screening hospital patients to select the exact right blend of skills and personalities. But Fairweather still needed months to train the group he had selected, and there is no way to evaluate the relative contribution of the screening vs the training for the success of Fairweather’s first Lodge. And in the modern world, where hospital patients and other prospective Lodge Members have more options, months of screening doesn’t seem practical.

A few Lodges around the country have employed “Training Lodges,” where prospective Lodge Members receive a few months of specialized training to become successful Lodge Members (“in vitro,” in a sense). I recommend “Training Lodges” where the resources allow, but more commonly, small groups of people with serious mental illnesses are thrown into a house – and given on-site training to becoming successful Lodge Members.

This “in vivo” training is provided by people from outside the Lodge. Typically these people are paid for their time and effort, they may themselves be “consumers,” and/or they may have professional training in the field of mental health; but regardless, let’s call these outsiders “staff.” Often, an individual staff person, with primary responsibility for a particular Lodge, is given the title “Lodge Coordinator.”

“Lodge Coordinator” is a title of great esteem, and Lodge Coordinators are, in some sense, the backbone of the Lodge Movement -- and deserve to be celebrated. (The CCL annually recognizes the national “Lodge Coordinator of the Year” with an award named for David Sanders, who served as the Lodge Coordinator of Dr. Fairweather’s first Lodge.)

But the introduction of “staff” into the Lodge, necessary though it may be, poses two major obstacles to Group Autonomy.

The first obstacle in developing Lodge Autonomy is that staff are well-meaning people who want to help. This sounds like a good thing; and it is good in many ways. But sometimes, the old saying, “Too much of a good thing,” comes into play.

When I ran Tasks Unlimited, we sponsored two dozen Lodges, including a Training Lodge that was critical to our success. Our Training Lodge required more staffing than a regular Lodge, which required more funding, which required licensing, which in turn required over-staffing (i.e., 24-7), which required staff meetings.

I attended (see “critical to our success”) regular weekly staff meetings to coach staff on preparing the Trainees to become members of an autonomous Lodge. These meetings were held in the modest staff area separated from the rest of the house by a closed door. A couple of incidents stick with me:

  1. Food-prep for the midday meal was often in progress, and one day an argument became loud enough to be heard quite clearly during the staff meeting. Two Lodge-Trainees making Hamburger Helper disagreed on the necessity of draining the hamburger grease before adding the pasta-mix from the box. As the argument grew louder, a young, very-well-intentioned staff member bolted from her chair. On this occasion, I was able to stop her before she reached the door. (But I wasn’t always there)
  2. Another young, very-well-intentioned staff member, who had previously worked in a “Clubhouse-type” program, expressed dissatisfaction that the door was kept closed. In his previous employment, the door between the staff area and the Clubhouse was kept open, “a warm invitation” for Clubhouse clients to speak with staff. And he felt uncomfortable being “protected” by a closed door. I explained that the door was not there to protect him from the Trainees.

When the Lodge training is provided “in vivo,” as is most often the case, staffing-levels understandably start out high, with the understanding that staffing will be gradually reduced, as close as possible to zero, as the Lodge’s decision-making becomes stronger. This can work, but is easier said than done. It can be very difficult for well-intentioned staff to recognize the limiting affect, of their very presence, on the development of Lodge Autonomy, and to back away.

The second obstacle to the development of Lodge Autonomy is the reluctance of Lodge Members themselves. Fairweather Lodges are not designed for the most successful members of our society; they are designed for folks who have struggled to succeed. Folks coming from psychiatric hospitals, from prisons, from homeless shelters, etc. are more accustomed to failure. The failure wasn’t their fault; it was due to the impact of their mental illness – and to some degree, our mainstream mental health system’s failure to provide effective services.

Never the less, folks coming from hospitals, prisons, shelters, etc., come with minimal experience succeeding as autonomous individuals, and zero experience succeeding as part of an autonomous group. Naturally, part of our training at Tasks was to inform them that the Lodge was different; that they and their fellow Lodge Members were autonomous, i.e., “in charge.” But this message, so far out of context of their life experience, was hard to sell. The standard response was a sarcastic, “Yeah, right.”

It is hard to convince folks coming from failure that they are now going to succeed; and even harder hard to convince folks coming from dependence that they are going to be interdependent.

It can work. And when it does, it is a beautiful thing. But convincing the staff and the Lodge Members that the Lodge Members’ judgment is usually better than that that of staff, requires blood, sweat and tears.

I used to tell our Lodge Coordinators that they would be held responsible for anything that went seriously wrong in their Lodge, but they had absolutely now authority over Lodge decision-making. Not an easy position.

My specific advice to Lodge Coordinators was consistently this:

  1. If you see something, hear something, smell something, that doesn’t feel right (to you), bring it up to the Lodge Group. Failure to do that is a dereliction of your responsibilities.
  2.  Press the Lodge to address the problem, but without taking responsibility for the solution.
  3. If they come up with a flawed solution, point out the flaws.
    1. But if they like their plan, let them try it; I’ve seen examples where a plan that made no sense to me --worked just fine.
  4. If their doesn’t work, point out that it’s not working (in your opinion), and urge them to revise the plan.
  5. And repeat.

This doesn’t sound efficient, but it will work eventually. And remember -- your Lodge Coordinator Plan will never work – in the long run, because it’s not their plan. It’s their Lodge, it’s their problem, and it has to be their plan.

That’s how you help a Lodge reach autonomy.

 

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