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Thursday 13th May.

Richmond VA. Millhouse Clubhouse. Frank gives me a guided tour. They've just moved premises and he hasn't worked out where everything is yet, but he knows it when he sees it. He tells me about his daughter, who is about to start college. He points out former and current members in the photographs on the reception wall. He seems to know people well.

At lunch time I tell Al (foreground) about my trip. He says I'm going to enjoy New York. It's a party town. Anything I want there, I can get it. Jeff (background) has been shredding paper in the communications unit. There is a lot of paper to shred because of the move. I ask him what he's shredding. He shrugs and laughs. 'It's in the shred box, so I'm shredding it. If you put it in the shred box you better be sure you want it shredding.' He tells me he was in a 'freak playing accident' when he was sixteen. He was wrestling with a guy, and the guy took him in a 'sleeper hold' and dropped him head-first on the black top. Al and Jeff talk to each other, share jokes, explain themselves to me. Like at the other Clubhouses, I get a strong sense of the bond between these members. They're proud to be involved. Pleased to look out for each other and any visitors that should come by. 

'I hate this "inappropriate" sh*t,' says Jack. I ask him what he's talking about. 'It's hard for someone like me to meet someone. When you say something to a lady they say it's inappropriate. But what they think is inappropriate, I think it's appropriate. Robert,' he says, gesturing to his friend, 'he's bad. He argues the point. He was like that from day one.' I recognise his sentiment. The question of personal relationships, psychosexual well being after injury, boundaries between staff, members, volunteers - these are things we've wrestled with, and are yet to fully resolve, at Headway East London.

Robert has colour-coded keys on a strap around his neck. It looks like a good system if you have memory problems I say. I ask what they are for. 'The orange one is my house. The blue one is a spare.' What about the red and the green? 'I forget.'

I ask Raymond about his tattoo. He says Chumley is a character in a Hannah Barbera cartoon, Tennessee Tuxedo. Apparently Chumley was a walrus. Raymond explains that people in New York would understand the reference. On Long Island you might get beaten up for being a snitch. I find it a little hard to understand Raymond at points. He uses long words and sometimes I can't find the subjects in his sentences. He says it's partly because he had a stroke. He writes me an advisory note about the Big Apple.

After the Clubhouse I meet Harvey Jacobs at his office. Harvey is an influential figure in Clubhouses. He was responsible for adapting the model for use with the brain injury population, and helped gain funding for the first brain injury Clubhouse in California in the 80s. He also ran the Moss Rehab Clubhouse in Philadelphia during the 90s and remains closely tied to the movement. He says he's 'a Clubhouse member without a Clubhouse'. He takes me for dinner at a place called Positive Vibe Cafe. It's an Affirmative Enterprise - a non-profit company set up to be commercially viable while at the same time addressing social problems; in this case acting as a training venue for people with disabilities and other disadvantages. Harvey explains that the owner's son has Muscular Dystrophy. That's why he set it up. Because his own son encountered so many problems in getting work. We are served by a mixture of staff, some who are evidently in training, others less obviously so. But all of them are polite, affable. We order calamari followed by soft-shell crab with corn salad. Harvey says the crab are molting at the moment, 'They catch them when they're right out of their shells. You eat them whole, you don't worry about the guts or anything.' I do as I'm told. It's good.

We've been talking for quite a while. I feel like I've earned Harvey's confidence. I ask him what he thinks about the Clubhouses. 'Some of them are a bit stuck,' he says. 'When we started out, we were able to get training from the ICCD,' (International Centre for Clubhouse Development), 'they let us join in their programmes, just like they did the staff at the mental health Clubhouses. The director of the Ontario Clubhouse was trained by them. So were a couple of others.' Harvey has mentioned the Ontario venue. When I spoke to him on the phone earlier in the week he immediately said I needed to got to Canada and visit them. They are the only brain injury Clubhouse accredited by the ICCD. 'They're still very supportive and open, but then a few years ago they decided they couldn't afford to extend the training to other groups any more - they had to prioritise their original mission to train groups comprised of with people with psychiatric problems.' Harvey seems to feel that the model has yet to be perfected in the brain injury setting, that some elements may have been lost in translation. He points out how some of the Clubhouses have staff offices separated off from the rest of the space. 'They form a haven for staff members. That shouldn't happen.'  He says conversely there has been an unnecessary focus on certain elements that are less important - replicating standard tasks rather than letting activities be defined by the goals of the members. 'A lot of Clubhouses have kitchen units because people get hungry and want to eat; communication units to answer phones et cetera. As a result people often think that these are required in a Clubhouse, but this is not necessarily the case. The only units needed are the ones that serve the needs or interests of the members. Conceptually, if people didn't want to eat at a Clubhouse, a kitchen unit wouldn't be needed. The problem is when people think that the specific units, rather than the goals of the members take priority.' The risk with the Clubhouse model is, it seems, that you could end up creating tasks for their own sake. I've heard Harvey described as a 'purist' regarding the Clubhouse model, and he says as much himself. 'But then again, they're doing a job nobody else is doing, motivating and engaging a whole lot of people who would otherwise be totally unsupported. It's a model of consensus,' he says. 'We're still finding our way.' The funding situation is more difficult in the US than in Canada, he explains. In Ontario, the Cornerstone Clubhouse has a yearly stipend, direct from the department of health. It means they have a lot more freedom, a lot less pressure. Harvey tells me about the first Clubhouse, Fountain House in New York City. The story is inspiring, beginning in the 1940s with a small group of psychiatric inpatients forming their own support meetings, eventually buying a property in Hell's Kitchen, and employing staff to help them, slowly expanding the possibilities. Today, he says, Fountain House has over four hundred people visiting each day. They have residential places, outreach, case management. 'It's like a beehive,' he says. 'When you walk in there, it seems like chaos. But it's a good chaos, people are doing things, solving problems.' Harvey is visibly excited as he talks about the place. It makes me want to visit too. The story of Fountain House is one of spontaneous, gradual emergence. It makes me wonder if this might influence the situation for those trying to replicate it. In transplanting a system that originally occurred organically in this way, one inevitably loses something. Doing so is inevitably an attempt to miss out all the interval phases, the stages of growth that went into the original, to jump to a 'finished article' that complies to model standards. The problem, surely, is that by doing this (and especially with a different client group) one risks failing to respond to the local context - the problems or advantages or simple differences - that might afford or require a different infrastructure. Perhaps the strength shown by emergent structures comes from the long, difficult history of their evolution during which a fine grain of trial and error has occurred? Perhaps a brain injury Clubhouse, in order to be successful, needs to be something different from a mental health Clubhouse? But only perhaps. I decide I need to visit Fountain House. Outside I laugh at Harvey's license plate. 'Nobody's perfect,' he says. At the bus station he sends me off with a firm handshake. He promises to advertise my blog on the Clubhouse listserve. I feel like I've made a friend.