"Pushing the Boat Out": A Meta-synthesis of How Members, Staff and Family Experience the Clubhouse Model.

To explore how member, staff, and family experience the contributions of the clubhouse model to outcomes for adults with severe mental illness. Given the significant role social and vocational arenas play in promoting wellbeing, irrespective of health status, explorations of the role such arenas can play in helping individuals accomplish their life and vocational goals may be useful in guiding policy and practice. A metaethnography was conducted using 11 qualitative studies published between 2000 and 2015. Four themes and an overarching metaphor were identified: (1) Stepping out of limiting realities; (2) anchoring; (3) creating ways of flourishing; and (4) prospects of a life outside the clubhouse. "Pushing out the boat" as a metaphor holds promise in facilitating discussions about the subjective outcomes of the clubhouse model and for expanding knowledge about clubhouses as multi-dimensional programs that provide social, educational, and vocational opportunities for adults recovering from mental health problems. Our findings show that clubhouses are valuable communities for meaningful doings for individuals to build self-confidence, relations, and perspective-all crucial for processes of recovery. Clubhouses provide people a place to establish an anchor in a supportive environment where they can try things out and regain their self-confidence. From there, they may choose to push their boat out. However, many members might need to choose not to-the seas may be too rough or their boat may not yet be strong enough for the journey. Further research is needed to examine members' experiences with integration into mainstream social networks and employment. It will also be important to examine how practitioners can intentionally interact with Clubhouse members and their families to promote the individuals' processes of social integration outside the clubhouse.