DURHAM, N.C. — Richard Hudson has been a member of Threshold Clubhouse for three years. He says that it’s become an indispensable part of keeping his schizophrenia at bay. Hudson was diagnosed in 1977 while he was serving in the Navy. After being discharged with no medication or doctor’s referrals, he says he struggled to find a daily routine that would help him cope with the illness. However, when he discovered the clubhouse model, first at Carrboro’s Club Nova and later at Threshold, he immediately noticed an increase in his self-esteem and level of motivation.

Today he serves on Thresholds board of directors. His biggest concern is the clubhouse’s potential loss of Medicaid funding. Clubhouses already command some of the lowest reimbursement rates of any mental health service. He recently participated in an overseas trip to Finland, where he met with other clubhouse members and administrators to discuss methods of attracting more temporary work arrangements for members, which could make Threshold slightly less vulnerable to shifts in Medicaid funding. To do this, Hudson says Threshold needs to take aim at the persistent stigmatization of mental patients, who are often written off by potential employers as unreliable or, worse yet, dangerous and violent.

“We need to change and reach out to the community. But, it’s got to be a mutual thing. We can’t just hold our hand out and say won’t you please help us. We’ve got to turn around and say, how can we help you?”

HOLDEN BEACH, N.C. — Ouida Hewitt has been a community activist in the Brunswick Islands area her entire life. For years she served as the executive director of the Brunswick Family Assistance Agency, which remains a vital lifeline for individuals in need of food and assistance. While Brunswick boasts of some of the highest growth rates among any county in the United States, services for impoverished families or for those suffering from mental illness are severely limited. Faith-based organizations, in which Hewitt plays a big part, have stepped in to fill in the gaps but still many must make their way to Wilmington in order to find essential services like counseling and community support.

HILLSBOROUGH, N.C. — Jim Albright is a vocational evaluator at Orange Enterprises. Orange Enterprises is a non-profit community rehabilitation organization, which serves adults facing mental and developmental disabilities.

CARRBORO, N.C. — Club Nova is a form of pyscho-social rehabilitation, in which members and staff create a work-like environment and a work-ordered day. Members are called upon to assist in running the clubhouse, as it is called, performing essential tasks ranging from Medicare billing to preparing lunch.

Heather Nash has been a member at Club Nova for several years. She says she comes mainly for the sense of community. As mental health reform flounders, she has become increasingly involved as an advocate for those trapped in a complex and unsatisfying bureaucracy.