The thrust of Voices of Hope is to portray the interactions between clubhouse members, clubhouse staff, and the clubhouse structure. The 23 clubhouse clients all have serious and persistent mental illnesses, many have co-occurring substance abuse, and many have multiple DSM-IV axis I diagnoses, including schizophrenia, schizoaffective disorder, bipolar affective disorder, psychotic depression, obsessive-compulsive disorder, anorexia nervosa, and social anxiety disorder. Alcohol and most street drugs are represented throughout the sample. Most clients have lengthy psychiatric histories, including multiple psychiatric admissions. Some are parents, often single parents who do not have contact with their children. Some are the children of mentally ill mothers. A few report sexual abuse by a parent. Beyond their psychiatric disorders, the clients have concomitant disorders, including legal blindness, obesity, status postcerebrovascular incident, medical sequelae of a suicide attempt, and the concomitant medical problems of anorexia nervosa.