BIPOLAR DISORDER

The Clubhouse Model for Healing the Mentally Ill

By Kristie Reilly and Temma Ehrenfeld @temmaehrenfeld
 | 
March 20, 2023
The Clubhouse Model for Healing the Mentally Ill

Community and regular duties promote a sense of purpose and self-esteem. For the mentally ill, it may help them heal and begin paid work again.

Clubhouses — a longstanding community model to heal mental health — are getting a boost in funding and attention. The key idea is a day built around work.

It took a crisis to win more funding. In New York City, newly elected Mayor Eric Adams faced a post-COVID-19 pandemic increase in mentally ill people living on the streets or sleeping on subway trains. Subway ridership was already down — and then a mentally ill homeless person pushed a woman in front of a train, killing her.

 

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The city needed to act to prevent panic and keep riders.  When Adams announced a new comprehensive plan for mental health, it included funding for clubhouses.

“Mayor Adams’ plan encapsulates some of the strongest learnings from our mental health crisis: that we all need people, place, and purpose to succeed and thrive,” said Tom Insel, MD, former director of the National Institute of Mental Health and member of the Board of Directors of Fountain House, the nation’s first clubhouse.  

New York City's problems make headlines, but the problem is national. In the United States, people with mental illness are 10 times more likely to end up in a prison than a hospital.

The story might run like this: A young person with psychosis stops taking his medication and ends up homeless. When he acts erratically, he is taken to an emergency room — or to jail. Then he picks up a drug habit. On a bad day, he becomes violent.

The reality is that more than 70 percent of the people in the nation’s criminal justice system have at least one diagnosed mental illness or substance use disorder, if not both.

The clubhouse model

Regular work and feeling bound to a community that expects the best of you is good for everyone.

Fountain House, founded in 1948, is one of 15 clubhouses in the city, more than 200 in the United States, and 320 around the world that provide friendship and volunteer and paid work, along with access to healthcare, support for education, and job training.

The goal of this support system is to reintegrate members into the larger community.   

Clubhouses have spread widely since Fountain House received a grant from the National Institutes of Mental Health in the 1970s to expand training and outreach.

In New York, almost 40 percent of the members of Fountain House have experienced homelessness or unstable housing when they arrive.

When they join, they receive support for finding and remaining in safe housing. Early on, they volunteer. A member might help maintain the organization’s gardens or work at a farm in Montague, N.J., that supplies produce for the culinary unit, which prepares breakfast and lunch every day.

A history of patchy, interrupted primary and psychiatric care is the norm for members, who now are supported to receive stable services. Each member can meet weekly with a trained care manager.

For seniors, the organization maintains a residence within walking distance from the main clubhouse. Staff and members also visit members who live in adult homes, nursing homes, or independent apartments.

The program encourages ambition. There is a workspace and a gallery for visual artists, as well as support for college and other education.

 

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A work-ordered day

Kenneth Dudek, who led Fountain House from 1992 until his retirement in 2019 (he’s now a senior advisor), realized early that many people felt unable to deal with social situations.

Instead, the clubhouse offers a “work-ordered day,” Dudek says. “People contribute their voluntary efforts … and that's how they begin to feel better about themselves.”

The nonstigmatizing model, which emphasizes staff working in partnership with members, serves as a bridge to meaningful and productive work as well as better relationships.

“One of the things about people who have serious mental illnesses, particularly bipolar and schizophrenia, is that they tend to lose a lot of their relationships,” he says. “They don't tend to have many. So, this is a way for people to begin to rebuild those relationships.”

Members may come for the wide range of services.

“But the core of the thing is the community itself,” Dudek says. “It's very hard to help someone who has a serious mental illness until you have some kind of a relationship with them. There's a lot of mistrust, a lot of confusion in their thinking. So, you have to establish that relationship first.” 

After finding stability in volunteer jobs within the clubhouse, members move to transitional employment. Six- to nine-month positions are conducted as partnerships between local employers and the clubhouse.

Employers are guaranteed attendance; another member or clubhouse staff will fill in if the employee is absent. Some members have paid positions in Fountain House projects.

Eventually, members may find permanent jobs with the clubhouse’s support — 65 percent of Fountain House members do, the organization says, compared to just 15 percent of the seriously mentally ill nationwide.

Productive work is a key element to recovery and successful rehabilitation, Dudek says. “We believe it's actually the work that really makes the thing happen. People need to feel worthwhile. They need to feel needed in some fashion. And if you have a serious mental illness, you can quickly go to a place where you don't feel like you have anything to offer the world at all. And that in turn just tears apart your self-esteem.”

Research has backed this approach.

One study found that joining Fountain House cut the cost of care under Medicaid by 21 percent. Another study from the Weill Medical College at Cornell found Fountain House members were less likely to go to the emergency room or need long-term care than people in other residential programs.

New York City’s move may inspire similar action around the country.

“This investment in clubhouses can turn the tide from people being forgotten in our jails, shelters, hospitals, and streets to being welcomed and embraced in our communities,” says Arvind Sooknanan, a member of Fountain House Bronx and a board director.

 

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Updated:  

March 20, 2023

Reviewed By:  

Janet O’Dell, RN