Community and meaningful work provide effective recovery from serious mental illness.
A unique method for helping the seriously mental ill is attracting increasing attention.
Called the “clubhouse” model, it has its roots in an organization called Fountain House in New York City. Founded in 1948, Fountain House is at the center of a movement to create a support system for the seriously mentally ill that helps reintegrate them into productive employment and community life.
In an era of increasing crisis in healthcare for the mentally ill, the clubhouse model may finally be getting its due. In 2014, Fountain House received the Hilton Humanitarian Prize, awarded to global organizations that alleviate suffering.
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. . There are now 171 clubhouses in the United States, and an affiliated organization, Clubhouse International, has accredited about as many clubhouses around the world.
In New York, Fountain House’s 1,200 members participate in work assignments that help the organization function. Work “units” include employment, communications, wellness, reception, and horticulture — even a farm in Montague, N.J., that supplies produce for the culinary unit, which prepares breakfast and lunch every day.
The work is entirely voluntary, and it’s what differentiates the clubhouse treatment from other models, says Kenneth Dudek, president of Fountain House. “One of the things we know is that you don't want to really create a social setting for people. The reality is that people aren't very good at that. A lot of people kind of walk away when they're faced with those situations.”
Instead, the clubhouse has what it calls 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.”
In return, members receive opportunities for wage-earning employment or get help with housing or going to school. “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.”
As members become integrated, they take on jobs within the clubhouse. Eventually, they’ll move to transitional employment, a key part of the model. 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. 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.
“At first, a clubhouse for people with mental illness sounded like something out of a nightmare,” one Fountain House member told Dudek. “It was quite the opposite. I found a professional work environment, where people go to happily volunteer their skills to learn, to heal, and to prosper.”
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.”
In an era of deinstitutionalization — the closing of residential mental health facilities across the country over the past several decades — those suffering from mental illness have specialized needs the clubhouse model addresses. Dudek hopes research will increasingly focus on the model in the coming years, but much has already shown to be effective.
One study found the clubhouse model to be as effective as another established model for transitioning the seriously mentally ill back to productive employment. Those in clubhouses were also likely to earn higher wages and stay in their jobs longer. 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.
Further integrating clubhouses into nearby communities is the theme of a conference this fall in Colorado organized by Clubhouse International. Dudek describes recently visiting Genesis House, an accredited clubhouse in Worcester, Mass., where members work at the city’s local art museum. “I thought to myself, ‘that's the ideal. That's what we're trying to do.’ We want these places to be part of their local community, and yet provide support for people when they need it.”
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Janet O’Dell, RN