Fountain House – Where it All Began

The Clubhouse Model

Fountain House is located in New York City, and had its humble beginning in the year 1948, although the roots of the thought behind it began even earlier. In 1943 at Rockland State Hospital in New York, a group of self-help patients and counselors worked to get people discharged from the hospital. They grouped together in society for mutual support. With the help of a group of volunteers, they were able to raise enough money to buy a small, brownstone building located at 412 West 47^th Street in Manhattan.

The building had a fountain, and a small garden for their use, and became their, “Clubhouse.” The year 1948 saw that clubhouse become a not-for-profit agency. They named it, “Fountain House,” most likely in honor of the fountain the property came with, and as a symbol of both rejuvenation and hope. The program these former patients, volunteers, and counselors created was the first of its kind in the United States of America.

Fountain House began creating interventions which involved key areas, to include transitions to residential living and employment; such programs were most likely unheard of during the time period Fountain House was developing. In America today, these same key areas of focus are standards for people with serious mental illnesses in order to situate them into communities across the nation. With more than fifty years of history, Fountain House continues to lead the Clubhouse Model, fighting mental health stigma related to attitudinal barriers concerning people with mental illness living in the community. They promote activities that are community-based for persons with mental health disorders.

Fountain House has always been a leader in America, and still is today. They have been instrumental in helping to create a training program that has promoted the establishment of the Clubhouse Model. Today there are more than three hundred clubhouse model programs in America and around the world, including the very same Freedom House I once participated in located in Lynnwood, Washington. Every single one of those Clubhouses can trace their origin back to Fountain House, and the work of those original people who began it.

The philosophy of Fountain House has been adopted, in some form, by every Clubhouse. Fountain House declares their philosophy to be, in part:

The Fountain House philosophy

“Fountain House's mission is to provide opportunities for men and women with mental illness to live, work, and learn together while contributing their talents through a community of mutual support. The aim of the clubhouse is to help people with mental illness to stay out of hospitals while achieving their social, financial, and vocational goals.^”

“The Fountain House vision encompasses the overarching goals of bettering the lives of people with major mental illness everywhere and ultimately of eliminating the stigma of mental illness so that people with mental illness can achieve their potential and be respected as coworkers, neighbors, and friends.”

The Clubhouse Model, as a whole, is intentionally designed as a therapeutic community made up of people who have mental illnesses and accompanying general staff who work there. The idea is that when needed and financially, “reach-able,” services are provided to people with mental illness the costs associated with those services decrease, and the overall quality of life for the people with mental illness rises. The approach that Fountain House has taken in this regard, and passed along to hundreds of other Clubhouse’s is very innovative.

Fountain House separates a person’s mental health diagnosis from Clubhouse membership; there are no doctor’s present, nor are there any medications distributed. The Clubhouse provides occupational, social, and interpersonal resources in order to meet the needs of its members. Fountain House builds links between resources outside of the Clubhouse and medical and psychiatric care providers. Clubhouse members are members; not clients, consumers or patients. They are friends; they are part of the community.

As a member of Fountain House a person has rights, to include what type of work activities to pursue – or whether to work at all. They can choose what staff members they want to work with. Members can always access their personal records that are kept at the Clubhouse. Members also have a lifetime guarantee that they can come back into the Clubhouse to get the services they need.

With those rights comes responsibility. Clubhouse members must perform some task that is essential to the operation of that same Clubhouse. Some form of work, both as a volunteer and through paid employment in a position outside of the Clubhouse, is one of the major focuses of every single Clubhouse program.

There are no fees related to participation in Fountain House, and there is no upper age limitation. Membership is open to anyone with a history of mental illness. You can be referred to Fountain House through a hospital psychiatric ward, a clinic, a homeless shelter, by a friend or family member; you can even refer yourself. You are welcome to participate at Fountain House, or any other Clubhouse. Volunteers are most welcome as well.

Clubhouse model programs around the world help more than twenty-five thousand people each and every single year. Every single member of these Clubhouses’s has a mental illness; some have a secondary diagnosis of a developmental disability, or a history of some type of substance abuse. Almost every Clubhouse member in America has an income that falls below seven thousand dollars a year, lives in poverty, and receives public support in some form. With time, further advocacy, and relief from immense social stigma; hopefully individual incomes will rise through employment.

The services Fountain House offers its members include opportunities for transition to independent employment in the community, help with entitlements, help with finding appropriate housing, money management assistance, and social activities and events. One of the main things that makes a Clubhouse a Clubhouse is something known as the, “Work-ordered day,” and is one of the base services that Fountain House offers.

What is life without a sense of doing something meaningful? Fountain House is there to meet this highly important need – three hundred and sixty-five days a year. However, Monday through Friday, Clubhouse members work side-by-side with staff members doing things that are essential to the operation of the Clubhouse. The tasks that members perform alongside staff members include everything from research and administration, hiring, intake and orientation, training and evaluation of staff members, advocacy, public relations, and evaluation of the very Clubhouse itself. Clubhouse members volunteer to perform these tasks in order to prepare them to achieve educational, vocational and housing goals. The effectiveness of their Clubhouse depends on their membership and participation. It also depends on their very evaluation of the Clubhouse, and that same volunteer time they spend there.

Fountain House is truly amazing; they *began* the concept of transitional employment. They began a program of part-time supported employment placement for their members in the year 1955. Their members work for an employer in the community at the current wage and are paid by the employer. Clubhouse members usually work around fifteen or twenty hours a week for six to nine months, and employment opportunities are not gauged by previous success or failure at previous work efforts. Staff members at the Clubhouse train members for the job they will be doing, and fill-in for members if they absolutely cannot show up on the job.

In the year 1998, this same transitional employment program put more than four hundred Fountain House members to work in forty-one New York companies that included places such as financial institutions, publishers, and legal firms. These Clubhouse members with mental illnesses, with few exceptions, had been told that they would never work again because of their disabilities. Doctors; social stigma, and any lingering self-doubts were wrong. Faith in themselves and support won through.

Permanent employment is, of course, a Clubhouse goal. There is an Independent Employment Program at Fountain House. Members who are ready to participate in this program will receive assistance finding permanent employment in the community, and help keeping that same job.

Fountain House recognized the need for suitable housing as early as the 1950’s. They began the development of housing programs that reflect its philosophy of member autonomy and empowerment. Now Fountain House offers a number of services related to housing; from independent apartments with leases in member’s names, to group homes with staff on-site twenty-four hours a day. Clubhouse members can choose their roommates, and the location of the housing they live in.

The flexibility and variety in housing that Fountain House offers in housing has shortened or even prevented hospital stays. Even if a member does end up spending some time in the hospital, fellow Clubhouse members and staff members help to ensure that the hospitalized member keeps their housing. Since 1998 more than four hundred and eighty Fountain House members have participated in their housing programs.

Another service offered by Fountain House is case management, and it plays an important part in helping members to receive services not offered directly by the Clubhouse. Basic educational opportunities related to computer skills and literacy are offered at Fountain House, along with the opportunity to take advantage of educational resources through the community. Members receive help returning to school in order to earn degrees or start vocational programs. Members also get help with resources in the community regarding psychiatric, dental, medical, and substance abuse services. Having fun is a part of a good life, and Fountain House is aware of this too. For members who have become employed, the Clubhouse helps them to keep in touch with fellow members and maintain supportive relationships they have developed there through a social recreation program. Fountain House, always on the lookout, has outreach programs for people who find themselves homeless. They have programs for young adults who have mental illnesses, and programs for persons with mental illnesses who are deaf as well.

Keeping a Clubhouse such as Fountain House running costs money. In the late 1970’s, The National Clubhouse Expansion Program started at Fountain House, and was funded for eight years by the National Institute of Mental Health. Eventually, the program, which was intended to replicate the Clubhouse model, drew substantial funding from the Robert Wood Johnson Foundation and Pew Charitable Trusts. By the year 1995, the National Clubhouse Expansion Program was a separately incorporated International Development (ICCD) program. On a world-wide scale, ICCD has assisted and coordinated in developing Fountain House style programs that work with persons with mental illnesses, family members, volunteers, mental health professionals, and local governments in order to create and strengthen Clubhouses wherever they are needed or wanted.

Training provided by the ICCD concerning the clubhouse model includes consultation, and assistance in development of the Clubhouse model. Without continued dedication, Fountain House is one of the places that offer their three-week training course. The training course offered by ICCD presents in-depth training to more than two-thousand mental health professionals in three hundred and ninety-six mental health facilities. Due to the training being provided, there are more than three hundred programs, which are community-based and modeled after Fountain House, established in America and forty other nations around the world. All of this, from a group of people who needed services, so long ago; alongside healthcare workers who cared, and bothered to take a little extra time.

One other program the ICCD offers is one of certification that began in 1995. The program certifies that Clubhouse’s are operating in compliance with the standards designed to make sure that it offers opportunities and respect to the members it is open for. Those standards define the Clubhouse model as one of rehabilitation and include provisions regarding relationships between members and the staff, space requirements, staff responsibilities, the very nature of membership, administrative duties, and which services must be offered. Assessments are done by the ICCD, members of the Clubhouse, and staff members every other year. There are more than one hundred and fifty ICCD certified Clubhouses around the world.

Volunteers are an essential part of what happens at any single one of the Clubhouses around the world, as are the members. Those members, who work alongside staff members, do all of the work needed to keep a Clubhouse running. The Clubhouse members are involved in every area of decision making; they are included all the way up to the Board of Directors. Around ten percent of the paid staff are persons with a mental illness.

Fountain House is reaching into the surrounding community, seeking out community members through business leaders willing to work with staff and Clubhouse members in order to develop and expand Clubhouse members’ opportunities for independent, paid employment. Members in the community are participating in the council at Fountain House. These community members promote education, advocacy, and training.

Fountain House and the ICCD have been a grass-roots phenomenon for several decades. Recently, they have started services which involve research studies. The Clubhouse model is many times a part of service evaluations, done by researchers who are not Clubhouse members or staff. The purpose of this research is for comparison.

Research personnel at Fountain house are currently performing an eight site demonstration program related to employment, funded by the Substance Abuse and Mental Health Services Administration, to find out the effectiveness of various methods of Vocational Rehabilitation. One of the sites being researched located in Worcester, Massachusetts, finds researchers comparing the effectiveness of forms of interventions which are modeled on the assertive treatment program and the Fountain House Clubhouse model. Program evaluations are being done at Fountain House by research staff members that perform quality assurance studies, as well as audits for federal, state and local, including private funding sources.

Over the last decade, the Clubhouse model of rehabilitation has grown rapidly. With a fairly low cost of intervention, the Clubhouse model has gained a considerable amount of recognition. Family and advocacy groups are providing strong support for this model. One example of the recognition being received by the Clubhouse model occurred in 1996, when the National Alliance for the Mentally Ill named Fountain House the, “Mental Health Rehabilitation Program of the Year.” Clubhouses have even been labeled as preferred sites for mental health services in many states. Some of those states include Pennsylvania, Hawaii, Michigan, Massachusetts, Utah and North Carolina.

Medicaid reimbursement for Clubhouse services is allowed by most states in America, or includes those same services as a part of a capitated or pre-paid Medicaid plan. The costs associated with Clubhouse services are being kept low by relying on undergraduate level rehabilitation workers and counselors. Around half of the staff on duty at Clubhouses are at a Bachelor’s degree level of practice, and have obtained training in the Clubhouse through the ICCD.

Fountain House is exceptional; they had an operating budget for the year ending on June 30^th, 1998 of around thirteen million dollars. Fountain House has clearly been around the longest, they started it all. The average, common Clubhouse, doesn’t have anywhere near that budget. The costs, during that same year of 1998, for services for one person per year at a Clubhouse, were around six thousand dollars a year. In 1998, the budget for the residential programs was around twenty-one thousand dollars per person, per year. Funding from federal, state and city government agencies accounted for about eighty percent of the funding. The remainder of the money came from gifts from corporations, foundation and organizational grants, individuals, and fundraising events. For your everyday Clubhouse; help is very much needed.

For the likes of Fountain House, the search for innovative and state of the art services to provide to persons with mental illness is an ongoing effort. Among the major projects implemented in 1999 was the expansion of the Clubhouse’s clinical links to providers of psychiatric, preventative medical care, and substance abuse resources to members living in independent housing via referrals from a mobile team of staff and members from Fountain House itself. Proactive, routine contact and outreach efforts between this mobile team and every supported housing resident not otherwise involved in Clubhouse programs are a feature of this program. Talk about dedication.

Some of the residents are most at risk of medical or psychiatric problems; they will be visited by team members. Included with that contact is an assessment of the person’s desires and needs regarding additional services, emphasizing medical, psychiatric or substance abuse treatment. Those residents that have not been engaged in medical treatment which is ongoing will be seen by a primary care physician at a Fountain House facility.

Fountain House apparently has plans to integrate services in the community that will be drawn up by a clinical team. These plans will be served by the Fountain House mobile team, along with residents and others. Experienced Clubhouse members, who many times get along better with residents and have similar life experiences, will be crucial participants in the planned outreach efforts. The same mobile team will serve residents who are in crisis, and assist to re-start a process of providing additional services for residents who have stopped treatment.

With a seemingly non-stop sense of leadership, Fountain House is once again taking on that leadership role, preparing other Clubhouses to operate in a Managed Care environment. Everyone from Board Members, staff, and Clubhouse members of Fountain House are helping to formulate and design a managed mental health care plan for New York State which will make sure that there is a continuation of improved access to high quality services. The leadership example being provided by Fountain House is exemplary.

Fountain House is pursuing coalition building with agencies and programs to improve advocacy surrounding the elimination of mental health stigma, entitlements, and additional issues that affect people with mental illnesses. They continue to design and create programs and services for people with mental illness, young adults with mental illnesses, and services for parents of this group of citizens. They do the same design and creation of programs in partnership with clinical and medical providers in the community.

The people involved with Fountain House today look forward to expanding services to members, and increasing their model of rehabilitation. They continue their accomplishments while holding to the very principles they established in 1948. At Fountain House, their philosophy of people who have mental illness having strengths and abilities beyond their disabilities and symptoms is very true. Fountain House believes in their member’s common humanity and potential. They believe that their member’s wellness can and must be achieved. At Fountain House, they believe that every single member is entitled to a home, a job, and a chance to succeed. They believe that their members deserve dignity, and that every member must have a real and direct impact in determining the path of their individual rehabilitation, as well as their lives.

From my personal perspective, this is the human respect and dignity that every citizen in America and around the world deserves. For their efforts, Fountain House has earned the Gold Achievement Award from The American Psychiatric Association, as well as a monetary award from Pfizer, Incorporated. In my opinion, Fountain House, and the entire Clubhouse Model, should not only be recognized by the President of the United States; annually, but should be recognized by the United Nations as well for their efforts. Akin to Social Security, permanent funding needs to be in place to support this highly successful model of rehabilitation and support for persons with mental health disabilities across America, if not the world. The need is there, success has been proven repeatedly through the likes of Fountain House; it is time to support this wonderful Clubhouse model.

Fountain House - http://fountainhouse.org/

Thomas Weiss, M.A.

Original Article - http://psychservices.psychiatryonline.org/cgi/content/full/50/11/1473