How Clubhouses Work

The daily activity of a Clubhouse is organized around a structured system known as the work-ordered day. Members and staff work side by side as colleagues to perform the work that is important to their community. Instead of traditional talk therapy, members and staff share responsibility for running every aspect of the Clubhouse. By sharing responsibility for critical work, members and staff build relationships focused on each other’s strengths and gifts, rather than weaknesses and liabilities. In this environment, the real needs of the community, and individual members, create meaning. Helping each other address those needs builds confidence and self-esteem. It also creates the shared activities through which positive and helpful relationships are developed. These relationships ultimately create the fabric of a profoundly regenerative community.

In spite of the many challenges facing people with serious mental illness, returning to work is the number one dream of many people with whom we work. We have been successful in helping hundreds of people return to work. From the very supportive Transitional Employment program to the less intensive assistance of Supported Employment and Independent Employment, we are able to assist members with their employment goals wherever they are in their recovery.

• Transitional Employment is a highly structured program for members returning to work in local business and industry. Transitional Employment placements are at the employer’s place of business, are part-time (15-20 hours per week), and include a lot of on-the-job and off-site support from Clubhouse staff and other members. These placements generally last from six to nine months. Members can then try another placement or move on to independent employment. Transitional Employment is specifically designed as a vocational rehabilitation program where a member can gain or re-gain the skills and confidence necessary to have a job while he or she is employed in a “real world” position. The only requirement for the member to participate in Transitional Employment is the expressed desire to work.

• Supported Employment is a Clubhouse employment program, in which members receive help accessing and being successful with employment at a community business or public employer.  However, Supported Employment positions are not time limited. They can be career-oriented and may provide opportunities for advancement within the company. The Clubhouse staff still provide on-site and off-site support for the member and the employer as needed and requested. There is usually a competitive interview process for the position, and the job is not set aside for the Clubhouse. In Supported Employment, the job may be full- or part-time and paid at the prevailing wage for the position. The type and duration of the support provided to the member and the employer may differ from member to member, and from job to job, and may eventually no longer be needed.

• Independent Employment is a program through which members, when ready, are broadly helped by the Clubhouse to seek and obtain a job of their own. The Clubhouse then provides ongoing support and encouragement for the members as long as they remain employed and want assistance. There is no on-site support at the place of business for members in Independent Employment; all support takes place at the Clubhouse, or in the community.

In addition to work opportunities, Clubhouses provide evening, weekend, and holiday social and recreational programming. Members and staff together organize structured and non-structured social activities. These activities are scheduled outside of the work-ordered day. Holidays are celebrated on the day on which they fall. Activities are scheduled both at the Clubhouse and in the community.

Community Support is the service the Clubhouse offers to assist members in overcoming barriers to living independently in the community. These supports include: benefits assistance, linkage to other services, advocacy, access to medication and psychiatry, transportation, financial management, crisis intervention and outreach.

Part of the daily work of the Clubhouse involves keeping in contact with all active members. When a member does not attend the Clubhouse or is in the hospital a “reach-out” telephone call or visit is made. Each member is reminded that he or she is missed, and welcome and needed at the Clubhouse. This process not only encourages members to participate, but it is also an early warning system for members who are experiencing difficulties and may need extra help.

As with employment, education is a real and immediate path back into the community. In addition to tutoring and other in-house supports, the Clubhouse assists people to access educational opportunities in the community. From adult basic education through graduate school, Clubhouses assist members to pursue their individual educational goals.

Members use the support of the Clubhouse to overcome the barriers to living independently. This support includes: finding housing opportunities, physically moving into new places, mediating with landlords, maintaining apartments, and any other support needed to live independently in the community.

Decision-making and governance are an important part of the Clubhouse work. Members and staff meet in open forums to discuss policy issues and future planning for the Clubhouse. Clubhouses also have an independent board of directors or advisory board that is charged with oversight management, fundraising, public relations and helping to develop employment opportunities for members.

Although Fountain House started more than fifty years ago and has been replicated more than four hundred times around the world, the Clubhouse concept is still a radically different way of working in the field of community mental health. Most program models still focus on assessing a person’s level of disability and limiting the expectations based on that assessment. Most use teaching or treatment as the vehicle for providing rehabilitation. In a Clubhouse the expectations are high and mutual work, mutual relationships, and meaningful opportunities in the community are the vehicles of choice.

• Anderson, S. B. (1998), “We Are Not Alone: Fountain House and the Development of Clubhouse Culture,” New York, New York, Fountain House.
• Beard, J. H., Propst, R., and Malamud, T. (1982), “The Fountain House Model of Psychiatric Rehabilitation,” Psychiatric Rehabilitation Journal, 5, 47-53, Boston, MA.
• ICCD, (2002), “The International Standards for Clubhouse Programs,” New York, New York.
• Vorspan, R., (1986), “Attitudes and Structure in the Clubhouse Model,” The Fountain House Annual, Vol. 4, New York, New York