The Clubhouse Model of Service

for Adults with Mental Illness: An Overview

The History of Clubhouse

The first psychosocial rehabilitation clubhouse was started in 1947 by a group of people with a mental illness who realized they could help each other in their recovery. The original group, called WANA (We Are Not Alone) became Fountain House in New York City. Professional staff were hired by the clients and a unique partnership between staff and members developed for the cause of creating opportunities for people living with mental illness to be respected members of society. Over the test of time, thousands upon thousands of persons with mental illness have achieved this goal thanks to the clubhouse model.

The Expansion of the Model

The clubhouse model has expanded over its nearly 60-year history in the following ways:

  • Today there are close to 400 clubhouses in 30 different countries around the world serving over 55,000 people.
  • In the United States there are 196 clubhouses in 32 states serving approximately 37,500 men and women living with mental illness.
  • 318 clubhouses belong to the InternationalCenter for Clubhouse Development (ICCD) and 150 are ICCD Certified Clubhouses.
  • 20 new clubhouses open each year with the assistance of International Training Bases, located in New York, Massachusetts, South Carolina, Missouri, Toronto, London, Sweden, South Korea, Finland and Australia.
  • 120 new teams of clubhouse staff are trained each year.
  • Recently, the United Nations gave the InternationalCenter for Clubhouse Development “Special Consultative Status” with the United Nations Economic and Social Committee (ECOSOC). ICCD is the only international mental health organization with this status.

The Efficacy of the Clubhouse Model

Recent SAMHSA (Substance Abuse and Mental Health Services Administration) supported research has verified the efficacy of the clubhouse model. In this study Clubhouse and PACT, Programs for Assertive Community Treatment,programs were compared to each other. Clubhouse participants were shown to have longer work duration and higher earnings than those in PACT* programs. Clubhouse jobs were of higher quality than those gotten by PACT model programs. And the cost per person was demonstrated to be less in clubhouse than in PACT with as good or better outcomes. Clubhouse not only addresses helping members (clients) get jobs, but also addresses their social needs, a shortfall in other less comprehensive model programs.

The ICCD

The InternationalCenter for Clubhouse Development was started because of a need for standards in clubhouse programs. In the past, as word of the success of the clubhouse model spread, many day treatment programs began to call themselves clubhouses. They would establish a work unit or two and call clients members, but fell far short of producing the restorative environment and opportunities that a fully functional club can provide. Much like PACT, standards are necessary to assure quality control. Many “clubhouses” in name were more like drop-in centers and day treatment programs and began to corrupt the image of clubhouse for those who confused these programs from “the real thing.” The ICCD was established to maintain a standard of performance for programs to assure that the outcomes generally achieved in a clubhouse model program could be replicated and assured by all programs that call themselves a clubhouse. The standards cover such areas as club membership, relationships between members and staff, space, the work ordered day, employment, education, functions of the house, funding, governance and administration. Free or minimal cost technical assistance is available through the ICCD and clubhouse community for those who wish to achieve this standard.

The KentCenter’s Hillsgrove House

Hillsgrove House, an ICCD certified clubhouse located in Warwick, is not available to others living around the state and operates at a financial loss. Rhode Island needs more clubs, but there is no financial incentive to develop them. Clubhouses are designed to meet the needs of people with severe and persistent mental illness. In Rhode Island, these individuals are usually enrolled in our PACT model Mobile Treatment Teams (MTT). Under the current regulations, if a client receives services from a MTT, he cannot be supported by Medicaid to attend the club. But some of these individuals in the MTT’s are the very people who could most benefit from the club, in addition to MTT services. By amending the regulations as suggested, there would be a financial incentive for other mental health organizations to establish ICCD certified clubhouses in Rhode Island. The combination of Club and PACT would be the best possible option for some of our most severely ill Rhode Islanders.

* The PACT model provides community outreach, case management, psychiatry, vocational services, along with mental health and substance abuse counseling for adults in the community mental health system who need a high level of service intensity.