July 22. 2018 12:16AM

Beyond the Stigma: Clubhouse model thriving in 32 countries

New Hampshire Union Leader

Lauren Hoepp, left, of Hampton shows Paula Rockwell how to sign in on Rockwell's first visit to the Seacoast Pathways clubhouse in Portsmouth. (Shawne K. Wickham/New Hampshire Union Leader)

Seventy years ago in New York City, six men with mental health challenges started Fountain House, a "clubhouse" where they could find friendship and support in a safe place that was all their own.

The model that they started back then is now thriving in 32 countries.

Joel Corcoran is executive director of Clubhouse International, which is headquartered in Manhattan and counts around 300 member clubhouses, more than 200 of them in the United States. He said clubhouses address issues of "social and economic isolation" for those living with mental illness.

"There's enough evidence to show that people with mental illness can recover and live successful lives," he said. "But people get isolated because of their mental illness."

"What we do in a clubhouse program is we address that isolation socially by giving people a place to belong, and building a social network that's real," he said.

The model emphasizes the value of work and social interactions; members work side by side with staff to develop job skills and access education, employment support and social services.

Corcoran said many states fund the clubhouse model with state dollars; most rely on Medicaid funding. Pennsylvania, for example, funds 26 clubhouses; Michigan uses Medicaid funding to sustain 47 clubhouses, he said. Some clubhouses even provide housing for members.

Corcoran said the clubhouse model has proven outcomes in job placement and housing for individuals with mental illness. And he said studies have shown that an investment in clubhouses pays off in reduced costs of hospitalization, incarceration and emergency room visits - not to mention the value of helping individuals recover jobs, families, friends and self-worth.

"Clubhouse programs ... have some of the strongest outcomes in terms of building successful living for people in the community," he said.

But while more states are moving to the state-funded model for clubhouses, he said, "Mental health funding is a fickle, fragile item."

Some states, including New Hampshire, have opened clubhouses without government funding, Corcoran said, but "it's a lot harder."

And as clubhouses prove successful and grow, sustaining that funding becomes even more difficult, he said. "The more successful you are, the more referrals you're going to get from doctors and advocates and mental health providers," he explained. "The demands are going to go up. You really need to find a plan for recurring state funding or government funding, and that can be a really heavy lift if you don't have a sympathetic ear from decision makers in the state system."

Corcoran said it takes strong advocacy within a community to get that buy-in from state leaders.

Ken Norton, executive director of NAMI New Hampshire (National Alliance on Mental Illness), said one of the biggest challenges facing New Hampshire's mental health system is a lack of continuum of community-based services.

When individuals are discharged from the hospital, Norton said, there are few "step down" options available. "Clubhouses are part of an array of services that can be offered to people to promote connectedness and recovery - which ultimately reduces hospitalization, or for those hospitalized, can ease transition," he said.

Norton, who recalled visiting the original clubhouse in New York City 30 years ago, said clubhouses provide vocational support from peers and supportive business owners, which helps people get engaged in their communities. "It would be great to see New Hampshire have more clubhouses available to promote recovery," he said.

Corcoran said he's never forgotten what a member said to him during a visit to a Milwaukee clubhouse about five years ago. The man had lost his family, home and job because of his illness, he told Corcoran; the clubhouse had saved his life.

But it's what the man said next that stuck with Corcoran. There's no doubt the clubhouse could help those individuals who end up on the streets, the ones the public sees, he said. But he went on: "Most of us are in our mothers' basements, watching TV, drinking coffee, too afraid to come out. Those are the people we need to reach."

"That's really what it's about," Corcoran said. "People are marginalized and invisible to the rest of the world."

The vision of Clubhouse International, he said, is that clubhouses one day will be as commonplace as YMCAs, Boys & Girls Clubs and senior centers. He ticks off the facts: One in four families has someone living with a serious mental illness. People with mental illness are more likely to die prematurely.

"There are enough people in communities that need what Clubhouse provides," he said. "I think a community has an obligation to provide those kinds of social services to people who need it."