- There's a happy hum in the basement of the North Church Parish House when a visitor arrives on a recent mid-summer morning. Two women step forward with broad smiles of welcome; across the room, several people are busy on computers, but they, too, look up and smile.
Welcome to the clubhouse.
This is Seacoast Pathways, a nonprofit mental health program for adults with mental illness. It's a place to make friends, practice job skills and find educational and employment support.
It was Paula Rockwell's first visit to the clubhouse, and she admitted she was a bit nervous. She was recently discharged from the behavioral health unit at Portsmouth Regional Hospital, which is where she heard about the clubhouse.
"It's good that they have this place, so when you go home, you have somewhere to go so you're not alone," Rockwell said.
Lauren Hoepp of Hampton, a friendly woman with a quick smile, was helping Rockwell, who is visually impaired, sign the logbook. "I used to be shy and isolated," Hoepp said. "This is a place for me to come and have structure."Peer support key
At a time when New Hampshire leaders are putting together a 10-year state plan for behavioral health services, advocates say peer support programs such as the clubhouse model play a key role in keeping individuals engaged in their communities - and out of psychiatric hospitals.
Within minutes, Rockwell was chatting easily with Erin Stroup of Seabrook, who's been a clubhouse member for two years. Stroup said her therapist recommended she give it a try.
Before then, she said, "I was sitting home in isolation. I was getting more depressed. I didn't want to go back to the hospital again."
On her first visit, Stroup said, "Someone greeted me right away. I started making friends, people who understood me for me."
Stroup now does presentations about the clubhouse at Portsmouth Regional Hospital. She said she cherishes the friendships she's made here.
"We're like-minded," she said. "We understand each other. It's nonjudgmental."
When she was younger, Stroup said, only her parents knew about her illness. She avoided making close friends at school, afraid to tell anyone about her condition. "The stigma was there," she said.
Stroup has a degree in communications and did graduate work in health management, but she hasn't worked in 10 years, she said. That's about to change, thanks to the clubhouse.
"The support here has been fabulous," she said. "I have the confidence to move on."
Seacoast Pathways is open Mondays, Wednesdays and Fridays; it hopes to be open full time in the future.
The clubhouse model relies on what's called a "work-ordered day," with members choosing tasks such as meal preparation, budgeting or data entry during morning meetings. Members and staff work side by side to accomplish goals and support each other when challenges arise. There are music, art, computer and writing programs; there's no cost to attend and a small fee is collected for meals.
Jim O'Callaghan started coming here about three years ago. He had a problem with drugs and alcohol and had stopped going to AA meetings, he said.
Then, "I came here and I met friends," he said. "It gave me a purpose."
O'Callaghan now writes well-received movie reviews for the clubhouse newsletter; his favorite movie is "The Sound of Music."
And, he tells the group, he's been sober since May 7, 2015. They all applaud as he grins proudly.
Scott Garnett has a degree in microbiology and worked as a scientist for eight years. But, he said, "I realized those jobs were not that great for my mental health."
He started a second career in human services, working with individuals with developmental disabilities. He'd been a member of the clubhouse for three years when a staff position opened up; Garnett applied and got it.
The best part of his job now is "making a difference in people's lives," Garnett said. "I like to be a part of people's recovery."
"It's more rewarding. Money isn't everything," he said. "When I was a scientist, sure, I got paid well, but I didn't get that satisfaction. Here, I get that satisfaction."A vital program
Stephen Curtis, director of behavioral health services at Portsmouth Regional Hospital, calls Seacoast Pathways "a fantastic component of our community."
"Programs like this are vital for all of us because of the importance of developing relationships, purpose within our lives, and finding meaning in the activities that we do," Curtis said. "Our behavioral health services are very appreciative of their work and want to continue to support their growth."
Joe Hill, another Seacoast Pathways staffer, said a family situation brought him and his wife to a NAMI (National Alliance on Mental Illness) New Hampshire support group years ago. He remembers posing a simple question: "Why isn't there a place for people to go after they get out of the hospital?"
Because without that, Hill said, "They go home, pull down the blinds and get isolated."
The conversation that followed was the spark that brought the clubhouse model to New Hampshire.
Joel Corcoran, executive director of Clubhouse International, said there are more than 300 clubhouses in 32 countries, including about 200 in the United States. Many clubhouses provide supportive housing, but the real focus is on "psychosocial support, helping people live successfully in their communities," Corcoran said.
Ann Strachan is director of mental health services for Granite Pathways, the umbrella agency for the Portsmouth clubhouse. She is passionate about what this program can do for individuals with mental illnesses.
But finding a sustainable financial model has been challenging.Funding is an issue
New Hampshire's first clubhouse, which was also called Granite Pathways, started in Manchester in 2010 with funding from donors and grants. After a rocky start - some neighbors worried about the impact on the city's quiet North End neighborhood - the clubhouse found a home at Brookside Congregational Church.
But when its five-year lease was up at the end of 2015, the clubhouse started looking for a new home and additional funding.
It's been a struggle. Some members continue to meet once a week at the Nackey S. Loeb School of Communications on Manchester's East Side. But three members, all in their 30s, said it's not the same.
Musician Dan Radlinski of Manchester said when the Brookside clubhouse closed, "That was heartbreaking. It was a loss."
Fellow member Justin Melanson of Raymond said he's been having a rough time of late, with the recent loss of his father and other family members. For him, the Manchester clubhouse means "friends, and knowing that I'm not alone."
Sean Jameson of Hooksett believes that state funding is needed to make the clubhouse model viable here. "The time is now to fund clubhouses in New Hampshire," he wrote in a message to state policymakers.
"It is important to be well and have something to do every day," he said. "I am concerned about the people in the community on disability that have nowhere positive to go and nothing productive to do every day."
Jameson, an artist, said having a mental illness is like having any other kind of illness. Without medication, he said, "The chemistry in my brain isn't balanced enough."
But he said others don't always understand. "It's a stigma," he said.
Strachan said before the Manchester clubhouse does reopen, she wants to make sure it will be sustainable, "to not have the same heartbreak that we had before."
The group is pursuing a new site that is more centrally located. Strachan is working on a projected budget for both the Portsmouth and Manchester clubhouses; she expects it would cost around $250,000 annually to run each location initially. And she is preparing a proposal to the state Department of Health and Human Services to include clubhouses in services covered by Medicaid.
Granite Pathways has been involved in a working group to develop the state's 10-year Plan for Mental Health, and Strachan hopes that clubhouses will be included in the final plan.
It sounds promising.
Jake Leon, spokesman for the state Department of Health and Human Services, said peer supports such as the clubhouse model are "vital components" of the state's mental health continuum of care. And he said the department is "exploring options for the state's Medicaid program to be able to support mental health peer support models, including the clubhouse model."
The Manchester members said they're still sad about losing their old clubhouse, but they're feeling more positive about the future.
"There's a story ahead of us, too," Jameson said.For more information, visit granitepathwaysnh.org and SeacoastPathways.org.Beyond the Stigma, sponsored by the New Hampshire Solutions Journalism Lab at the Nackey S. Loeb School of Communications, is funded by New Hampshire Charitable Foundation, Dartmouth-Hitchcock Medical Center, NAMI New Hampshire and private individuals. Contact reporter Shawne K. Wickham at firstname.lastname@example.org.