Inside Mental Health Podcast: Clubhouse Model For People with Mental Illness

Episode Description

Do you know what a peer clubhouse is? What about a member’s only clubhouse for people living with mental illness? These types of clubhouses have existed since 1949 and there are over 200 in the United States alone.

Join us as we chat with Dr. Ashwin Vasan, the CEO of the oldest clubhouse in America, Fountain House. Dr. Vasan tells us the theories behind the clubhouse model, the importance of respect in our communities, and what kind of results Fountain House has been able to achieve.

Guest Bio

Ashwin Vasan, MD, PhD, is the president and CEO of Fountain House, a national nonprofit organization that serves those living with serious mental illness. Fountain House’s model of psychosocial care has inspired over 300 affiliate locations in 32 states. Dr. Vasan is also a primary care physician and assistant professor at Columbia University’s Mailman School of Public Health. He has over 15 years of experience in improving health, social welfare, and opportunity for those with the greatest need.

Inside Mental Health Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

To learn more about Gabe, please visit his website, gabehoward.com.

Episode Transcript

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everybody, my name is Gabe Howard, and welcome to this week’s episode of Inside Mental Health: A Psych Central Podcast. I want to thank our sponsor, Better Help. You can get a week free by visiting BetterHelp.com/PsychCentral.

Calling into the show today, we have Ashwin Vasan, M.D., Ph.D., who is the president and CEO of Fountain House, a national nonprofit organization that serves those living with serious mental illness. He is also a primary care physician and an assistant professor at Columbia University’s Mailman School of Public Health. Dr. Vasan, welcome to the show.

Dr. Ashwin Vasan: Thank you, Gabe. It’s such a pleasure to be with you today.

Gabe Howard: Today, we’re going to learn all about peer clubhouses, but before we get too far into the show, let’s establish exactly what a peer clubhouse is.

Dr. Ashwin Vasan: Yeah, we call them peer clubhouses. We call them mental health clubhouses or just clubhouses. It was started in 1948 here in New York City. A group of people coming out of hospitalization for serious mental illness at an institution upstate in New York said, we’re coming back, we’re leaving. What do we do now? Where do we go? Where can we go and feel safe and where can we go with dignity? Where can we go and engage in life? And in those days, members only clubhouses were quite common. And so they said we should create our own members only clubhouse for people living with serious mental illness. And so on the steps of the New York Public Library, they created an organization called We Are Not Alone or WANA, and that grew into what is now known as Fountain House, which is a members only clubhouse, a sanctuary really for people living with serious mental illness. So that includes people with schizophrenia, bipolar disorder or major depression. It also, we also take folks with a whole host of diagnoses. We’re much more interested in really addressing the needs of people who are socially isolated, looking to rebuild their lives, looking to recover in the community as they live with the ups and downs of having mental illness. The clubhouse is really a place for people to form community. Community is our therapy. Why do we think that and why do we know that that works? Well people living with mental illness are just like everyone else. They want something to do. They want purpose in life. They want to wake up each day with direction and with dignity and with the sense that there’s a place that they can go, where they’re wanted, where they’re needed, and where they’re going to be missed when they’re not there. And that’s what clubhouses offer.

Gabe Howard: It sounds like paradise almost. I know that it’s for people like me, I live with bipolar disorder. So on one hand it addresses social isolation and the needs that I have. But on the other hand, it’s like my tribe, right? It’s where I can go and be around people like myself and get access to services.

Dr. Ashwin Vasan: We believe very strongly in creating the most beautiful and dignified environment for our members. It’s beautiful. I mean, if you come to Fountain House or you come to some of our affiliate clubhouses, these are beautiful places because there is dignity in the environment that we create for people who often have that dignity snatched away from them and who are left to kind of cycle through negative systems like jails and prisons or shelters or emergency rooms, places that are not really set up to elevate the humanity and dignity of people. Fountain House was started in 1948, as I mentioned, but there are over two hundred of these mental health clubhouses across the United States in 40 states. Everyone who lives with mental illness, who lives with significant isolation and marginalization, who wants to be a part of our communities, should have that accessible to them in their own backyard. And that’s the vision that we’re trying to advance.

Gabe Howard: Now, Fountain House is nationally known. Many people who aren’t familiar with the clubhouse model or what a peer clubhouse is, have heard of Fountain House. They might not understand it, but they know it’s that mental health place. What makes Fountain House so well-known and so special?

Dr. Ashwin Vasan: When I walk through the door of Fountain House, the first time in 2019, I was just blown away by the community. I was blown away by the relationships between staff and members, the partnership and the egalitarianism. The fact that you couldn’t even really tell who was staff and who was a member. You know, our staff doesn’t wear uniforms and try to distinguish themselves from our members. In fact, they make it very clear that we are partners, we are equals, and we are on the same level as you. I saw a vision when I walked through those doors of what communities should look like. The rest of the world should look an awful lot more like Fountain House. And that’s really the vision we need to make a reality. It’s so special because of those relationships, because of the strength of the community and because of the values, the values of choice, of agency, of dignity, of respect, of egalitarianism. Those are all things that are taken away from people with serious mental illness, both by virtue of the illness itself. As well as by the stigma and discrimination that society and systems really meet those folks with. We are trying to give all of that back and allow folks to take it back for themselves. That’s really what makes Fountain House so special, and clubhouses all over the country and the world so special is that it’s really founded on members, people being at the center of their own recovery. And why don’t more people know about it? Why isn’t it a standard part of our community mental health system? That’s largely why what I’ve come to try to achieve here at Fountain House is to really put this model on the map. It should not be the exception. It should be the rule.

Gabe Howard: Now, one of the things that you said is that they’re your members. That makes me think of, you know, like the local warehouse club where you have to pay to be a member. Is there a cost to use Fountain House?

Dr. Ashwin Vasan: There is zero cost to the members. We call them members very intentionally because they are not patients, they are not clients. We are not delivering a service in the traditional sense of service delivery. They are here by choice. They are choosing to be a member of our community. The community is choosing to take those folks. And that’s why we really emphasize and have always emphasized since the beginning of Fountain House that folks are members. They are a member of our club, a member of our community, and deserve all the rights and respect and dignity and inclusion that comes along with being a member of something. When you sign up to be a member at Fountain House, we’re obliged to create a community for you that is supportive and dignified and therapeutic, and in return, you agree to be a part of that community. So that’s our social contract with each other. We found that people come to Fountain House and stay at Fountain House by choice. No one goes to health care or goes to a housing program or another social service program by choice. They go because they need to. You know, they go because they have a need that needs to be met, but they come to Fountain House by choice. And that is the strongest form of engagement that you can possibly have, right? Being told to do something. Any of us being told to do something is much less effective than choosing to do something yourself. And that’s really one of the major founding principles of Fountain House, is that we have to give people back the ability to choose for themselves and choose a brighter and better future for themselves.

Gabe Howard: It sounds like you’re saying that mental health is not solely a health care issue, it’s a societal issue. It intersects with a great many things. How do we even begin to unpack that?

Dr. Ashwin Vasan: I’m a public health professional and an epidemiologist, so I think about health not just as something that health care can affect and that health care can impact, but something that is generated, created or harmed much further upstream. In public health, we call those social determinants of health. Well, in mental health, those are social determinants of mental health. Housing, the quality of your housing, your ability to get housing is clearly an impact on mental health. And there’s plenty of research to show that economic security, your ability to know whether you can pay your bills, stay in your home, pay your rent, send your kids to school. Those are mental health issues. If those are taken away from you, that security is taken away from you. This is a strain on mental health and can be a driver of the development of long term mental illness. Criminal justice and trauma and police violence, this is another trauma and trigger of mental health issues, in addition to disproportionately falling on people living with serious mental illness. So you can start to see none of what I talked about was about health care, right. In addition, we have a health care system that makes mental health care too hard to access. One out of three Americans can’t get mental health care when they need it. We have to take on a much more holistic and comprehensive view of what creates mental health, what can improve mental health, what can worsen mental health.

Dr. Ashwin Vasan: And when you start to have that conversation, it intersects very clearly with policy and politics. You cannot get out of the conversation about why does our housing system look this way or why do we have so many chronically homeless Americans? Unless you’re addressing mental health and unless you’re taking into account the impact on mental health. You can’t talk about income inequality and who’s on one end versus another unless you think about the mental health impacts of it. And you certainly can’t talk about race and racial justice, law enforcement and criminal justice and mass incarceration unless you tackle the idea and the data that shows that people with mental illness are disproportionately met by law enforcement, incarcerated. When we talk about being an organization for people with serious mental illness, we’re taking on all dimensions of that problem, not just the services, not just the health care. And until we all accept that we have to take on all dimensions of this issue, we’re not going to be able to make the change that we need to. And lastly, I’ll just say, where has this come into stark relief? COVID. The burden of COVID is falling disproportionately on people of color, on essential workers. So, yes, mental health is not solely in the health care issue and we have to take on its intersectional impacts.

Gabe Howard: I want to remind our listeners that Fountain House is in New York City, in the state of New York, and lately there has been a lot of discussion around the way law enforcement responds to a mental health crisis call. You mentioned it yourself. In your opinion and also in Fountain House’s opinion, how should society respond to a mental health crisis? And what does that response look like?

Dr. Ashwin Vasan: This issue is very personal for us at Fountain House. In 2016, one of our members, Deborah Danner, a beautiful 67-year-old woman with schizophrenia, small, tiny woman, was killed by police in her apartment because she was having a mental health crisis and the police were not appropriately trained, nor was that the correct response. And so the ripple effects of that tragedy have been really they continue to live with us at Fountain House and have caused us to really make mental health crisis a central issue in our work. We’re leading a campaign called Care Responders to really organize around clubhouses in those communities and to bring together stakeholders to say why can’t we change the way that mental health crises and emergencies are dealt with? And first and foremost, this is a health issue. I’m a physician, I’m a public health professional. This is the only set of conditions for which we deploy a punitive response for a health issue. If you’re having a heart attack, if you’re having dizziness, if you lose consciousness and faint, we don’t bring the police. We bring emergency medical services. We bring health care workers. We get you to an emergency room as quickly as possible. Why don’t we do the same? Why is it that we deploy people who are armed and uniformed with flashing lights to what are ultimately issues of mental illness? And it goes back to your question about stigma and discrimination. We have these long standing, embedded cultural racialized views of people with mental illness as unsafe, as safety threats to themselves, to others, principally others. But I’ve certainly talked to many, many people who have had mental health crises.

Dr. Ashwin Vasan: The person who is most scared and vulnerable in those situations is the person experiencing the crisis, the most disoriented, the most confused and the most in need of help. And we’re deploying the wrong response. And the last thing is, I’m also an academic and I know what works. The data is very clear. We can respond to mental health crises without police and still have really good outcomes. All you need to do is look at the famous CAHOOTS model in Eugene, Oregon. Thirty years of experience. In 2019, they had 24,000 mental health calls. Only 250, one percent, required law enforcement backup. The rest were dealt with by a combination of social workers, mental health workers and peers, peer experts and emergency medical services. We know what to do. It’s a question of can we find the political will and can we tackle those really strongly held embedded cultural beliefs about mental health and violence and safety and the stigmatization of that.

Gabe Howard: I know that one of the arguments against what you just said was imagine if somebody was inside Fountain House and they were a danger to the other people and they were violent. Do you want a social worker to show up or do you want the police to show up? And I noticed that that gets used as so that’s why everything that we’re doing is fine. I very much appreciate what you said, that 99 out of 100 times that’s not needed. What about the one time that it is? How is that addressed or worked out?

Dr. Ashwin Vasan: I think the CAHOOTS model and others show that you can simply have law enforcement back up ready to be on site if needed. But the vast majority of mental health crisis calls, many of which start exactly as you described and many of which we’ve dealt with at Fountain House. It’s not as if our members don’t experience crisis. They just experience crisis at far lower rates than the rest of the population with serious mental illness. But when they do, what we have are skilled mental health workers who are skilled at engaging people, at deescalating situations and ensuring the safety of the person and those around them and these are all things that you need skilled mental health workers to be able to figure out, not police. And then, yes, I mean, you can always find law enforcement back up.

Dr. Ashwin Vasan: I think people think that these things play out in a matter of seconds. They largely don’t. It’s not as if you have seconds to make a decision. You have time. In many cases, you have time. It requires really smart and thoughtful assessment. These mental health workers are deeply trained at crisis response. We really need to lean on them instead of sending people who are just not fit for the cause. And the interesting thing is and maybe the potential the positive thing is that the police agree with us. In all of those communities I mentioned, including here in New York, the police are saying the same thing. We don’t want to be the first responders for these calls. We’re not the right people. We’re not trained. You can give us training, but we’re never going to be as good as a skilled mental health worker whose whole job is mental health. So we need to listen to them, too, and say stop putting them into positions where there’s a higher risk of making bad choices.

Gabe Howard: To tie this all together, I think it’s important to point out to our listeners that the Fountain House clubhouse is a building filled with people living with serious and persistent mental illness who are doing just fine. I think that the average person would hear a giant building filled with lots and lots of severe and persistent mentally ill people? There must be constant problems. That’s not what you’re seeing, right? Fountain House is essentially just a regular place filled with regular people who just also happen to be living with serious and persistent mental illness.

Dr. Ashwin Vasan: That’s exactly right, and the fact is Fountain House is full of different people. They don’t necessarily come every single day, right? They go out and they work. Our employment data is twice the national average for people with serious mental illness. They go out and they finish their education. Nearly 80% of our members achieve their educational goals. They are back to work. They’re back to school. They’re back in the community. They’re reconnected with their families. And then they come to Fountain House when they need it. We meet Fountain House members, often at their lowest point, and they rebuild their lives through us and with us. And then they go off and live. But that’s the thing about serious mental illness that we just don’t want to acknowledge in the society, that it’s all around us. It’s all around us. Right? This is not uncommon. And that’s where Fountain House steps in, is that we help you redirect your trajectory on your own through a supportive community. And so this is not a mental health institution. This is not we keep people behind the walls so you don’t see them on your subways and on your streets. Absolutely not. This is about human beings and their goals and their aspirations. And our success is not just the members who come to us every day. It’s the members who stop coming and who are back at work and who are back at play and back at school and reconnected with their families. We have to confront this notion, the stigma again, that somehow you can’t recover or live with serious mental illness. It’s all around us. It’s all around us.

Gabe Howard: We’ll be right back after we hear from our sponsors

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Gabe Howard: And we’re back discussing peer clubhouses with the CEO of Fountain House, Dr. Ashwin Vasan. I appreciate this conversation so much, let’s swing it all the way back to the beginning. It’s just a question that I’ve been wondering about while we’ve been talking. What can a member expect when they walk in the door? You’re brand new. You’ve never been there before. You’re thinking about utilizing Fountain House. That’s your day one. What’s that look like?

Dr. Ashwin Vasan: Well, the experience is that you’re there because you want to be. The second you don’t want to be, you don’t have to be there. That’s number one. Number two, we’re trying to meet you where you are. As I said, we meet a lot of members at their lowest point in their mental illness journey. There is so much isolation, demotivation, lack of self-confidence, lack of sort of forward momentum that what you’ll see is a celebration of the fact that you got to our front door. The fact that you’re there means you want to get better and you want to pursue something different with your life. And that’s something to be celebrated. You get to look around and see people like yourself and people at different stages, people who are beyond where you are and who have recovered. And you start to see, oh, gosh, you know, there are models of what I could look like. The other thing that our members say all the time is they’re spoiled for choice. Choice is the one thing or one of the things that’s really snatched away from people with serious mental illness, both by the illness itself as well as systems and by stigma and discrimination. So we give them back that choice. No one has to do anything when they arrive there. They can take the time to really find their feet. It’s a beautiful place. It’s a dignified place. It’s a safe place. And it’s a place where you’re an equal. You’re not there to receive services. You’re not a client. You’re a part of a club. You’re part of a community.

Gabe Howard: Everything that you’re describing with Fountain House sounds great, but of course, things are closed down, especially in New York City. Does COVID impact what you’re able to do? Are you closed right now?

Dr. Ashwin Vasan: Yeah, Gabe, we are closed, and for the first time in 72 years, we had to close and clubhouses around the country have had to close. We’ve been open through 9/11, through Hurricane Sandy, but we had to close because of the pandemic. And that was a huge schism for our community. This is their safe harbor. This is the place that they rely on, count on, community that they go to for support. Before we closed the team and I really took time to say, all right, how do we keep people connected during this pandemic? Which at the time, about a year ago now, we weren’t quite sure how long this would all last. Number one, we started a bunch of home based outreach, meals delivery, medication delivery, all the things that we do and folks depend on within our four walls, we decentralized those. And even during the pandemic, we did that safely. We did that with PPE. Number two, we built a virtual clubhouse community. So we brought together platforms like Zoom, Facebook, Slack and Skype, and we stitched them together in a way that approximated the way that we organize our community in the physical environment. Obviously, you can’t do all the same things, but we were able to organize moderated forums, moderated groups. We created a mask production group, a unit we call them, where we were stitching together masks for our workers and to distribute to hospitals around the area.

Dr. Ashwin Vasan: We did a whole bunch of stuff that kept people engaged, and we have found a few things that have been so remarkable. Number one, 70% of our membership is connected online, and that’s really crossing a third rail of our perception and stigma for people with serious mental illness that they’re not digitally literate. Many are. Many are, most are. That was really an important pressure test for us, that people were actually engaging and they continue to engage. And they have said through our research that they want to continue to engage even after the physical clubhouse reopens, likely this summer. Number two, we have found that we’re able to bring in new members from around the city and beyond who have never set foot in a physical clubhouse. They just like the community. They like the community online. They like the ability to talk to other people who sound like them, look like them, and they can relate to. And that’s allowed us not only to expand geographically where we can reach, but also expand into different communities like limited mobility and physically disabled populations and younger people who are more digitally native and able to connect online. And lastly, it’s highlighted where that divide is.

Dr. Ashwin Vasan: There’s obviously equity issues around who’s able to connect, who’s not able to connect, who’s got digital skills, who doesn’t have digital skills. So we’ve created a digital literacy training program where we can work directly with our members in their homes or outside, where it’s safe to train them, on how to use email, how to use all of these platforms. And because we know in this modern world, it’s no longer a nice to have to be online, it’s a must. It’s a necessity. You can’t apply for a job. You can’t go to school. You can’t do basic things. You can’t get your benefits arranged unless you know how to navigate the Internet. This has been, I hate to talk about silver linings from a global pandemic, but this virtual community and this virtual clubhouse is going to be a part of our business model forever going forward.

Gabe Howard: It’s incredibly interesting and I like what you said about hating that there is a silver lining to the global pandemic, but a lot of people have found that virtual communities with support groups, and just not having to leave their house is really booming and really popular. And I do think it will stick around.

Dr. Ashwin Vasan: That’s exactly right, telehealth is a perfect example. I talked about the fact that one out of three Americans don’t have access to mental health care in their communities when they need it. Well, this is one way to cross that divide and just to close that gap is to get people access to telehealth and tele-mental health. The same is true for non-clinical interventions like ours, we’re a community intervention. But we have shown that we can create communities and create forums online that people want to connect to. And the fact that we’re designing specifically for people with serious mental illness is really innovative because this is a population that everyone forgets and everyone leaves behind when they’re designing a technology. Most of the mental health technology that exists is designed for the worried well, but we’re designing something for some of the hardest to engage and most challenging for conventional services to serve. We’re really designing specifically for them, and I think we’re starting to show some really interesting and good results.

Gabe Howard: It sounds wonderful if people want to learn about Fountain House from all over America or the world, how do they find more information?

Dr. Ashwin Vasan: They can come to our website www.FountainHouse.org, or they can follow us on Twitter and Instagram. Just give us a call. Send us an email, send us a message. We’re happy to engage you in a conversation. We also have links to the other two hundred clubhouses around the country. We’re really excited and about the future for this work. We think it’s finally time for a national conversation about mental health and about mental illness. And we’re just we’re really honored and glad to be a part of it with our members.

Gabe Howard: I highly recommend all of our listeners check out FountainHouse.org. It also has a list of other clubhouses to see if there is one available in our community and to all of our listeners, thank you so much. We can’t do the show without you. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations,” as well as a nationally recognized public speaker. Wouldn’t it be really cool to have me at your next event? You can also grab a signed copy of my book with free swag or learn more about me over at gabehoward.com. Wherever you downloaded this podcast, please rank, review, subscribe, use your words and tell other people why they should listen. And I’ll see everybody next Thursday.

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