Expansion of City’s Mental-Health Clubhouses Could Shut Down Smaller Sites

When people walk into the Fountain House mental health clubhouse in midtown Manhattan they are greeted by a unique type of security guard.

The front door of the six-floor center is manned by a member of the community — someone with serious mental illness.

Almost the entire self contained community is operated by one of its approximately 2,000 members. They do everything from preparing meals to manning phones to determining the organization’s policy agenda — and even playing a major role in selecting the new CEO.

The community hub is similar to that famous television bar where “everyone knows your name,” Fountain House member Dan Frey told THE CITY.

“It’s my ‘Cheers,’” he said. “It’s a community. It’s friendship.”

Now, the Adams administration is seeking to expand the Fountain House model, long seen as a therapeutic — and cost effective — way to keep people out of prisons and homeless shelters.

The clubhouse itself is designed like an elegant exclusive club with a piano on the main floor lounge, elegant and cushy chairs, sleek chandeliers, and beautiful bouquets of flowers.

The hub provides a place to combat social isolation where members can just sit around and schmooze or play board games. They can also attend classes in everything from botany to French lessons to meditation.

Clubhouses don’t offer traditional therapy but focus on what they describe as “social practice” where members play a key role in their own recovery.

On Thursday, Gov. Kathy Hochul toured the center and met with members.

“Governor Hochul has prioritized transforming the mental health continuum of care, including a historic $1 billion investment in last years budget, and visited Fountain House to see their innovative model first-hand,” her spokesperson Avi Small said in a statement.

Because this model is widely touted as successful, the city’s Department of Health and Mental Hygiene last October issued a request for proposals (RFP) to find additional providers to boost total citywide clubhouse membership by another 3,750 individuals — with a goal to eventually get total enrollment to at least 10,000 people.

But everyone isn’t happy at this seeming expansion.

Although there are currently 16 clubhouse sites serving approximately 5,000 members, the Health Department in April only offered contracts for 13 locations under a reorganization plan by the Adams administration, meaning several pre-existing sites will likely have to shut down. City officials have said their goal is to operate new larger, sites, focused in high-need areas.

But the $30 million revamp has been chaotic and appears to be coming at the expense of nine of the pre-existing clubhouses, according to operators of those sites and multiple City Council members.

That’s because the added city funding is specifically earmarked for clubhouses with 300 or more members — a bar only three out of the 350 clubhouses in the world pass and just Fountain House in New York City.

Some have decided to expand while other clubhouses have said they will be forced to close in the next few months because they were ineligible for the new round of funds.

“The 300 minimum is not a universal clubhouse standard,” said Fountain House member Ann Kasper, who noted that standards were set in 1989. Clubhouses throughout the world average 109 members, according to the University of Massachusetts Chan Medical School’s Program for Clubhouse Research .

The Adams plan has also been widely criticized by 33 of the 51 members of the City Council. On June 20, they sent a letter to city Health Commissioner Dr. Ashwin Vasan, urging him to revamp the plan and restore funding for existing clubhouses.

“To avert a disastrous step backward for our city’s mental healthcare system in the midst of an already acute crisis, we are committed to keeping these clubhouses open,” the letter said. “We urge that funding be restored to these essential services for our most vulnerable and isolated New Yorkers.”

They are also worried the new plan may go against a local law passed in 2022 that forces the city to open at least five new clubhouses by the end of next year.

The City Council earlier this month allocated its own $2 million with hopes of sustaining five of the nine impacted clubhouses through the end of the fiscal year.

Vasan, who previously served as the Fountain House CEO from September 2019 to January 2022, has steadfastly defended the clubhouse restructuring.

“What we tried to do with this RFP is to invest in people who had interest, who had the ability to provide the services in the priority neighborhoods,” he testified before the City Council on May 13.

Vasan and his press office have also argued that all the current clubhouse providers were eligible to respond to the request for new operators but many didn’t.

“The providers that did not submit clubhouse proposals could not be considered to continue receiving funding for their clubhouse services through the re-procurement process,” DOH spokesperson Rachel Vick said in an email.

Asked about the criticism of the closures and 300 membership requirement, she responded by touting the clubhouse model and added, “Organizations that applied and committed to meeting this criteria were awarded contracts.”

Serving a Need

By all accounts, there’s a great need for added services for people with serious mental illness.

New York City is home to approximately 250,000 adults diagnosed with serious mental illness, according to the city Department of Health and Mental Hygiene.

A clubhouse expansion “ concept paper ” published by the department last June said the plan was to retain the 5,000 current members and “engage 10,000 additional new members within two years.”

The request for bids issued in October then said the Health Department was actually seeking “to actively engage at least 3,750 new active members in high need neighborhoods across NYC.”

Meanwhile, thousands of people with mental illness are currently locked up in city jails and living on the streets, based on city records and reports.

Currently, an estimated 40% of the 6,368 people in city jails have a mental health diagnosis, according to the Mayor’s Management Report.

An estimated 30% of the city’s street homeless population also have some type of mental illness, according to 2022 study Bronxworks , a nonprofit that assists people without housing.

Fountain House was started in 1948 as a community based alternative by a group of people inside the Rockland Psychiatric Center who initially called themselves We Are Not Alone

Upon their release from the hospital, they met up on the steps of a New York Public Library and came up with the idea of creating a safe space run by themselves and others with similar diagnosis. They bandied together to get funding to buy a building on West 47th St.

The emphasis has long been on jobs, education, and perhaps most importantly, friendship.

The setup has become the worldwide model for assisting people with mental illness by connecting them with a community of peers and giving them autonomy.

“Everything at the clubhouse is voluntary and centered around rebuilding a person’s dignity and self-efficacy, recognizing that our members have often been stripped of their agency in other more traditional, clinical settings,” said Fountain House spokesperson Minhee Cho.

There are now more than 350 clubhouses in 32 countries, according to Clubhouse International, the global organization which grew out of Fountain House in 1989.

Some measures of success are hard to gauge and often overlooked, said Dr. Jeanie Tse, Fountain House’s senior medical director. But she noted members have conducted in-house research to look at intangible metrics, like how clubhouse membership reduces loneliness and hospital visits..

“Measures that actually matter, not just how often does a member show up,” she said.  “We actually want to see an impact in their quality of life.”

Fountain House says it costs approximately $4,000 to provide services for each member annually. By contrast, that’s roughly the same amount it costs for a two day hospital stay for people experiencing a mental health crisis.

“The cost savings is enormous,” she said, noting that clubhouse members and some of the staff are routinely able to prevent their peers from being sent to a hospital for acute psychiatric care.

A 2016 New York University study showed that Fountain House members reduced Medicaid costs by up to 21% via reduced hospitalizations and emergency room visits.

Additionally, a report from Fountain House earlier this year argued clubhouses save the government $11,000 a person each year in everything from disability benefits, to repeated ER visits and criminal justice involvement.

Reaching Out, Reaching In

People seeking to join the clubhouse can apply online , in person, or via a hotline. They can also email jointheclub@fountainhouse.org .

The Fountain House enrollment team says they respond to everyone and can talk to health care providers to assist new applicants.

“We have some outreach too because not everyone finds us,” said Tse, noting they have a “recharge station” booth on West 45th Street and 7th Avenue, which is about three blocks from the 425 West 47th St. clubhouse itself.

“That becomes a way we meet people who would like to be here,” she said, noting they also do “in reach” at hospitals and shelters.

Last year, some 830 people applied and 500 were accepted, according to Cho.

Inside the clubhouse, members and staff are nearly impossible to distinguish.

During a visit on Tuesday, the Gregorian designed building was a beehive of activity with two ongoing classes and some people just lounging around and talking. A group was also busy putting together the clubhouse’s weekly newsletter with updates on advocacy, internal surveys, and future and ongoing classes.

Some members were also spotted sitting around a table or via zoom where they get help returning to college or completing high school degrees.

For many, their schizophrenic or depression symptoms first emerged when they are 18 to 24 years old.

“So that disrupts a lot of plans for school,” said Cho. “Their friends are going to college or getting their first jobs and they kind of feel left behind.”

The model doesn’t work for everyone all the time.

Tse said sometimes they are forced to send home members who show up drunk or high. But they also have a visiting program for members who are in the hospital.

For Arlene Lokomowitz the camaraderie has been a life saver.

“I really just feel like it’s just helped me blossom, and really gotten a lot out of it,” she said.

She became a member in March after she was hospitalized for around five months with severe depression.

She uses the gym on the top floor and is also part of multiple committees including the organization’s advocacy group. She’s also on the special programming committee.

“I’m busy with meetings. I don’t have much free time,” she said. “The days just fly by.”

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