People with Serious Mental Illness Find Community in a Clubhouse

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In a spacious sunlit room on a midsummer day, 11 people are gathered at San Francisco’s Westside Community Services, one of the nation’s oldest community mental health providers. Everyone is watching staff member Marcellus Ducreay demonstrate the preparation of his cherished black bean salad recipe.

But this gathering is about much more than a delicious meal. It’s one of many weekly activities for Westside clients who are working with clinic staff and other professionals to create a special community for people with serious mental illness. The model, which originated decades ago in New York, is called a “Clubhouse.” This one will be for Westside clients with both serious mental illness and substance use disorders.

Phyllis, one of the participants, is interested in leading a book group that focuses on the works of Black authors like Terry McMillan, Maya Angelou, and Langston Hughes. She enjoys the camaraderie she finds among her peers. “I have a place where I can come and be myself,” she said. “I don’t have to worry about someone judging me.”

“If today I feel like singing, hopefully, we’ll sing, and tomorrow, if I feel like the Wicked Witch in Oz, [that’s okay] as long as I don’t pull my cane up and start putting spells on people,” she continued to laughter from her peers. “We have the freedom here to laugh, to care about each other, to enjoy each other’s company.”

Other participants echoed Phyllis’ comments, expressing their desires to form a community that helps them feel more comfortable socializing and enables them to make new connections to ward off loneliness — a major health risk for people with serious mental illness.

Attaining a measure of freedom from the stigma and loneliness that often shadows people with serious mental illness was among the goals set by the founders of the first Clubhouse in the late 1940s — a group of former psychiatric patients who would meet on the steps of the New York City Public Library. They joined with volunteers and mental health professionals to create what would become Fountain House.

They did so, said Fountain House CEO Ken Zimmerman, “based on their common experience that being institutionalized had been the most traumatic thing that ever happened to them.” From those meetings, “they realized that they needed each other’s company, but even more, they needed community,” he continued.

We have the freedom here to laugh, to care about each other, to enjoy each other’s company.

—Phyllis, Clubhouse participant

Collaboration is foundational to the Clubhouse model. Participants, known as members, work in concert with staff to design the community, collectively determining what it will offer instead of being presented with a menu of activities. Decisionmaking is done by consensus, and on “work-ordered days,” members join staff to complete all kinds of Clubhouse jobs.

Social, wellness, and skill-building activities are available during the week, as well as on holidays and weekends, when other community-based programs may be closed. Members also receive support in searching for employment and housing if needed.

Research shows that Clubhouses improve members’ health. Today there are 320 Clubhouses in 34 countries, which together reach 100,000 people each year. About 20 of these programs are in California.

Many Clubhouses are privately supported and tend to be in higher income areas. That’s what makes Westside, located in San Francisco’s South of Market district, different. Its Clubhouse would be attached to the clinic, which is situated in a historically underserved neighborhood, to better care for its patient base of primarily Black and Latino/x patients with low incomes.  In Los Angeles, the County Department of Mental Health is also developing a Clubhouse for people experiencing mental illness and homelessness as part of its Hollywood 2.0 initiative.

“It really is just cultivating a social life for people that we think is important for their recovery,” said Mary Ann Jones, PhD, CEO of Westside. Services that shore up social connections for people with serious mental illness have historically lacked Medi-Cal funding, she said. But the California Department of Health Care Services’ BH-CONNECT proposal to the Centers for Medicare & Medicaid Services could change that by allowing coverage for Clubhouses and building a robust continuum of community-based behavioral health care services.

Lives Transformed

Jones, who previously served as a clinical director for Clubhouses in Alameda County, had reservations when she first heard about them, but is now a big fan. “I came from a medical model, and honestly I didn’t think that peers could run programs and have a place to be where they didn’t need clinical supervision,” she said. “But when I worked in those programs, I saw how much [they] transformed the lives of the people who participated.”

Her enthusiasm for the model is backed by a body of research showing that Clubhouses improve quality of life and health outcomes for people living with serious mental illness. A recent study in the Canadian Journal of Community Mental Health, for example, found that psychiatric hospitalizations for 656 Clubhouse members dropped by more than half after they joined the program. And the longer that members participated, the study found, the less likely they were to be admitted to inpatient psychiatric care. While 44% of recent enrollees were hospitalized, the hospitalization rate was 21% among those enrolled in a Clubhouse for at least 13 years.

Westside now has a core group of around 24 members and staff working with Wendy Everett, ScD, and Sheila Fifer, PhD, of Atlas Clarity to design a pilot. CHCF is supporting this work.

When Fifer and Everett asked members how they would know that the Clubhouse was working for them, “they said things like having friends, having contacts, feeling comfortable talking with other people,” said Fifer. “Mostly, it’s about having a safe place to be during the day, being able to get out of wherever they live and be someplace safe, having people they can talk to who don’t treat them like they’re weird.”

Leslie Roberts, a Clubhouse member in nearby San Mateo County, attests to the value of participating. Before she joined her Clubhouse two and a half years ago, she could barely get out of bed. “It was a lot of rumination,” said Roberts, who reports she has bipolar disorder. “You could be just sad or paralyzed because you’re so overwhelmed with life. Everyone can have that, but we just have it more.” When she first joined the Clubhouse, Roberts said she was hardly able to speak because she hadn’t been social for a long time. “It was a matter of opening myself up to get to know people,” she said, explaining how helpful it was that people were so welcoming. “I just jumped in. I just love it. I absolutely love it.”

Activities and Outings

Since they began planning their Clubhouse in March, members of the Westside group have drawn up a list of activities that interest them, including guitar jam sessions, cooking, and making collage artwork. In addition to the black bean salad demonstration, they have enjoyed some boisterous karaoke singing, prepared lunch together, and heard experts speak about patient advocacy and the interactions that result when people use both street drugs and prescription medications. Outings to a pottery studio and the San Francisco Symphony are coming soon.

Having a regular place to go and socialize is important to Ayana, a member of the group with stylish green, yellow, and magenta hair who has studied film, makes music videos, and hopes to one day make a feature-length movie. “Interacting in a group helps put some structure to my day, my week,” she said. “And it’s sort of an accountability thing to show up and be present.”

Ducreay, who prepared the bean salad and is a project leader for Westside’s African American Health Collaborative, beamed as he observed the Clubhouse members engaging in animated conversation while one participant played guitar in the background. When they’re not here, he said, many of Westside’s clients are outside, where they too often “experience all kinds of trauma, whether it’s people, whether it’s assault.” Within this group, 20% of the members are experiencing homelessness, and 20% were recently released from jail or prison.

The Clubhouse provides a meaningful alternative to its members, said Ducreay. “You’re able to say, ‘Come see me at the Clubhouse.’ And they come and they’re like, ‘Wow, there’s people I know. And it’s so calm.’”

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