The Clubhouse Model provides housing, employment, and job and social skills to those who wish to participate. A voluntary program, it is based on the philosophy that recovery from a mental illness must involve the person in a community offering respect, hope, and opportunity to access work, housing, education, and the friendship of others. Such a philosophy has become a "clubhouse culture" – a way of viewing mental illness and a framework for dealing with the human and social costs of caring for those disabled with mental illness. The model was established to counter the societal barriers that keep mentally-ill persons segregated from everyday life. The isolation many mentally-ill persons experience is believed to exacerbate disability. In contrast, Clubhouse serves to minimize disability and help people with recovery and rehabilitation.

The model has existed for over 50 years. The first facility based on this model is called Fountain House, (http://www.fountainhouse.org) located in New York City. Established in 1948, the program was set up as a club where people with mental illness could belong as members. The clubhouse culture that evolved is based on the notion that persons could participate in self-help activities and learn to live, work, and socialize in the larger community. The director of Fountain House, James Beard, developed a "therapy" over time that encouraged mentally-ill persons to participate in work activities – both at the clubhouse and eventually out in society. Fountain House staff negotiated with employers for jobs in the community. The staff guaranteed employers that the job would get done, either by the Fountain House club members or by the staff. The program differed significantly from traditional rehabilitation programs where clients participate in training programs or work in sheltered workshops. Work done through Fountain House was real – in the community for pay. Mentally-ill persons boosted their self-esteem and readiness to contribute to society. Workers learned job skills and habits required to keep their jobs. By the late 1970s, others in the mental health field sought to replicate the Fountain House program. Through a NIMH grant, many across the country received training. The terms "clubhouse model" and "transitional employment" were used to describe such programs. In 1994, an International Center for Clubhouse Development (ICCD) (http://www.iccd.org) was established to provide a network of programs throughout the world.

Current information on the Fountain House program is available in The Psychosocial Rehabilitation Journal – The Fountain House Model of Psychiatric Rehabilitation. The authors tress four important messages conveyed to every individual involved in the program: 1) Fountain House is a club and belongs to those who participate in it; 2) Members are made to feel that their presence is expected and their participation makes a difference to someone; 3) Programs are set up so that each member becomes a wanted and needed contributor; 4) All clubhouse activities are carried out jointly by staff and members working together – meeting the basic human desire to be needed. Two other beliefs pervade every aspect of the program: that even the most disabled psychiatric client has potential for productivity; and work and participation in gainful employment is a "generative and reintegrative force" for each person.

Further information on the transitional employment (TE) program is available in the paper, A Response to the Criticisms of Transitional Employment, (http://www.iccd.org/a_response_to_the_criticisms_of_.htm) as well as information on the current issue of Managed Care and Clubhouses.

Access the ICCD homepage (http://www.iccd.org) and locate the Clubhouse program nearest you. If possible, visit the program yourself or with your classmates and assess how it meets the needs of those in your home community.