- [Jeff] Welcome to "Healthy Minds."

I'm Dr. Jeff Borenstein.

Everyone is touched by psychiatric conditions, either themselves or a loved one.

Do not suffer in silence.

With help, there is hope.

(soothing music) Today on "Healthy Minds."

(soothing music) - It's amazing and frustrating and maddening how when people start to have mental health struggles, their life is so disrupted, and they become so disconnected to the things we all take for granted.

I think you can't underestimate the powerful effects of isolation that mental illness causes.

And it's rare, if I spend time in a clubhouse, where two or three or more members don't say to me, "This place means everything to me.

Without my clubhouse, I'm not sure I would be here today."

- That's today on "Healthy Minds."

This program is brought to you in part by the American Psychiatric Association Foundation and the John & Polly Sparks Foundation.

(soothing music) There are clubhouses throughout the United States and around the world.

These are membership organizations that provide support for people living with mental illness.

Joel, thank you for joining us today.

- Thank you for having me.

- I wanna jump right in and ask you, what is Clubhouse International?

- Well, thank you.

Clubhouse International is an organization that is dedicated to ending social and economic isolation for people living with mental illness.

The way that we do that is we work with communities, cities, and towns around the country, and in fact, around the world, to create a local community center, an organization, called a clubhouse.

A clubhouse, it's an opportunity center for people living with mental illness.

It is a psychosocial rehabilitation program that's designed to give people living with mental illness a place to belong, a place where they're needed and wanted and expected every day, but it is a structured organization that is full of opportunities.

Opportunities to get help with accessing needed healthcare, help with employment or going back to school, building a social network, help with housing or transportation, or anything someone living with mental illness might need.

Jeff, as you know, people living with mental illness are often disenfranchised and marginalized and in fact become invisible to the rest of the community.

And they lose a lot of the things that we take for granted, like opportunities to go to to work or friendships, or someone who cares about them on a daily basis, cares what they're doing.

So the clubhouse, it's a social support program designed to give people all those things they need in addition to healthcare to be successful in the community.

- Basically, the premise is that in addition to medication, therapy, the social interactions, the decreasing isolation, not having isolation is, in many ways, the most important aspect of somebody regaining their health.

- Without a doubt.

In the clubhouse world, although we don't provide, you know, psychiatric treatment or therapy in the clubhouse, we help our members access what they need.

You know, most need some kind of psychiatric service and some kind of healthcare or therapy.

But medication alone, you know, is not enough.

It's not enough to help people regain control of their lives and reenter and participate in their community as full citizens.

So what happens at a clubhouse is we create an intentional community where people living with mental illness come.

They're referred to as members.

A clubhouse is a membership organization.

It's entirely voluntary.

But someone can come and participate as little or as much as they want to.

We believe that everybody living with a mental illness, regardless of how challenging their circumstances are, has the potential to contribute to a larger community, but also has the potential to recover and live a personally satisfying and meaningful life.

And so at the clubhouse, we've created this environment that is always welcoming.

And you know that people with mental illness are often not welcomed in a lot of places for a variety of reasons.

But at the clubhouse, once you're a member, you're always a member, and you're always welcome to be there and to participate in the way that makes sense to you.

So some people when they come to us, you know, they may not be at their best, so they may just need a safe place to be and have a cup of coffee and talk to somebody in the community.

But the clubhouse offers a lot more than that.

You can come and just have the cup of coffee if you want to, but the clubhouse is kind of a sophisticated opportunity system.

It's organized around a structured workday, so people contribute back to the community.

It might be making meals, it might be making phone calls or giving tours, or advocating for mental health services in the community, helping members, supporting each other, going back to work or school.

There's an evening weekend social and recreational program that helps people rebuild their social network.

So throughout the course of the day and the week, there's lots of opportunities for people living with mental illness, clubhouse members, to begin to participate again with others and to set goals and to return to those things that are important to them.

Employment is a cornerstone of the clubhouse model.

Every clubhouse has a robust employment program providing members with repeated opportunities to go and work in the community at community businesses for the prevailing wage.

And the clubhouse provides tremendous, tremendous amounts of support to members as they return to work.

The same is true with school.

So a good way to think about it is it's an opportunity center for people living with mental illness, where there's a small professional staff, but the bulk of the work is done by members and staff together.

So people who are living with mental illness who might not have been expected to do much of anything are asked to contribute their skills, their talents, their energies.

And again, it's voluntary, so people do what they want to, but what happens is the clubhouse becomes this incredibly welcoming place where people want to be there.

As their life goes and they want to go back to work, or they wanna go back to school, or they wanna make new friends, or they want to try something new, like, maybe, you know, getting involved with technology or putting out a newsletter or public speaking, they're given the opportunity to do that.

And the clubhouse creates this environment where people can begin to see themselves as contributors.

Again, contributors back to the clubhouse community and to the larger community.

Does that make sense?

- Makes a lot of sense, and especially the aspect of collaborating, working together, with peers, with other people who are living with a mental illness, and both as a role model to say, "Hey, look, this is what I've accomplished.

You can also."

and as a support system.

It makes such a big difference in people's lives.

- Well, that's absolutely right.

You know, what we understand is that a mental illness diagnosis does not define the person entirely.

And at the clubhouse, we look at the whole person, and we know that everybody has talents and skills and potential.

And we focus on that.

We focus almost no time at all in talking about someone's mental health diagnoses or their treatment or those kind of problems.

We focus on getting people involved and participating and doing things and giving people a chance because, you know, we take sort of a holistic view of a person and, you know, invite them into the community.

But the reason it's so successful is because we create a community.

People belong to a community of other people where everybody is committed to creating success for each other and for the organization.

And that's a powerful vehicle for recovery.

Work-mediated relationships are restorative and image enhancing, and people have an opportunity to try new things and to see themselves as participants in life again.

And what we have been doing now for the last 27 years is working community by community and town by town to find people who are interested in doing more for people living with mental illness.

And so today there are 335 clubhouses in 32 countries around the world.

200 of them, maybe a little more than 200, are in the United States.

Every year, clubhouses around the world reach about 100,000 people now.

But of course, that's not nearly enough.

We are very, very aware that, you know, there are 450 million people in the world struggling with a mental disorder.

And there are many, many people living with serious mental illness, many more than we're reaching now.

So it is our mission to keep growing this way of working around the world.

So we are always looking for community leaders, leaders in community mental health, family members, peers, people with lived experience of mental illness who are interested in helping to create a clubhouse in their community.

Today, we've seen about 12 to 15 new clubhouses open each year for the last three or four years, and we're gaining momentum.

Part of the reason we're gaining momentum is because clubhouse works.

And there's plenty of evidence.

There's many studies that show some significant outcomes for people.

For example, improved quality of life, as reported by members and those who care about them and those who provide services to them.

But also, clubhouses help people return to school.

We have a very good record helping people return to school.

Reducing the need for hospitalization or the use of emergency services.

Reducing criminal justice system involvement.

And employment is probably one of the most impressive outcomes with clubhouses, where in this country, people in the public mental health system, who are living with a mental illness, the employment rate is about 15%, or another way to say that is 85% unemployment.

But at accredited clubhouses for the last 15 years or more, clubhouses have maintained a 42% employment rate for members who are coming to the clubhouse on a regular basis.

And, you know, most people, most adults would prefer to be working and contributing and making an income and being part of something larger than themselves.

And so employment is a key goal for many people with mental illness.

Therefore, it's a foundational piece of what we do.

- When a community starts a new clubhouse, how does that work?

What do they do?

- The first probably most important thing is for a group of people to come together.

It's usually three to six people.

You know, usually there's one fire soul, you know, who says, "We have to do this.

We have to bring a clubhouse to our community."

And they gather other people.

In the United States, it's often people who are family members associated with the local National Alliance on Mental Illness who reach out to us and say, "Hey, how do we bring a clubhouse to our community?"

The first thing we do is we help them learn exactly what a clubhouse is because it is a bit of a different way of working than most community mental health services in that it's entirely voluntary, and that we rely heavily on the contributions of members to make the entire place work.

And so we help people understand what a clubhouse is.

And then Clubhouse International has a series of training programs, first to help community leaders learn what a clubhouse is, find other people to help them and design and build the clubhouse, either as a free-standing, not-for-profit organization, or as part of a larger sponsoring organization that provides other services.

But when you get involved with Clubhouse International, we help you by giving you all the information you need to understand what a clubhouse is, how to start a clubhouse, and we give you a mentor who works with you for a year or more with your group to begin to find the ways.

How do you find the funding?

How do you find the building?

How do you get other community leaders to support what you're doing?

How do you build a board of directors?

And then we have a formal training program that's ongoing training for clubhouse members and staff.

So once you've started, there's an incredible support system.

In the United States, there are five clubhouses that are very strong clubhouses that are training centers and train members and staff and give them action plans and work with them to help create a clubhouse community in their town.

- I think one of the keys is that there is this training and ongoing support so that the level of excellence of each clubhouse is built and maintained so that the clubhouse is successful for their members.

- Well, Jeff, you're absolutely right.

One of the most important parts of Clubhouse International's work is managing the international standards for clubhouse programs.

There are 37 best-practice standards developed collectively amongst clubhouse members, staff, board members, and volunteers and updated every two years that define the best practices of a clubhouse.

And our training program and our accreditation program are anchored in those standards that call on a clubhouse to have a strong employment program, to make sure that members of clubhouses are significantly involved in the design and management and planning of the clubhouse and the services and supports that are provided.

Membership is voluntary and for life.

So once someone joins a clubhouse, they're always a member of that clubhouse.

Again, they can come and go as as much as they want to, but you don't get too sick or too healthy to be a member of a clubhouse.

- What's a typical day like?

You mentioned some people may come in for a cup of coffee, and that's sort of their day.

But for people who are more involved, what's a typical day like at a clubhouse?

- Clubhouses are organized around something we call the work-ordered day.

So typically during the week, it's typical working hours in the United States.

It's, you know, nine to five, Monday through Friday.

And during that time, the clubhouse is organized into working sections, or what we call units, where, you know, if you bring a lot of people together, then you have to provide food.

You know, so there's a dining room, and there's a kitchen staff.

There's the employment program.

So part of the clubhouse is organized around helping members who want to go back to work find those jobs and support them as they go back to work.

The same is true with school.

Most clubhouses have a newsletter and maybe a television show or a social media presence.

There's a reach-out program, which is an incredibly important part of the clubhouse, where members and staff keep track of all the members, either through social media or phone calls or visits or cards, just to continually let people know that they're wanted, they're expected, and there are people who care about them.

And that goes on on a daily basis.

Helping people access the healthcare and social services they need on an individual basis.

Educating the rest of the community about what the clubhouse is and how it works.

Maybe it's visiting the hospital and telling people there, or going to the local community mental health center and describing those services.

Of course, you have to take care of your building, so there's facilities and maintenance.

There's someone who has to operate reception.

All of these opportunities to work together with other people, members and staff working together.

Staff are not there to provide treatment to members or to teach members.

People work together as colleagues.

So if you come to the clubhouse in the morning, you might come in and have a cup of coffee and talk with some of your friends, and then there'll be a meeting in the morning that organizes the work for the day.

People volunteer for what it is they want to do and how they want to participate in the clubhouse.

And then throughout the course of the day and the course of the week, there's a highly structured program where multiple things are going on around the clubhouse that are work related.

There's not talk therapy, there's not arts and crafts groups, there's not social programming during the day.

Like everybody else in the community, in the business community, there's work going on at the clubhouse.

But in the evening and on weekends and on holidays, we think it's important if you're gonna work together and build a full and rich and successful life that, you know, having social relationships and having fun is important too.

So every clubhouse has an evening, weekend, and holiday social and recreational program.

Clubhouses are sort of, again, they take a holistic approach.

And it's kind of a comprehensive wraparound service for the kinds of social support people living with mental illness need.

- What are the ages?

What's the age range of people who are able to be members?

- The average clubhouse in this country are for people 18 years and older, adults.

Some clubhouses have begun to lower that age and to work with folks a little bit younger than that.

A lot of clubhouses are creating new and innovative services, reaching out to people who are young adults from 18 to 35.

But the average clubhouse, you know, has members of all ages.

And again, there's so many opportunities.

There's something for everyone.

So if you're older and maybe you're not going back to work, but you want to be part of something and you want to contribute, you might work at the clubhouse.

If you're younger and you've had your education disrupted, you may be mostly focused on getting back to school and getting tutoring and help with with the disability office there and getting through the rest of your degree.

- I think the opportunity for education, especially younger people, who their illness might interrupt their progress through education, whether it be high school or college, is a very important opportunity as people regain their health.

- Without a doubt.

You know, Jeff, it's amazing and frustrating and maddening how when people start to have mental health struggles, their life is so disrupted, and they become so disconnected to the things we all take for granted.

You know, being able to participate at school.

You know, having friends, having money in your pocket.

You know, those things often go away.

And so when you're young, if there's this opportunity center where you can belong and begin to rebuild those pieces.

I'm fortunate that I get to visit a lot of clubhouse.

And it is rare if I spend time in a clubhouse where two or three or more members don't say to me, "This place means everything to me.

Without my clubhouse, I'm not sure I would be here today."

I think you can't underestimate the powerful effects of isolation that mental illness causes.

And the way that we see it is, you know, isolation leads to desperation.

And desperation can often lead to bad things, all kinds of bad things.

So if we can create a place where people living with mental illness and mental health issues can come and get the support and be given the constant message that they're wanted, needed, and expected, we can change the whole ballgame.

And, you know, it's interesting, clubhouses are by far more cost effective than many other community mental healthcare services that are provided out there.

You know, there is a staff, there is a building, but on average, you know, clubhouses cost a lot less than some of the just sort of more structured, community mental health treatment type services that we've had.

And again, clubhouse aren't in competition with them, they just work alongside them.

But for a relatively small investment, a community can in fact change the future for, starting with, you know, dozens and hundreds, and over decades, thousands of people, you know, and reduce, you know, some of the problems that we see in community related to mental illness: homelessness, poverty, overburdening the healthcare and the criminal justice system and the emergency rooms and psychiatric hospitals.

You know, so a clubhouse program to me is just a no-brainer.

You know, our vision is that one day clubhouses will be as commonplace in communities as Boys & Girls Clubs and YMCAs and senior centers, because every community in the world has people living with mental illness.

Mental illness is everybody's business.

And if we can provide the reasonable accommodation, the necessary support to help people overcome these social problems that come along with a mental illness in addition to the healthcare they need, we can change the world.

We can change the world for people for a long time to come for millions of people.

- Joel, it's so clear how passionate you are about this.

How did you get into this position?

How did you get involved with Clubhouse?

- You know, I was a young man, and I wanted to work with people, and I had a couple of social service jobs.

And I took a job at a state hospital.

And as a young man, I couldn't believe that people were ill and living in these giant hospitals and living there for long, long periods of time, sometimes years.

And in a way, we were treating people more like prisoners than patients.

And I was just struck by it.

And I got involved with, you know, helping people get their lives back together and move out of the hospital, helping to try to provide services.

And then, you know, early in my career, I discovered, I was led to my friends and colleagues to a program called Fountain House in New York City.

Fountain House was the first clubhouse and is still operating.

It's the largest clubhouse in the world and doing many wonderful things in the arena of mental health.

But I learned this model, and I saw something very different.

I saw that people were treated with dignity and respect and a fundamental belief in their potential, and I just got captured by it.

I went back to my hometown in Hyannis, Massachusetts and created a clubhouse, and working with my agency, we opened two or three more.

And eventually, the need came, I was working with Fountain House, the need came to create an organization that was gonna promote this way of working and help support clubhouses in terms of quality and growth and development.

And I was invited to come work at Clubhouse International.

I've been the director since 1997.

- Joel, if somebody's watching right now, and they're living with a mental illness, and they're isolated and alone, or a person's family member is in that situation, what do you say?

How do you encourage somebody to really take advantage of the benefits of being a member of a clubhouse?

- Well, you know, I wish there was a clubhouse in every town, and I could say, "Just go to your local clubhouse."

And we have, you know, over 300 clubhouse, over 200 in this country.

The first thing I would say to them is there is hope that you or your loved one can recover and live a personally satisfying and successful life with friends and family and work and decent, dignified housing.

All of those things, you know, it can get better.

And I would steer them to our website.

There's a wonderful directory on our website.

It's an interactive map where you can scroll over cities and towns and see where clubhouses are throughout the United States and throughout the world.

And all the contact information is there.

And one thing each of our clubhouses really loves to do is to show other people what we're doing.

And so it's very easy to get a tour of a clubhouse.

You just call and let them know you want to come by, and they'll tell you when to come by for a tour.

And members and staff of the clubhouse will show you how it all works.

And, you know, there are a lot of clubhouse in the United States, so it's really pretty easy to find them.

And if, you know, if you struggle with using a website to try and find the things, it's really easy.

You can search by city or by state or by country or by name.

But if you struggle with that, you can just call us.

Call us at Clubhouse International, and we'll help you locate the closest clubhouse.

- Joel, I want to thank you for all the work you do and the team does and the members do.

And thank you for joining us today to really share this important vision and accomplishments that Clubhouse has had and will continue to have over the years.

Thank you.

- Thank you, Jeff.

It's a pleasure to be here.

(soothing music) - One of the greatest challenges for people living with mental illness is isolation.

Don't suffer in silence alone.

Don't try to go it alone.

Make use of support services such as Clubhouse to move forward with your life and reach your fullest potential.

Remember, with help, there is hope.

(soothing music) Do not suffer in silence.

With help, there is hope.

This program is brought to you in part by the American Psychiatric Association Foundation and the John & Polly Sparks Foundation.

(soothing music) (soothing music continues)