In 1948, Fountain House pioneered the clubhouse model of community-based rehabilitation in New York City. As of 2008, more than 400 such clubhouses have been established in 32 countries throughout the world by Fountain House. Fountain House is an “intentional community” based on the belief that men and women with serious and persistent psychiatric disabilities can and will achieve normal life goals when given opportunity, time, support, and fellowship. The essence of membership in the clubhouse is based on the four guaranteed rights of members:
· A place to come to
· Meaningful work
· Meaningful relationships
· A place to return to (lifetime membership)
The clubhouse model provides members with many opportunities, including daytime work activities focused on the care, maintenance, and productivity of the club-house; evening, weekend, and holiday leisure activities; transitional and independent employment support and efforts; and housing options. Members are encouraged and assisted to use psychiatric services, which are usually local clinics or private practitioners.
The clubhouse model recognizes the physician–client relationship as a key to successful treatment and rehabilita-tion while acknowledging that brief encounters that focus on symptom management are not sufficient to promote rehabilitation efforts. The “rehabilitation alliance” refers to the network of relationships that must develop over time to support people with psychiatric disabilities and includes the client, family, friends, clinicians, and even landlordsemployers, and neighbors. The rehabilitation alliance needs community support, opportunities for success, coordina-tion of service providers, and member involvement to maintain a positive focus on life goals, strengths, creativity, and hope as the members pursue recovery. The clubhouse model exists to promote the rehabilitation alliance as a positive force in the members’ lives.
The clubhouse focus is on health, not illness. Taking prescribed drugs, for example, is not a condition of par-ticipation in the clubhouse. Members, not staff, must ulti-mately make decisions about treatment, such as whether or not they need hospital admission. Clubhouse staff sup-ports members, helps them to obtain needed assistance, and most of all allows them to make the decisions that ultimately affect all aspects of their lives. This approach to psychiatric rehabilitation is the cornerstone and the strength of the clubhouse model.