In 1948, six former patients of a New York state psychiatric hospital began meeting on the steps of the New York Public Library. They called themselves WANA — "We Are Not Alone." Three years later, with help from a small grant, they bought a townhouse on West 47th Street with a fountain in its garden. They named it Fountain House. Three quarters of a century later, the small experiment that began on those library steps has grown into Clubhouse International, a global network of more than 300 accredited Clubhouses across roughly 30 countries.
A Clubhouse is a member-driven community of people living with serious mental illness, organised around a shared "work-ordered day" and pathways to employment, education, housing, and friendship.
What a Clubhouse is — and is not
A Clubhouse is not a treatment program. It is not a clinic. There is no diagnosis or symptom-tracking on the front of the door. People who come are called members, not patients. There is no fee. Membership is voluntary and lifelong — once a member, always a member, regardless of how many years pass between visits.
The work of running the Clubhouse — answering the phones, writing the newsletter, managing the kitchen, doing data entry, planning outreach — is shared between members and a small staff. This is the heart of the model. Everyone in the building has something to contribute, and the day is organised so that those contributions are visible and necessary.
The work-ordered day
A typical Clubhouse divides into work units. A culinary unit makes lunch for 80 people every day. A clerical unit handles records, communications, and reception. An education and employment unit runs the supported employment and education programs. Members and staff work side by side. There are no member-only or staff-only tasks. The point is not to "train" members for outside jobs (although it often has that effect) — the point is that the work is real and that people who do it together build relationships.
Transitional, supported, and independent employment
Clubhouses pioneered transitional employment: a job in a real outside business, lasting six to nine months, in which the Clubhouse guarantees coverage. If the member can't make it on a given day, a staff member or another member fills in. This removes the employer's biggest fear. Transitional employment is described in detail in our transitional employment article.
Beyond transitional jobs, Clubhouses support members through supported employment (jobs the member holds independently with Clubhouse coaching available) and independent employment (jobs the member chooses, with optional drop-in support). Many Clubhouses also run supported education programs in partnership with local colleges.
The international standards
Clubhouse International maintains 37 International Standards that define what counts as an accredited Clubhouse. These standards govern the relationship between members and staff (always equal partners), the role of the work-ordered day, the requirement that the Clubhouse have its own dedicated space, and the prohibition on coercion. Accreditation is reviewed every three years. Programs that drift from the standards lose accreditation.
What the evidence shows
Research on the Clubhouse Model includes naturalistic studies, quasi-experimental designs, and a smaller number of randomised trials. Findings consistently include:
- Lower rates of psychiatric hospitalisation among Clubhouse members compared with matched controls.
- Higher rates of competitive employment, particularly for members in transitional employment placements.
- Improvements in social functioning, quality of life, and reductions in self-stigma.
- Lower mortality in long-term follow-up — driven mostly by reductions in suicide and substance-related deaths.
Compared with IPS, the Clubhouse Model has produced lower competitive employment rates in some head-to-head studies, but better engagement, longer membership tenure, and broader effects on the rest of life. The two models are increasingly seen as complementary rather than competing.
Beyond Fountain House
Today there are accredited Clubhouses in cities such as London (Mosaic), Boston (Genesis Club), Helsinki, Seoul, Mumbai, and São Paulo. Each is locally governed but follows the same standards. Members travelling internationally can visit any accredited Clubhouse and immediately participate, which is one of the more remarkable features of the network.
What a first visit looks like
Most Clubhouses welcome drop-in visitors. A typical first visit involves a short tour, a meal in the dining room, an introduction to a current member, and an invitation to come back. There is no intake interview, no symptom assessment, no requirement to commit. The deliberate informality is part of the philosophy: people who have been processed by the mental-health system for years often need a place that feels less like a system.
Funding and access
In the United States, many Clubhouses are funded through Medicaid (often via Psychosocial Rehabilitation billing codes), state mental-health authorities, foundation grants, and private donations. Membership is free to the individual. In other countries, funding mixes vary — the UK relies on local authority commissioning, Scandinavia on national health systems, and many Clubhouses worldwide on private philanthropy.
Limitations and critiques
Clubhouses are not for everyone. Some members find the daily structure overwhelming or the social demands uncomfortable. Geographic access is uneven — most are in cities. The model depends on a critical mass of members and committed staff; small or struggling Clubhouses can lose momentum. Critics also note that the work-ordered day, while genuinely useful, sometimes substitutes for outside employment rather than leading to it.
Clubhouses are not crisis services. If you or a loved one are in crisis, call 988 in the US or your local emergency number. Once stable, a Clubhouse can be one of the strongest long-term recovery supports available.
How to find one
Clubhouse International maintains a global directory. NAMI affiliates often know which local programs exist. State and county mental-health authorities can refer.
The bigger idea
Fountain House began as a refusal — a refusal to be defined by hospitalisation, a refusal to be alone, a refusal to be unimportant. Three quarters of a century on, that refusal has become a model of community recovery that has outlasted countless treatment fashions. For many people, the Clubhouse is the place where they stop being a patient and start being a colleague again.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.