One of the most enduring innovations in psychosocial rehabilitation began in 1948, in the basement of a New York City brownstone, with a small group of former patients of Rockland State Hospital. They called themselves WANA — We Are Not Alone — and they met to provide each other the friendship and structure that hospital discharge had not. A donor bought them a house with a fountain in the courtyard. The name stuck. Fountain House became the prototype for what is now a global network of more than 300 Clubhouses operating in over 30 countries.
A Clubhouse is a community-based, member-run organisation where people living with serious mental illness work side by side with staff to run the daily operations of the place — building skills, relationships, and the routine that recovery often requires.
The core idea
The Clubhouse rejects the patient/professional hierarchy that defines most mental health settings. Members are not patients; staff are not therapists. The work of running the Clubhouse — answering phones, planning meals, doing intake, writing the newsletter, managing finances, maintaining the building — is shared between members and staff in what is called the work-ordered day. The shared work creates relationships, builds skills, and provides a reason to show up.
Beyond the work-ordered day, Clubhouses run employment, education, housing, and wellness programs, plus social and recreational evenings, weekends, and holidays — recognising that loneliness on a Saturday night is one of the most underestimated drivers of relapse.
The 37 international standards
Clubhouse International maintains 37 quality standards that define what makes a Clubhouse a Clubhouse rather than a drop-in centre. Highlights include:
- Membership is voluntary and without time limits
- Members choose how they participate; nothing is mandatory
- Staff and members work side by side as colleagues, not as helpers and helped
- The Clubhouse is open at least 5 days a week and includes evening, weekend, and holiday programming
- The Clubhouse provides its own employment programs (Transitional, Supported, and Independent Employment)
- Members have the right to a meaningful relationship with staff
- The Clubhouse is not a clinical treatment program — it does not provide therapy, medication, or case management
The work-ordered day
The work-ordered day runs roughly parallel to a normal business day. Members and staff together perform the actual operational work of the Clubhouse organised into "units" — typically a clerical/administrative unit, a culinary unit, and an employment/education unit. Tasks are real, not make-work. Newsletters get printed. Lunch gets cooked and served. Stats get reported to funders. Members participate at whatever level they can, from a few minutes a day to a full schedule.
This sounds simple. The therapeutic mechanism is not. People who have been ill for years often describe the work-ordered day as the first place they felt useful since their diagnosis — which is the soil that recovery actually grows in.
Transitional, Supported, and Independent Employment
One of the Clubhouse model's most studied innovations is its three-tier employment program.
Transitional Employment (TE) places members in real, paid, part-time jobs in the local community — typically 15–20 hours a week for 6–9 months. The Clubhouse holds the contract with the employer and guarantees coverage if the member cannot work that day (a staff member or another member fills in). This removes the employer's biggest concern about hiring someone with serious mental illness and gives the member a low-stakes way to test their ability to work.
Supported Employment (SE) is longer-term competitive employment with ongoing support. The Clubhouse member holds the job in their own name; the Clubhouse provides coaching, problem-solving, and crisis support as needed.
Independent Employment (IE) is competitive employment without ongoing job support — the member has a job and the Clubhouse provides whatever ongoing membership they want.
The model has been studied extensively. Outcomes generally include higher employment rates than traditional vocational rehabilitation, longer job tenure, and lower hospitalisation rates among employed members. See also supported employment / IPS for the related evidence-based approach now common in mental health centres.
The evidence base
Research on the Clubhouse model is more limited than on some other interventions, partly because random assignment to "Clubhouse vs no Clubhouse" is difficult. The available evidence includes:
- Macias et al. (2006, Schizophrenia Bulletin) compared Clubhouse to PACT (an Assertive Community Treatment model) and found similar functional outcomes with greater satisfaction and engagement in the Clubhouse arm.
- Schonebaum et al. (2006) found significantly reduced hospitalisation rates among Clubhouse members compared to community samples.
- Multiple longitudinal studies have shown reductions in hospital days, increased employment, and improved quality of life with sustained Clubhouse engagement.
The model's strongest claims are around community integration, vocational outcomes, and the reduction of social isolation — domains where conventional clinical treatment often performs poorly.
Where Clubhouses are
There are over 300 accredited Clubhouses in more than 30 countries. The US has roughly 200, with concentrations in New York, Massachusetts, Michigan, and California. Significant numbers exist in Sweden, Finland, the UK, South Korea, and Pakistan. Clubhouse International keeps a directory at clubhouse-intl.org.
Who Clubhouses are for
Membership is open to adults with a history of mental illness — typically schizophrenia, schizoaffective disorder, bipolar disorder, or major depression. There is no charge to members. Membership is for life; people can come for a year, leave, and return ten years later without re-applying. This stability is itself part of the model.
How a Clubhouse compares to other settings
A Clubhouse is not a treatment program (no therapy, no medication management). It is not a drop-in centre (the work-ordered day is structured). It is not a sheltered workshop (the work is real). It is not a peer support program in the traditional sense (staff are usually not in recovery). It is its own thing — a community that provides what hospitals and clinics typically cannot: a place to belong over a long arc of time.
How to find one
The directory at clubhouse-intl.org is the easiest place to start. Many community mental health centres have referral relationships with local Clubhouses. NAMI affiliates often know which Clubhouses operate in a region.
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.