Program Helps Mentally Ill Regain Productive Lives
There’s a revolution going on with regard to the seriously and persistently mentally ill, and it’s not happening at a university or a research clinic; rather, it’s going on near Times Square at the innovative nonprofit Fountain House.
Fountain House is the winner of APA’s 1999 APA Gold Achievement Award for small, community-based programs. It is the model for 370 programs throughout the world, and last year Fountain House trained more than 100 individuals with mental illness and staff from similar organizations, known as "clubhouses." In 1996 the National Alliance on Mental Illness presented Fountain House with the Philip and Sarah Francoeur Services Award. The award is given to an organization that made significant contributions in providing housing or other needed services to individuals with brain disorders.
Since its inception in 1948, Fountain House has helped 16,000 individuals with serious and persistent mental illness, mostly schizophrenia, reach incremental education and work goals. In those 51 years, Fountain House has assisted approximately 6,000 people working at transitional (that is, part-time, temporary) and full-time jobs.
In addition, Fountain House operates seven 24-hour staffed supervised residences in Manhattan, housing 150 people. The House also provides supportive housing services—but not 24 hour staffing—to another 300 members who live in subsidized housing throughout the five boroughs. Funding is provided by the New York State Office of Mental Health.
Because the clubhouse philosophy emphasizes mental well-being, not illness, psychiatric services are not directly administered at Fountain House, but rather are administered off site by Ralph Aquila, M.D., who works for St. Luke’s-Roosevelt Hospital Center and is a consultant for Fountain House. In fact, Fountain House participants don’t have to take their medication or go to therapy. However, they must meet certain behavioral requirements and, this, in reality, requires that they take medication and receive therapy.
These individuals, who are called "members" not "patients," have a free lifetime membership at Fountain House, where the motto is "We Are Not Alone." They first learn job skills by volunteering to work side by side with paid staff on tasks necessary for Fountain House’s operation—everything from creating newsletters to preparing meals. A member even approves most staff appointments, and three members are on its board of directors.
Many members move on to paid part-time, temporary jobs at corporations and then graduate to full-time, permanent positions.
Does This Approach Work?
What kind of program has those with mental illness working side by side with the staff in a team atmosphere? It is called a clubhouse, and Fountain House is the nation’s first. It was founded by former patients of Rockland State Hospital, Elizabeth Ker Schermerhorn, Hetty Richard, and others.
Fountain House serves more than 1,200 members annually. In 1997 and 1998, the average daily attendance was 300 members. Furthermore, 380 members earned more than $400,000 working at part-time employment lasting six to nine months. These positions were arranged and supervised by Fountain House employees at 40 companies, including Estee Lauder, Ernest & Young, LLP, Fox Television, and American Express Publishing. In addition, Fountain House helped 150 members secure full-time, permanent jobs, earning more than $1 million.
Kenn Dudek, Fountain House’s executive director, put these numbers in perspective. He noted that the average employment rate for people with severe mental illness is 0 to 15 percent and that many Fountain House members had been told they would never be able to work at all.
In addition, Fountain House helps members achieve educational goals: Currently, there are 20 members studying for their high school equivalency diploma or taking vocational or community college programs. Forty-five are enrolled in four-year colleges, including Empire State College, New York University, and the City College of New York at Brooklyn, Queens, and Lehman.
"Fountain House is at least as effective as case-management approaches, but costs less: The average annual cost for each member is $23,500, including clubhouse services, housing and outpatient psychiatric services, whereas case-management approaches typically cost twice as much," said Dudek. Without housing, the cost per member drops to only $7,000 annually.
Members Stay Involved
Why do members show up at Fountain House every day? One reason is that the six brownstones at 425 West 47th Street are beautifully appointed, not at all institutionalized. Floral arrangements decorate roomy areas, the furniture is stylish and comfortable, and outdoor gardens beg for a few moments’ pause. Although "work" is the cornerstone of the program, Fountain House offers humanizing touches that make its members feel valued: a coat check, inexpensive meals, haircuts, on-premises bank accounts, working vacations at Fountain House’s New Jersey farm, and mailboxes, which are especially important for members who are homeless. And for those pursuing educational goals, Fountain House often pays for textbooks and test-preparation books, and staff and members maintain a library, tutor members, and teach weekly classes. Furthermore, staff help members prepare their tax returns, budget their finances, and connect with agencies offering health, psychiatric, substance abuse, and dental services. A sign-language interpreter serves the 40 members who are deaf.
For those working full time or attending school, there are evening activities including "education" and "work" dinners, where members celebrate and discuss their recent accomplishments. During weekends and evenings, members can participate on the softball team, visit museums, attend parties, work out at the YMCA, and engage in other activities.
Lest one mistake the concept of "clubhouse" for social club, keep in mind that although the rooms are filled with noisy chatter, "this is a really serious place," explained Iris Jones, a member who leads visitors on tours.
"Kenn [Dudek] has faith that you can be more. And being here benefits your life so much that you have to take advantage of the opportunities or it will pass you by," she said.
At Fountain House, members work side by side with staff in more than 16 areas, including gardening, working in the reception or dining areas, doing clerical and advocacy work, working on the switchboard, creating floral arrangements, producing a daily television show, writing the newsletter, stuffing envelopes, and helping in the thrift shop.
One particularly noteworthy area is that of advocacy. Members write letters, participate in demonstrations, and visit politicians on mental health issues such as the Work Incentives Improvement bill and the Metropolitan Transportation Authority Half-Fare bill.
"Fountain House’s advocacy group led the initiative to pass the later bill," explained Dudek. "This bill stipulated that a large segment of individuals with mental illness would be eligible for half-priced fare. After its passage, Assemblyman Jim Brennan and Senator Frank Padavan, who were instrumental in the effort, came to Fountain House to partake in a special celebration."
After members have worked at Fountain House for a time and are ready to move on to the next step, they then work at a part-time, transitional position for six to nine months at an average wage of $7.50 an hour. The employer first trains a staff member of Fountain House for the position, and that staff member in turn trains two members. (The two members work part time to fill one position.) The staff member oversees their work and remains in contact with the company supervisor. When a member calls in sick, another member or the staff member fills in.
This is a win-win situation: Members learn skills, improve their confidence, and build up their resume. Also, because the placement lasts only several months, members can try different positions until they are successful and find tasks they enjoy.
Companies win because they do not have to pay to find and train employees or worry about employees not showing up for work. Furthermore, although they pay members the standard pay rate, they do not provide benefits because members are allowed to keep their government benefits. However, members collect fewer SSI dollars because they are receiving a paycheck.
For members who are ready to move on, staff assist them in finding full-time jobs and are available if they need support.
One key factor in Fountain House’s success is that the members’ psychiatric problems are handled at a separate location, thereby encouraging members to leave behind the limitations of their prognosis, the stigma of being labeled, and the belief they can’t drastically improve their life.
"The issue that you believe that someone with serious and persistent illness can work, can get a bachelor’s degree, can get married—this issue of belief is the most important point," said Aquila. "And if you don’t believe that people with serious mental illness can turn their lives around, you shouldn’t even be in this field."
Said Jones, "We have a right to contribute something. We don’t have to carry a sign saying ‘Mental Illness,’ meaning we’re incapable. Here we learn that we can function in society."
But there is another, more subtle way that Fountain House encourages members to believe again. And that way is through networking: Members know other members who earned a bachelor’s degree, are holding full-time jobs, and are married.
"Look at these photographs: Everyone looks very happy," said Jones, as she pointed to photos of successful members on a wall. She said she got her inspiration to study for her high-school equivalency diploma from her best friend, a member who recently earned her diploma and then went on to study for a bachelor’s degree.
"I know that if she can do it, I can too," she said.
More information on Fountain House is posted on the Web at <www.fountainhouse.org>. An information packet can be ordered or a tour arranged during the week by calling (212) 582-0340 ext. 305.