Join This Club for Mental Health

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

“GAC is a collective of many faceted people helping disenfranchised people integrate into a complex, confusing, and often cruel society.”

–Fred Robinson, former US Probation Officer and GAC Board President 2020-2022

I think that it has been about 30 years since I was President of the Board of Grand Avenue Club (GAC) in Milwaukee. I was recently reminded of that when a thoughtful staff leader obtained historical information for their weekly newsletter, which last week focused on the history of the Board and its Presidents over the last 35 years. Though Boards often are not looking for credit, they are an essential component for the well-being of most organizations. Hence, a generation after GAC began, I kept advocating for the Board to be recognized as an essential contributor to the evolving vision of the originator of this club.

But what is this club and what does it have to do with psychiatry, you may be wondering, especially if you did not happen to read an article about the Fountain House in Psychiatric Times just about a year ago?¹

There has always been stigma against individuals with mental illnesses, especially those viewed to have the most serious illnesses. One of the harmful repercussions of that has been social isolation and rejection. Back in the early 1940s, some psychiatric patients at Rockland State Hospital in Orangeburg, New York, along with the psychiatrist Hiram Johnson, took matters in their own hands. Their idea was to counter that social problem and undue fear by establishing social support outside of the hospital by forming a club.

The club was called “We Are Not Alone,” By 1948, some philanthropic women like Elizabeth Schermerhorn, who became their first Board President, together with the National Council for Jewish Women, bought a permanent home for the club on West 47th in New York. It had a fountain in its courtyard, so adopted Fountain House as the name of the building. That also turned out metaphoric, as Fountain House continued to provide sustaining mental watering. The model was that of a supportive relationship between members and staff in the context of learning and doing everyday tasks.² That model persists today at Fountain House and is a model for almost 400 clubhouses in over 32 countries serving over 100,000 members, along with standards, an accreditation process, and reassuring functional outcome studies.

But why use the term “members”? I was to find out about 50 years later, when I had some advanced paralleling experiences with the Clubhouse Movement. In the 1990s, I was suddenly asked to become President of the developing Board of Directors of our local GAC. We were using borrowed space, but soon were told we had to move, and decided to try to find our own building, like Fountain House once did. I personally did not like to fundraise, but the Board came to the rescue, especially a retired Jewish businessman. Our place was right near the middle of downtown Milwaukee, and still is, with governmental facilities, performance arts buildings, public transportation, and shopping all nearby.

Fundraising is generally a challenge in GAC and many clubs. Fortunately, Fountain House was not long ago gifted with a grant of $12 million by MacKenzie Scott, the former wife of Amazon founder Jeff Bezos. Our own local GAC is now able to do needed renovations, currently to the kitchen. I wonder now if the governmental health care and mental health care funding cuts will have any adverse repercussions.

I got used to saying “members” instead of patients or clients. Members meant those with mental illness who joined this club voluntarily as potentially full participants. As such, some were also Board members. Formal psychiatry was not an essential part of the club, other than an occasional Board member like me. A self-sustaining philosophy meant generally not having any communication with the members psychiatrists, though it certainly was not anti-psychiatry, and that cultural division generally softened over the years.

I have come to think of such clubs as para psychiatry, that is, alongside psychiatry in the lives of the members. It seems almost like a mental health magic show where learning how to better function in society coexists with normalizing behavior in a work-ordered day.

Let me see if I can explain this magic. Often a staff and member work together as one in training until the member is ready to go on their own within the Clubhouse or an outside job. First 1 and 1 becomes 2, then the 2 separate back almost unnoticed into healthier 1s. As a Board member and clinical psychiatrist, sure there were some expected failures, but I was often astonished by the progress that was made by all, including my own previously limited expectations. But really, it was hard work, appropriate caring, and realistic optimism that made up the magic.

Before I left the Board, I was able to plant some seeds for wellness activities, being quite concerned with the much shorter lifespan of those with severe mental illness back then. Now, those seeds have blossomed and there is a daily lunch hour Wellness Walk and related programs.

However, one psychiatric drawback is that very few psychiatric residency education programs teach about the Clubhouse Movements. Really, the clubhouses would make terrific educational opportunities for psychiatric residents that would nicely complement their experience in the hospital and clinics. What the members can end up accomplishing with the support of staff in terms of work and daily functioning is eye opening. If for some reason you have not been exposed to GACs, please investigate it where you live and become a supporting “member” of the club.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. O’Brien E, Tse J. The Clubhouse Model for depression and serious mental illness. Psychiatric Times. March 27, 2024. https://www.psychiatrictimes.com/view/the-clubhouse-model-for-depression-and-serious-mental-illnesses

2. Doyle A, Lanoil J, Dudek, KJ. Fountain House: Creating Community in Mental Health Practice. Columbia University Press; 2013.