When I moved into my five-foot-wide New York City bedroom, the walls were riddled with dark stains and loose tape that followed no pattern except chaos.
For two years, I did not clean or decorate it. Instead, every day I stayed on my mattress for up to 24 hours: acute depression, screen addictions, PTSD. My bedroom’s inch-thin walls were padded with soundproofing cushions and covered by white cloth. One day, I realized that my room resembled a padded cell.
In the second year, I signed up for a ketamine study for depression at the New York State Psychiatric Institute. Although the ketamine infusion seemed to lift my depression entirely, its effects wore off in a week. Each week for six months, the study psychiatrist and a social worker met up with me to take steps toward my recovery. Responding to my financial poverty, they helped me sign up for programs like food stamps. Responding to my depressive fatigue, they helped me sign up for Access-A-Ride, a taxi service for the disabled. I accepted these humbling forms of support without resistance. However, one recommendation I consistently resisted. Each meeting, and he asked nearly every meeting, I would say no when my psychiatrist asked, “Have you given the nice people at Fountain House a try?”
The face of Fountain House is its clubhouse, a five-story building two blocks from Times Square. It is exclusively for people with serious mental illness. A psychiatrist’s referral attesting to no recent history of violent behavior is the ticket for admission at Fountain House. There are 1200 active members; according to Kevin Rice, Director of Research at Fountain House, 37.9% of members who joined in 2019 self-reported a history of homelessness. While many members have diagnoses like depression and schizophrenia, it is the loneliness due to their mental illness that unites them. Like a second home, membership at Fountain House is free and forever.
The organization’s model is called “social practice”, a way of designing an environment to support those who are withdrawn to discover the power of belonging. Among one of its uses is mental health treatment.
Referring to social practice, Elliott Madison, the Executive Director of Fountain House, explained, “being involved is the practice.” When folks with mental illness who are withdrawn become involved in a community, they reap the many benefits of feeling welcomed to something larger than themselves, which can abide the symptoms of their illness.
Fountain House, founded by former patients who had been institutionalized and wealthy patrons in 1948, has viewed itself through the lens of multiple models over the years, its most well-known being the “clubhouse model of psychosocial rehabilitation.” Fountain House is the type specimen that inspired the creation of over 300 mental-health-focused clubhouses around the world under the consortium Clubhouse International. A systematic review of the clubhouse model suggests that, despite the varied approaches of previous studies and thus the challenge to summarize their results as a whole, folks with mental illness consistently exhibited overall improvements in their quality of life after becoming clubhouse members.
However, current and former staff including Madison and Alan Doyle, a retired Fountain House social practitioner and author of Fountain House, suggest that social practice is Fountain House’s essence. This is because, although the clubhouse is a convenient place to create a community centered on well-being, it is possible – and even necessary, Madison suggests – to bring social practice to places like high schools and hospitals to make mass mental health a norm. It is not the architecture that matters, but the intention behind the design. Alongside its clubhouse, Fountain House has a farm in New Jersey, which is where Alan Doyle actually believes the strongest transformations in members occur.
When folks with mental illness who are withdrawn become involved in a community, they reap the many benefits of feeling welcomed to something larger than themselves, which can abide the symptoms of their illness.