I’ve just completed comprehensive clubhouse model training at Fountain House. This training was once again another true example of Fountain House’s innovation and commitment to developing strong clubhouses across the globe.
In this magical training we covered the basic principles of a working community, including the Fountain House history, member choice, the need to be needed, and creating a collaborative work environment.
The core group included six directors from Italy, Sweden, the United States, and of course, Australia. With the core group being made up of directors, it helped us define our ultimate role in the clubhouse community and explore together the true meaning of what started on West 47th Street New York more than sixty years ago.
If I were to summarize what makes me so excited about my last two weeks here at Fountain House, it would be not about a model that is 65 years old, but more a way of helping people with mental illness that has recovery, innovation, and strategic direction at the heart of all that it does. For directors like me, these three principles that are practiced every day at Fountain House are paramount to its success. We as directors need to accurately illustrate them in own communities across the world.
I attended with one of our members, Nick, who helped me to keep fresh in my mind the true member needs of the Toowoomba Clubhouse and to reflect on our daily discussions and what they really mean for our community in Toowoomba.
Luke Terry Executive Director, Toowoomba Clubhouse
The Fountain House Supported Education program is rooted in its successful "working community" approach.We are pleased to announce that Fountain House has received the National Council for Community Behavioral Healthcare’s Award of Excellenc
In a recent Fountain House blog, Summer Berman addressed the renewed stigmatization of those living with mental illness, which has become so common in recent discussions of gun violence. It is now a popular reaction, particularly from those who want to promote the widespread possession of guns, to say that mental health treatment should be expanded in order to “control” people with mental disorders. Enhancing the availability of mental health care is, of course, an important goal, but as Summer pointed out, such efforts would have little impact on the overall rate of violence, because people with serious mental illnesses actually commit only a very small percentage of violent crimes. Most violent crimes are committed by people without major mental illness.
Guns provide the most reliably fatal way of committing suicide. Whereas suicide attempts by overdosing on pills are not usually fatal (probably less than 15 % of the time) suicide with guns is almost always fatal (probably 85% of the time or more.) Many suicides are not planned in advance; often, suicide is an impulsive act. Having a gun readily available makes an impulsive suicide attempt much more likely to be fatal. Comparing the suicide rates in different states seems to bear this out: states with the highest suicide rates (e.g. Alaska, Montana, Wyoming) have almost three times as many suicides per 100,000 people, compared to low-suicide states like New York and New Jersey. In the high suicide states, as many as 60% of people keep guns at home, whereas in New York and New Jersey, relatively fewer people do (perhaps 12-18%).
The factors that determine the suicide rate are very complex. They certainly include the prevalence of mental illness, including PTSD; the prevalence of substance abuse; the degree of stigma toward mental illness, which can deter people from acknowledging that they need help; as well as the availability of mental health care for those who do seek it. But one hypothesis generated by considering the data quoted above would be this: that the lower availability of guns kept in the home tends to protect people in New York and New Jersey from the risk of death by impulsive suicide.
If we take the issue of suicide prevention seriously, it is abundantly clear that much of the heated debate about guns in the media and in Congress is irrelevant to suicide. Laws restricting the sale of semi-automatic rifles and large magazines would have no impact on the problem of suicide, since most gun suicides require only a single bullet. Some regulations might be helpful, for example, requirements for trigger locks or storage of weapons in locked cases. Even these measures, however, do not protect the person who has the key. And while many gun owners reassure themselves that they don’t have to worry about suicide, the fact is that no one knows whether they might be seriously depressed five years from now.
Changing our gun culture – for example, moderating the idea that guns are necessary everywhere for home defense – will continue to be a very long-term process. (One piece of good news is reflected in another, front page Sunday Times article this week: the rate at which people keep guns in their homes has in fact been decreasing gradually all across the country in recent decades.) In a way the problem is similar to the overall problem of stigma, because attitudes about the risks of guns in the home, like attitudes about the risks and dangers of mental illness, tend to change slowly in response to public education. For this reason, our continuing efforts at addressing these issues realistically and without stigmatizing those with mental illness are that much more important.
Howard Owens, MD Forensic Psychiatrist Board of Directors, Fountain House
With the recent prominence of gun violence in the media due to the mass shooting at Sandy Hook Elementary School last December, we as mental health advocates are in a very precarious situation. The discussions resulting from this atrocity have centered around two topics: gun control and expansion of mental health services. While we may vary in our stances on gun control, increasing the public discussion about mental illness is every mental health advocate’s dream—unless the backdrop of that conversation is violent crime.
The uneducated public and the story-hungry media are quick to jump to conclusions about the mental health status of people such as Adam Lanza and others who commit these horrible crimes. They are quick to label these troubled young men as “mentally ill.” And perhaps they are. According to the National Institute of Mental Health, for a very small percentage of people—those with “episode[s] of psychosis, especially psychosis associated with paranoia and so-called ‘command hallucinations,’ the risk of violence is increased.” Co-occurring substance abuse or childhood antisocial behavior may increase the risk of violence. But the majority of people with mental illness are not violent.
Thus, when we use the risk of violence as a rationale for better and more available services for people with mental illness, we also put at risk all the good works we have done over the years to reduce the stigma surrounding mental illness. When we conflate mental illness and violence we do ourselves and our community a disservice.
For decades, Fountain House and other mental health organizations have fought to educate the public as well as the government about the causes and effects of mental illness - to challenge the myth that people with mental illness are violent, unintelligent, worthless, lazy, incompetent, and dependent. While we certainly know that some people with mental illness are prone to violence, we also know that some members of the general population are prone to violence for some of the same reasons. When factors such as substance abuse, being a victim of violence (physical or sexual), and poor school performance as a youth are present, the likelihood of a person committing a violent crime increases. These factors play a role whether or not a mental illness is present.
As advocates, it is our role to take advantage of every opportunity to engage the public in productive dialogue and agitate for more and better mental health services. But we must also weigh the cost of increasing our visibility in the gun control and violent crime debate. We must be cautious, like any social movement, that we do not let an extreme example represent our entire population and movement to the general public.
My diagnosis of depression does not make me a violent person. Most people with mental illness are not perpetrators of violent crime. As a movement, we must be sure to take hold of this opportunity to raise awareness of mental illness and push for improved funding and delivery of services. But we must be clear that we stand by our statement that people with mental illness can be and are productive members of society - that our communities are not put at risk by including people with mental illness in our schools, homes, and businesses, but rather enhanced and improved by the depth and breadth of the knowledge, skills, abilities, and talents we bring to the table.
Summer Berman Michael Walther Executive Fellow, Fountain House
From February 1st to February 15th, the United War Veterans Council (UWVC) embarked upon their 5th Annual Goodwill Valentine’s Caravan series – their effort to mobilize the public to send messages of love and gratitude for our veterans, military service members, and their families. I joined them on their visit to Walter Reed National Military Medical Center in Bethesda, MD.
What can I say about my trip?
“AMAZING” does not do it justice! To see the gratitude, the joy, the smiles on the wounded veterans at Walter Reed - to see grace at its peak - conjured emotions I’d not yet experienced!
At times it was hard to hold composure. I wanted to hug the vets. I wanted to scream and say, “Why did this have to happen to such a young population that has such a long road ahead, a long life to live? WHY?” Then to hear a wounded soldier say, “At least I’ve been given the chance to live; my buddies never came home,” shook me to my core and brought me back to the present moment. The gratitude of this wounded soldier - his zest for life, his acknowledgment that, though he lost limbs, he was a better person for it, because at least he had his life and now valued life in a different way - reminded me of how lucky we are to live in a country in which we feel free to do as we please. Yet freedom is not free! This was a WOW moment, and I reflected upon it for a long time. I’m grateful for this experience and the emotions it conjured, even though, as a soldier, I’d been trained to “suck it up!”
We also visited Ft. Belvoir in Fairfax County, Virginia, the base I once knew as my home base. It truly brought up sentiments I had long forgotten. It has become a place of tranquility for wounded soldiers, a place that made me proud of having served, a place that seemed like home. It was a true joy to see the faces of the veterans when they received the Valentine’s Day cards made by staff and members of the Fountain House Clerical Unit, and vets particularly loved and remarked upon our hand-made bookmarks. I was delighted and honored to introduce Fountain House to the veteran community
Everyone from the United War Veterans Council exhibited a solidarity that flowed naturally. I was reminded of “one for all and all for one!” I am sincerely thankful to have joined the group that was traveling to DC to deliver “Unconditional Love.” To give without conditions, to give without expecting to receive anything in return - that is the true meaning of “giving of oneself.” I am forever grateful for this experience!
Although I separated from the Service in 2006, it felt like I never left; the camaraderie was automatic. I’m flattered and honored to have represented Fountain House to the community that has sworn under oath to serve and protect the United States of America. I am a proud American; I am a proud Fountain House staff!
Jennifer Rivera Director of Human Resources, Fountain House
I get all revved up about this day, because it gives my peers and me a chance to go to Albany to see all the political leaders and let them know about the issues that the mental health community at large faces and how important accredited clubhouses are throughout the metropolitan area and across the country. It seems that when the general public hears about clubhouses, they think only of social clubs. Fountain House and all the other clubhouse programs that follow Fountain House’s model are so important for the mental health community. They give people with mental illness hope, a chance to re-enter society and live productive lives.
This year I was fortunate enough to be a team leader, not only for my group from Fountain House, but also for Metro Club PROS (MCP), where I work as a Recovery Specialist. I’m very proud to say that the Fountain House group I led up to Albany consisted of members and staff, working side by side as usual – a crucial part of the clubhouse model formula. Each person shared their personal stories of how clubhouses have imporoved their lives with the legislators and their staffers.
We also discussed relevant issues of the day, specifically the violence erupting across our nation that has been linked to mental illness. We expressed our concern about how the media portrays it and the stigma it’s creating against our community, even though, in reality, occurrences of violence are miniscule relative to the overall mental health community. Members of our group also discussed other issues, such as reinvesting savings from state hospital downsizing to boost community-based housing and also employment and peer services.
Let me backtrack a little so you can get an idea of how the day was. I arose at 4:30 in the morning, was out of the house by 5 AM, and by 5:30 I was at the bus departure area at Union Square. The first person I saw was Carla Rabinowitz, the NYAPRS point person who coordinates the Legislative Day trip. We went over the lists of who was coming from Fountain House and MCP, and we made sure they were all on the bus. We departed at approximately 6:30 AM and arrived in Albany between 9:30 and 10 AM.
When we arrived, Harvey Rosenthal, President and Director of NYAPRS, greeted us heartily and directed us to an auditorium in the New York Capital District’s iconic Egg Builiding, where we would be until lunch time. On the program schedule, Harvey gave us an overview of the New York State budget. NYAPRS Co-Presidents Maura Kelly and Steve Coe and Public Policy Co-Chairs Carla Rabinowitz and Raymond Schwartz then collectively made presentations on this year’s priorities:
Protecting the community mental health safety net
Reinvesting savings from state hospital downsizing
Enhancing Medicaid community recovery supports
Protecting Medicaid beneficiary rights and medication access.
Serving New Yorkers with psychiatric disabilities in the most integrated settings
Around noon we had lunch and reviewed our strategy before we went to rally at the steps of the State Capitol building. Following the rally, we kept appointments with our respective assembly people; my group saw Mark Gjonaj, Assemblyman 80th District and Linda B. Rosenthal, member of Assembly 67th District. By four in the afternoon we were back on the buses and on our way home after a very productive and satisfying day!
Alan Miller Clerical Unit and Advocacy Committee, Fountain House
Earlier this week, the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration released new data that show one of every three adults with mental illness smokes, compared with one in five adults without mental illness. Although we suspect this number is slightly lower among the Fountain House membership (and plan to gather data to evaluate that claim), there’s no question that smoking represents a major health risk to our community.
In order to support members in their efforts to quit smoking or to help them cut back on smoking, we created the Fountain House Breathe Free program. We hold a meeting each week (Tuesdays at 5 pm) where members come together to discuss their efforts, learn about possible approaches to aid in smoking cessation, and hear updates from their peers, all while cultivating an atmosphere of trust and mutual support. The meetings are structured such that there is time at the beginning of each meeting for any relevant announcements and members are encouraged to bring up any issues that are currently significant (e.g. Mayor Bloomberg’s recent ban on smoking in parks and beaches, President Obama’s struggles to kick his smoking habit, efforts to curtail smoking within Fountain House, etc.). Often times this involves reading through a magazine or newspaper article. Periodically, the group will watch a film on the topic or invite a guest speaker - usually a member or staff that has successfully quit smoking - to talk about their experience and answer any questions group members pose. Each meeting features a discussion aspect on topics including:
At the end of each meeting each member has an opportunity for a personal check-in. During this time they share with the group what their specific short-term goal was for the week and how it went. They may bring up what went well, in which areas they could use more support, or ask questions of the group.
The weekly group typically consists of 5 to 15 people. In 2012, 40 members received support with smoking cessation through these groups. Given that Fountain House has about a thousand active members, we can reasonably estimate that about 300 of them are smokers. We clearly have much work to do in terms of recruiting and engaging more members in smoking cessation efforts.
However, the member success stories are the heart of the inspiration and mutual support that provide the foundation for the Breathe Free Program. Just this week, a member who has been part of the group on and off for the past six years announced that he had been without a cigarette for two and a half weeks. Another long-time group member is going on four months smoke-free. The group meeting provides the forum for continued support, shared struggles, frustrations, encouragement, and hope.
Several group members have written about their experiences for the weekly Fountain House Newspaper and/or attended trainings on tobacco cessation in mental health programs and specifically within the clubhouse environment. Group leaders are also available to meet with people individually for additional support. The goal of the program is to continue to expand and to incorporate different methods of support to attract more members to the group.
Joseph Shaffer Wellness Unit Leader, Fountain House