Every day, visitors from across the country and around the globe come to tour Fountain House, and one of the first things they often remark upon is the beauty of the surroundings. From the graceful curve of the staircase in the Classical Georgian foyer to the sleek, sun-drenched grandeur of the Wellness Unit, Fountain House is indeed a lovely place to be – a stark contrast to the impersonal or shabby trappings that are common in the world of mental health.
This emphasis on physical environment is an important part of our approach. The founders of Fountain House believed that the structure and condition of the building made a statement to the people living and working within them. The dignity and worth of the Fountain House community are reflected in the beauty of the setting. Despite stylistic differences, this value is shared by Fountain House-model programs everywhere, whether it manifests in the modern, loft-like elegance of Independence Center in St. Louis or in the cozy, country home-feel of Klubitalo Fontana in Finland.
At Fountain House, some very special corporate partners have helped us to keep up our appearance during the economic uncertainty of the past few years.
AFM Safecoat, a leading manufacturer of nontoxic paints, adhesives, and cleaners, graciously donated 140 gallons of low VOC paint to Fountain House for the cost of shipping. Norman, a member who is actively engaged both in trying to help save FH money and in promoting a greener, healthier lifestyle, made the connection to AFM. We’ve been using this high-quality paint around Fountain House and in our residential buildings, and we’ve even sold gallons, at a nominal cost, to members and staff who wish to paint their own apartments. This gift has not only brightened our walls – it’s kept our environment healthy!
Fresh flowers were among the early casualties of a leaner budget. Members and staff in the Horticulture Unit lost one of their most creative and inclusive jobs, and the rest of the House missed the vibrant arrangements that had graced every area. Enter member, artist, and stalwart lover of flowers, Kathy. She organized a “Bring Back the Flowers!” campaign and appealed to Associated Cut Flower Company, a family-owned and operated business that has been selling in the New York Flower Market for more than 50 years. Their generous weekly donation keeps us in buds and blooms. The flowers are back!
At the end of every season, Chelsea Garden Center, renowned purveyor of plants and a great neighbor, regularly gifts us a variety of beautiful plants and trees especially selected for the urban gardener. Their contribution immeasurably improves the look and feel of our buildings and gardens.
Many thanks to our wonderful partners who help us realize the beauty of our building. It’s an enormous source of pride to our community and one component of the therapeutic environment that helps members take steps toward mental health.
Andrea Roy Communications Director, Fountain House
The Importance of Belonging According to Abraham Maslow, satisfying the need to belong is a prerequisite to developing self-esteem and confidence, which in turn is a prerequisite for self-actualization - the motive to realize one's fullest potential. These higher order needs require a social context, which is why belonging supports self-esteem in Maslow’s pyramid.
The need to belong is driven by evolutionary factors. It is a powerful, fundamental, and extremely pervasive motivation. Belonging helps people in times of trouble. It provides a place to share good and bad news and to avoid loneliness and feeling unloved. It’s the place to get the information and the real interpersonal rewards that build confidence and self-esteem. Belonging’s powerful effect on productivity is well-studied and understood in business and industry forums all over the world.
Understanding the importance of belonging, present day thinkers and mental health program planners want all programs and services delivered within the context of the general community, with specialized professional support from case managers. The rationale is threefold: 1) all people have the right to belong to the general community 2) learning that occurs in segregated facilities doesn’t translate to the general community and 3) the presence of role models in the general community facilitates learning necessary skills.
Acceptance: A Crucial Component
This approach may be useful to some who have serious mental illness or other disabilities, but for many there is a problem. A sense of belonging - what Maslow states is the necessary prerequisite to self-esteem and fulfillment - requires acceptance. How can people develop a sense of belonging to a community if they don’t experience basic acceptance by that community? The literature is replete with examples of stigma and the resultant isolation that happens to many people with serious mental illness living in the general community.
Although it is true that all people have the right to belong to the general community, the reality is that the general community establishes conditions which must be met before full acceptance is achieved. This is why immigrants to America established their own communities and subcultures in which they prepared themselves and their children for general community participation. Is it possible that planners are proposing this unrealistic, idealized notion of general community belonging as treatment because they have no idea of how to create programs that offer satisfaction of the need to belong?
Adults with serious mental illness who choose membership in a Fountain House-like, intentionally-created working community achieve basic acceptance, a sense of belonging and being needed, social and emotional support, and pragmatic opportunities to increase self-esteem and confidence. They are in a place of acceptance, a place to prepare for total general community participation.
What is a Segregated Community?
Today’s planners think that the Fountain House approach is a segregated community lacking general community role models. Before responding to this notion we must understand what a segregated program - or for that matter, a segregated community - is. Segregated communities or programs have distinct boundaries and do not offer their participants bridges to the general community for one of two reasons: 1) they do not hold a value for general community participation, as in the case of the Amish in Pennsylvania or 2) they do not believe that their participants are capable of successful functioning in the general community, as in the case of special education classes in the public school system. Few of these participants adjust in the general community, so they fail to motivate their peers through any realistic or appropriate modeling.
How Is Fountain House Different?
A Fountain House-type working community program is a social context where hope, respect, opportunity, and support facilitate the confidence to successfully adjust to the general community and to fulfill one’s talent and potential. The Fountain House model values general community adjustment and believes that most all of its membership can achieve it. In practicing this belief and value, all of its programs have specific programmatic bridges to the general community.
In employment, transitional employment and supported employmentare two programs that represent bridges to the general workforce.
In education, tutoring programs and in-house classes give way to university classes and degrees.
In wellness, an onsite fitness center and training program leads to subsidized memberships at a local YMCA.
In housing, supervised and supported housing evolves into living independently.
In artistic creativity, an art gallery showing members’ art holds exhibitions and events and competes as part of the New York City art scene.
The nature of the Fountain House working community makes the modeling of staff - who work side by side with members in all community groups, committees, and activities - a powerful motivator. Even more powerful is the modeling of other members who are visibly engaged in varying stages of general community activities.
In conclusion Fountain House should never be equated with a segregated community program because it holds a value for general community adjustment, it believes in its membership’s ability to achieve it, and it offers an environment filled with role models and pragmatic programmatic bridges to assist its membership in their quest for personal fulfillment. Program developers must learn how to create these working communities so that everyone who chooses can experience belonging and the personal benefits that flow from it.
Many, if not most, mental illnesses manifest during adolescence and young adulthood. Fountain House has had a longstanding interest in reaching out to young adults who are experiencing the onset of illness. Lisa Dixon, MD, MPH, recently wrote an article for the New York State Office of Mental Health website detailing the importance of early intervention, as well as some of the challenges that must be addressed before we can enjoy the great promise that this approach holds. She writes:
"Early intervention in the treatment and possible prevention of serious mental illnesses, including psychotic illness, is both an exciting possibility and imperative for our mental health system. Research has demonstrated that many, if not most, persistent mental illnesses start in childhood or adolescence. Knowing that illness comes so early in life underscores the need for, and opportunities of intervening as soon as possible with accessible and high quality services. The result can be reduced disability and improved quality of life over a lifetime."
"Biological, psychological and social functioning research suggests that early identification and intervention can reduce illness severity and the disability that follows...While many of these studies require replication, they offer hope and pathways for treatment leading to the meaningful improvement of lives."
Dr. Dixon, currently a Professor of Psychiatry at the University of Maryland School of Medicine, will soon be working on a first break initiative for the New York State Office of Mental Health. We’re thrilled that she’s coming to visit Fountain House and hopeful that we’ll find a way to work together to advance this exciting new venture.
Last Saturday, to celebrate Harry Houdini’s 138th birthday, Happy, our resident magician treated the Fountain House community to a fantastic magic show. For his grand finale, he escaped from a straitjacket – an object that is perhaps the most striking symbol of society’s callousness toward and misunderstanding of mental illness.
Happy’s feat suggested Houdini but was dedicated “to everyone who has survived the bondage of mental illness.”
My name is Julius Lanoil, and I will be doing my best to explain the sophisticated Social Practice developed at Fountain House, which for the past 63 years, has been working to help adults with serious mental illness fulfill their human potential in a world filled with stigma and irrational fears. I’m one of three authors of a soon to be published book on this subject.
This Fountain House practice has helped me as a person, a psychotherapist, and a program developer. It has been replicated in most US states and many countries around the world. I believe that a deep understanding of this practice is useful, not only for people with a specific interest in Fountain House or in programs for people with mental illness, but also for persons interested in social science theory or in exploring ideas about helping any population in need of support and human understanding.
Each week I’ll write about one element of the Practice and discuss why it’s important, how it’s related to social science theory, and how it’s implemented at Fountain House. Over the next weeks and months as I write about this unique practice, I welcome your comments and opinions.
Element One: Intentionally Creating a Community and Culture
People have needs that must be satisfied if they are to manage the complexities of life and function at their individual best. Many people with serious mental illness have significant obstacles to satisfying these needs. Therefore the first element of the Fountain House practice is the creation of a working community in which its members (people with serious mental illness) can fulfill their need for relationships - and avoid the pervasive and damaging isolation endemic in this population - while finding a purpose, a positive identity, and the comforting feeling that they belong.
The Fountain House community is a place where members can find support and assistance in most of life’s domains as well as specific opportunities in employment, education, wellness, housing, and recreation – all within a community context in which human potential, basic acceptance dignity, and respect are highly valued. This is demonstrated by several policies:
no time limits to membership
no separate staff or member meetings
no segregated spaces
complete freedom of movement
a policy of all inclusive decision making
freedom to choose the manner of your participation and the people with whom you will participate.
It’s important to recognize that the above policies of the organization that support the community are consistent with the values of the community.
As stated above Fountain House is an intentionally created WORKING community. Staff and members work side by side to satisfy the needs of the membership and the maintenance, growth, and longevity of the community. The community provides its membership with a normalizing experience, because it is organized with work activities during the day and recreation activities in the evenings and on weekends and holidays. All of the work of the community is organized into units representing the membership or organizational needs they attempt to satisfy (e.g. employment unit or research unit or food service unit). Each staff and each member belongs to both the Fountain House community in general and a work unit in particular.
The work of the Fountain House community programs are structured and led by a cadre of charismatic staff with a generalist orientation; by design they need the help of the membership. The fact that staff and members work side by side in the work of the units is both a demonstration of their commitment to their own goals and to the goals of their unit and their community. From a treatment perspective, this side by side work represents an important opportunity for members to increase their self-confidence, efficacy, and esteem which can facilitate the motivation to take positive risks in the general community.
Fountain House New York announces the Michael Walther Executive Fellowship for individuals who aspire to be clubhouse directors. As an immersion program, Fellows will integrate state of the art management techniques with the ideals and approach to social practice originated by Fountain House. The Fellowship is open to anyone who aspires to be a clubhouse director, including applicants from outside the United States.*
Since November, the Wellness Unit has been hosting a weekly workshop called Returning to Balance from 5 pm – 6 pm on Thursdays. It’s a combination of yoga and massage taught by a trio of teachers who alternate weeks – Ruth teaches self-massage, Shoko offers chair massages once a month, and Elizabeth teaches yoga and self-massage.
For me, this class is a good review. Many years ago, I learned acupressure and helpful basic trigger points from my brother, who is a health practitioner. (Recently, a friend had a cold, and I showed her the pressure points in her nose. She said it helped!) I studied self-massage with Ruth before, and every day I use it to ease chronic pain in my knee and in other places. These past weeks I’ve learned many new pressure points from the reflexology chart she gave to us, and I refer to it for help outside the workshop.
Elizabeth stresses how important it is for us to be aware of our bodies, “Your body is your own encyclopedia, so where you feel soreness you know what to work on.
This coming week is a yoga class. Yoga teaches deep breathing and ways to relax. I hope when this course is over, we will continue the yoga class in the Wellness Unit, because relaxation is so essential to us all.
Walking in the wind this early morning, I was happy to feel that my breathing had grown deeper. Practicing what you learn is important.
Alice Chernick 2nd floor and Research Unit, Fountain House