Diffusion is essentially a social process through which people talking to people spread an innovation.
As an intervention in mental health practice, the idea of Fountain House represents all the right values. It is
- successful (evidence-based)
- cost effective
And yet growth in the adoption of the model has remained stuck at the 300+ mark for over a decade now. Atul Gawande's article
in the recent edition of the New Yorker
magazine (July 29th) takes on this very problem. He asks why does one innovation in medical practice spread while another languishes, even though they both achieve obvious improvements in healthcare. His solution is that change in practice requires the intervention of coaches who establish personal trusting relationships. "People talking to people is still how the world's standards change," he asserts.
This is exactly what Fountain House did in the 1980's and 1990's to spread its message of hope and humanity in mental health. The training system
included the formation of a Faculty for Clubhouse Development, its "university without walls" as Propst (1998) once described it. As a result, Fountain House as an innovation in mental health practice enjoyed an early dramatic worldwide spread.
Gawande is clear about the impact such an approach would have in health care. In order to achieve a system where people routinely are doing X or Y when they are not being watched, he suggested this regimen:
- training opportunities
- a list of clear practices
- regular visits by a personable coach—a decidedly non judgmental approach— that replicates the highly successful seven-visit practice of pharmaceutical salesmen.
In other words, Gawande argues that we approach the diffusion of innovations in institutional healthcare in the same way clubhouses promote the recovery of individual members - through the personal intervention of trusted, nonjudgmental staff coaches. I suggest that what we know to be proven and effective in member recovery can apply equally as well to stimulate institutional growth and expansion—the marketing of the Fountain House brand should be fundamentally based on human agency of motivational coaches. This is the same broad mobilization technique Gawande posits that society has employed to address illiteracy (a public school teaching profession), pain in surgery (anesthesiologists), and agriculture (the extension agent system).
We have standing ready a cadre of capable, clubhouse members who can participate, even lead, in a movement to expand decent community-based support in mental health recovery. In my next article, I will outline what such a system would look like.
Alan Doyle, EdD
Director of Education, Fountain House
Gawande, A. (2013). "Slow Ideas," The New Yorker, July 29, 2013, 36-45.
Propst, R.,(1997), Stages in realizing the international diffusion of a single way of working: The clubhouse model. New Directions for Mental Health Services, 74, 53–66. doi: 10.1002/yd.2330227407.
Note: This is the first in a series of articles on promoting growth in the replication of the working community model of psychiatric recovery pioneered by Fountain House.