Not-for-profit's 'clubhouse' model effectively treats mental illness, study says
Researchers at NYU's Health Evaluation and Analytics Lab lends credence to Fountain House's approach
William, who suffers from schizoaffective disorder, first started attending Fountain House, a social center and resource hub for people with mental illnesses that's located in a stately brick building on West 47th Street, after being hospitalized last year. William said he experienced a psychotic episode after his support system crumbled, with the shutdown of his psychiatric support group and the departure of his church's longtime pastor.
"During the day I had nothing to do," said William, 42, who asked Crain's not to publish his last name to preserve his privacy. "With the isolation and the withdrawal, my symptoms exacerbated."
William, who hasn't been readmitted to the psychiatric ward in the 10 months since he joined Fountain House, credits the clubhouse model the agency pioneered. The nonprofit engages its members in the daily tasks that are vital to running the facility while also offering wellness skills, educational and employment opportunities, and care management.
A study released this week by researchers at NYU's Health Evaluation and Analytics Lab lends credence to the idea that the clubhouse model, which Fountain House has helped spread to more than 300 sites worldwide, helps cut back on hospitalizations for high-need patients, saving Medicaid money. About 90% of Fountain House members are enrolled in Medicaid, and researchers used a Medicaid claims database to conduct the study.
A group of Fountain House members who racked up more than $18,000 each in Medicaid expenses the year before they joined the clubhouse incurred monthly medical expenses that were 21% lower than anticipated during their first year as members, saving Medicaid about $783 per month. The authors found that although these 134 high-need members were costing Medicaid more money in prescription drugs and outpatient care during their first year, they were saving the system money overall because of reductions in inpatient care.
"You need that extra component, which is the community," said Dr. Ralph Aquila, medical director of Fountain House. "We understand the need for primary care, psychiatric care, but then the community you see here is just as important as any other delivery of medical services."
James Knickman, who co-authored the study, said he was surprised by the results. "It's very hard to budge the health care expenditure needle, and I've seen so many other efforts," he said. "This is one of those cases where there's pretty strong evidence emerging that a social-service approach is reducing the actual need for medical care."
Aquila said he believes Fountain House's value to the Medicaid system is not just in helping people avoid psychiatric hospitalizations, but also in helping members access primary care services to control chronic conditions such as diabetes and hypertension.
Currently, Fountain House relies on the government for about 69% of its revenue. Aquila said the center aims to increase its clinical partnerships and the funding it receives from Medicaid in the future.
But for William, who copy edits the Fountain House newsletter and produces audio stories about members to share with donors, what keeps him coming back are the relationships he has formed and the opportunity to hone his professional skills.
"Fountain House gives me structure, it gives me community and it allows me to have a place to come to every day where I'm needed," he said.
"Nonprofit's 'clubhouse' model effectively treats mental ilnnes, study says" originally appeared on Crain's New York Business.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.