Try clubhouse model over ER for mental health
The system failed Jordan Neely long before his violent killing on a New York subway train.
At age 14, after his mother was murdered, Neely fell into depression. He dropped out of school, and his mental illness progressed untreated until he was homeless and cycling through jail cells and emergency rooms.
Friends and family say Neely lived with schizophrenia and post-traumatic stress disorder. Despite hundreds of encounters with social work teams and a week-long stay at Bellevue in one of the city’s few psych beds, his life ended in tragedy.
Neely’s story highlights the cruelties of a broken system. People with serious mental illness are shuttled among prisons, encampments and hospitals for crisis care that costs the nation billions. There’s a better way.
Roughly a quarter of the unsheltered homeless in the United States are people with untreated mental illness. . Many with schizophrenia or bipolar disorder languish in urban single-room occupancy hotels or board and care homes.
Despite all efforts, the problem only gets worse. Why?
The painful answer is that society has failed to ensure that people with serious mental illness, especially those of color, get the care that could help them recover. They might receive medication in jail or the hospital. They might get emergency services. But less than 5 percent of the 14 million Americans with serious mental illness receive the kind of rehabilitative services that could have helped Neely.
These services include peer support, family education and supportive housing. They can be as effective as dialysis is for renal failure or physical therapy is after a stroke.
This is equally true of the clubhouse model, developed by and for people with serious mental illness. Here the creation of community is a therapeutic intervention. Clubhouses address the social determinants of health: poverty, housing insecurity and isolation.
The sanctuary they provide results in long-term recovery and thriving.
The original one, Fountain House in New York, where we’re all board members, was created 75 years ago. It has demonstrated its potential to reduce homelessness, increase employment and lower rates of incarceration — as one of us, Arvind Sooknanan, can attest from personal experience.
Sooknanan was hospitalized nearly two dozen times for mental illness by the age of 20. Unlike Neely, he recovered, through his involvement with Fountain House and is now living independently.
Why are these powerful and time-tested interventions not available to 95 percent of the people who would benefit? Follow the money. Remarkably, in a nation that spends $4.3 trillion on health care, rehabilitation after a psychotic break is left to local nonprofits that run on charitable contributions.
The current approach, cramming patients into emergency rooms and correctional facilities, is surely the most expensive and least effective. Sooknanan’s year in the clubhouse cost less than the price of two weeks in a hospital. And it has put him on track for meaningful recovery. Jordan Neely deserved the same.
Thomas Insel is a co-founder of Vanna Health and former director of the National Institute of Mental Health. Arvind Sooknanan is on the board of directors of Fountain House in New York. Ken Zimmerman is CEO of Fountain House.