Mayor Eric Adams and New York City health commissioner Dr. Ashwin Vasan are touting a new initiative to invest up to $30 million in clubhouses — places where people with a serious mental illness, who might otherwise be isolated, can go to socialize, participate in activities and take advantage of employment and educational opportunities.
The new money would more than double the current amount of city and state funding for clubhouses, which have been shown to reduce Medicaid spending on hospitalizations and emergency room visits for their members. In a business opportunity concept paper released in June, the city health department said it wants to expand membership in city clubhouses from 5,000 to 15,000 in the next two fiscal years, and an initial request for proposals, or RFP, set a baseline target of adding 3,750 new active members in high need neighborhoods.
But the money comes with new strings attached. The New York City health department is forcing existing clubhouses to reapply for their contracts — and rolling out ambitious new metrics for them to meet. Clubhouse leaders worry this will result in some long-standing clubhouses shutting down, potentially disrupting the lives of the members who rely on them. There are currently 16 clubhouses citywide, and the RFP indicates that the city expects to issue 13 new contracts.
“People have developed meaningful and long-term relationships, which is one of the elements that define recovery,” said Juliet Douglas, CEO of Venture House, which has clubhouses in Queens and on Staten Island. “You’re breaking up those relationships, so there is going to be a loss.”
The new requirements, outlined in the RFP issued by the city health department in September, exclude smaller clubhouses and those that only serve a niche population. Clubhouses based in institutional settings like hospitals are also a no-go. The city is giving preference to clubhouses located within a set of high-need ZIP codes.
The health department’s goal with these changes is to “expand and enhance the program reach and impact,” according to the RFP. The document notes that existing contracts will overlap with the new ones so that there is time to transition members out of any clubhouses that are shutting down into new ones.
Prior to becoming health commissioner, Vasan served as CEO of Fountain House, the Manhattan clubhouse that originated the model in the 1940s. But some in the clubhouse world say the new requirements are out of touch.
After receiving questions from the public, the health department extended the deadline for clubhouses to apply for funding from late November to mid-December and indicated that there could be some updates to the RFP.
“I want to fight for my clubhouse to stay open,” said David Mitchell, a member at TOP Clubhouse on the Upper West Side, which is run by Goddard Riverside Community Center. “It’s like a second home. It helps me feel good about myself.”
Mitchell, 53, said he has made friends at the clubhouse in his two-and-a-half years there and has started working toward his GED diploma. He added that other members help him study.
“Our goal is to expand the capacity and quality of clubhouses,” said Rachel Vick, a city health department spokesperson, in an email. “Reviewing and reinvigorating the contracts after more than a decade will connect members to resources to help them thrive in 2023 and beyond.”
She did not respond to concerns that some clubhouses will have to shut down or a request to speak with Vasan.
Under the RFP, clubhouses must have at least 300 active members – that is, people who engage with the program at least once every three months – and an average daily attendance of at least 120 members, or 40%.
But attendance at clubhouses is voluntary and it’s very rare for them to meet those metrics, said Joel Corcoran, the executive director and CEO of Clubhouse International, an accrediting body that has created a set of clubhouse standards. He said most clubhouses are smaller than that.
Corcoran said New York City’s effort to grow the clubhouse model is unprecedented in this way.
We don’t know yet whether it’s doable because we haven’t really seen a city invest this way in clubhouses before.
“We don’t know yet whether it’s doable because we haven’t really seen a city invest this way in clubhouses before,” Corcoran said. He added that he was glad the city is making the investment but hoped the health department would consult with Clubhouse International as it revises the RFP and works on implementing the plan.
Douglas said she believed Venture House would be able to scale up to meet the average daily attendance the city expected, but it would have to relocate the Queens clubhouse to accommodate everyone. Some other clubhouse leaders said it would likely be impossible to meet the city’s requirements.
The Job Connection Center Clubhouse in Downtown Brooklyn specializes in serving people with both a mental illness and an intellectual disability and has 48 active members, said Director Blessing Nwulu. She said she has had little success with expanding membership by recruiting people outside of that niche.
“It is very difficult for me to enroll people with only a mental illness, even though we have tried,” Nwulu said. “When they come in and see, they’re like, ‘This is not my level. This is not where I want to be.’”
The clubhouse also is not located in any of the ZIP codes that the city has identified as high-need, and Nwulu said the center wouldn’t be able to afford to relocate.
But she said the small clubhouse is important to those who attend. “I have seen them grow from being isolated and not talking to anybody when they enrolled to being this social butterfly,” Nwulu said.
Another clubhouse, Lifelinks, has 138 active members and is also at risk, according to Director Dice Cooper. It operates out of Elmhurst Hospital in Queens, which is run by NYC Health + Hospitals. Under the current RFP, the clubhouse would likely have to shut down or relocate because it is based in an institutional setting.
Cooper said the city isn’t giving clubhouses enough time to find a new space before the RFP deadline. “We’re looking, but it takes time,” he said.
Cooper also objected to giving preference to certain ZIP codes. “I know this community has a high need [for mental health services],” Cooper said. “I see it every day.”
Ayesha Delany-Brumsey, the chief strategic growth officer at Fountain House, said the Manhattan clubhouse is able to offer members more varied activities during the day because it’s larger. But she noted that other clubhouses will likely face challenges as they expand, like having to make more connections with potential employers for the members.
Delany-Brumsey said she admired the city’s commitment to expanding clubhouse membership but took issue with some of the specifics of the RFP – including the requirement that average daily attendance amounts to 40% of the total active membership. Fountain House has about 1,200 active members and daily attendance averages about 300, or 25%.
“We don’t necessarily want everyone coming in every day,” Delany-Brumsey said. “The clubhouse model is about engaging people in the clubhouse so that they build, not just relationships in the clubhouse, but that they start working, they reconnect with family, with friends, they build relationships outside of the clubhouse.”
Omar James is a member of Greater Heights, a clubhouse operated by Brooklyn Community Services. He said he likes attending a smaller clubhouse because crowds make his anxiety spike.
“They think they’re helping, but they’re creating a problem,” James said of the city health department. “We know where we feel comfortable.”