The Key To Tackling Our Mental Health Crisis: Community-Based Care

Written by Ken Zimmerman, CEO, Fountain House

In my career as a civil rights lawyer, federal and state official, philanthropic leader, and nonprofit executive, the throughline has always been equity, with a large emphasis on housing and homelessness, and on criminal justice reform.

As I reflect back on it, what is striking is that mental health was so closely aligned to the work I was doing, yet it was never the focus. That changed when our oldest child, Jared, developed a serious mental illness that led to his death a bit over six years ago.

Jared was a wonderful child: bright, idiosyncratic, a deeply loving son and big brother.

In the hellish journey he took over the four years before he died — through hospitalizations, a Kafkaesque run-in with the criminal legal system, and an astonishingly brave entry into college available only because of the number of AP courses he had taken before he became ill — what stood out most was how little he and we could figure out about how to move forward, and how to do so in a way that included community, promise and — above all — hope. I say this even though we had some wonderful professionals support him and us. And I want to emphasize that I relate this story not because our experience was unique, but the opposite: it is all too common.

This led me, when I left my post running the domestic program at the Open Society Foundations, to spend a year traveling the country to understand why our nation’s approach to mental health seemed so broken and what could be done about it. A preeminent takeaway was, for all the challenges, there was much promise in approaches and efforts that were not widely recognized or were just emerging. And it became clear to me that with the same kind of sustained attention that has been deployed in other domains, catalytic change was possible. Not easy, but possible.

So let me tell you a second story: this one about a man named Country, one of the many people I’m fortunate enough to encounter every day since joining Fountain House, a 75-year-old mental health nonprofit, as its new CEO. Until about a year ago, Country was unhoused and living with substance use issues. He was the first guest at our Recharge Station — an outreach kiosk in the heart of Times Square where staff and peers engage people who are homeless, live with serious mental health conditions, substance use issues, or all the above, and provide a respite.

As Country came to know, Fountain House and the model it has spawned in clubhouses across the country — what’s called “social practice” — starts with something that on the most basic level is common sense: that community is a critical form of therapy. And that is what Fountain House offers Country and others whose lives have been disrupted by their serious mental illness — a community that starts with individual dignity, rebuilds agency and trust, and leads not just to recovery but to thriving for upwards of 2,000 members in New York City.

This is a fundamentally different starting point from most other mental health approaches, such as medication or time-limited programmatic intervention. While these are critical pieces of the puzzle, they are not sufficient in and of themselves. The Fountain House model instead addresses the crippling negative symptoms of serious mental illness that drive loneliness, increase stigma, and impede success of other interventions. Social practice helps create a “stickiness.” It enables our members to go through the ups and downs associated with their mental illness in a community and, by doing so, remain engaged — in school, jobs, and housing — while staying out of the justice system and hospitals.

The evidence is powerful: Fountain House members have twice the rate of employment, better educational advancement, and are more likely to be stably housed than others living with serious mental illness. As reflected in an independent NYU study, it is also cost-effective: Fountain House members see a 21% reduction in Medicaid costs compared to their peers, largely due to the holistic benefits of this model. And, of course, the most powerful evidence is in the experiences of those like Country. That’s why the model Fountain House created has been replicated in 200 clubhouses around the nation.

Country is now housed and employed. More critically, he is in a community where he is respected. The research shows that his likely trajectory is one that will continue to involve being stably housed and employed while receiving psychiatric services and health care. For the budget counters amongst us, this allows the other public and private systems that Country might engage to be more effective at what they do, improving outcomes and using resources more appropriately. In other words, this is a concrete manifestation that addresses the social determinants of mental health.

Fountain House represents the kind of innovative and emerging approach that has huge potential, not only for the 60,000 clubhouse members across the U.S. but for the way that our country can enable those with serious mental health conditions to recover and thrive. And I want to be absolutely clear that this should be our north star: recovery and thriving and not the bigotry of low expectations that result in homelessness, incarceration, and hospitalizations. This type of intervention can and should be a fundamental building block in our nation’s approach to serious mental health challenges.

Something’s fundamentally wrong when the largest institutions housing people with serious mental health conditions are the jails in New York City, Los Angeles, and Chicago; when 63% of health care costs come from the 20% of our community with behavioral health challenges; and when communities of color and rural communities are particularly hard hit by these system failures.

Something’s fundamentally right when we go back to common sense and reaffirm dignity, community, and empowerment as starting points — lifting up approaches that advance mental health transformation and the catalytic change that is so desperately needed.