Fund the Places People Come Back To: Why Washington Needs Mental Health Clubhouses

One of our members found the Clubhouse because they kept seeing someone walking on the same trail every day. They got curious. Where was this person going? What were they doing? Eventually, that curiosity brought them through our doors.

Another member came because their therapist recommended the Clubhouse. Another hadn't worked in five years while struggling with sobriety. Today, they are working full time and have been able to get off state benefits.

And then there are the stories that are harder to hear. One member told me they genuinely didn't know where they would be without the Clubhouse. Maybe jail. Maybe living on the streets. Maybe dead. I think about that a lot.

I work in a mental health Clubhouse in Washington, and I am also getting my master's degree in social work. We talk constantly about our behavioral health crisis. We need more therapists. We need psychiatric beds. We need better crisis response. We need substance-use treatment. We need affordable housing. All of that is true. But I think there is another question we don't ask often enough:

What happens during the rest of someone's life?

A person may see their therapist for an hour a week. What happens during the other 167 hours What happens after someone leaves the hospital? What happens when someone is medically stable but has nowhere to go, no job to wake up for, few relationships and no sense that anyone particularly needs them anywhere? Clinical care matters enormously. But people need somewhere to go. That is one of the things I wish more people understood about mental health Clubhouses.

A Clubhouse isn't what most people imagine

When I tell people where I work, I sometimes have to explain what the word "Clubhouse" actually means. It isn't therapy. It isn't a treatment center. And it isn't a recreational drop-in center. Clubhouses serve adults living with serious mental illness through a model of psychosocial rehabilitation built around community, meaningful work, relationships and choice. Members aren't spending their days sitting in groups talking about their diagnoses or doing art..Instead, members and staff work alongside each other to operate the Clubhouse.

That might mean answering phones, preparing lunch, working on a newsletter, helping with outreach, organizing paperwork, maintaining a website, planning an event or welcoming someone who just walked through the door for the first time. Clubhouses also help members pursue employment and education and navigate things like housing, benefits and other resources. The work is intentional.

When mental illness has disrupted someone's life for years, it can take away much more than symptom stability. People can lose jobs, relationships, confidence, routines and communities. Eventually, it can become easy to see yourself primarily through the lens of what is wrong with you. The Clubhouse Model asks something different.

What can you contribute?

There is a huge difference between being told, "We're here to help you," and being told, "We need you." I've watched that difference matter.

Sometimes success looks like a job. Sometimes it looks like showing up.

We understandably like measurable outcomes in mental health. Employment is measurable. Hospitalization is measurable.Emergency room visits are measurable.

And Clubhouses have research behind them in those areas. A systematic review examining 52 studies of the Clubhouse Model found evidence supporting positive outcomes in employment, psychiatric hospitalization and quality of life, while also acknowledging that more rigorous research is needed. Those outcomes matter.

I have seen what employment can mean firsthand. One of our members hadn't worked for approximately five years while dealing with substance-use challenges. Eventually, they went back to work. Today, they are working full time. They have also been able to get off state benefits. Think about everything contained inside that outcome. There is the obvious financial piece: a person who once needed public assistance is now earning their own income. But there is also independence. Coworkers. Responsibility. A place to be in the morning. The experience of realizing, perhaps after years of believing otherwise, that you can do this. Those things are harder to enter into a spreadsheet.

And sometimes Clubhouse success looks much smaller. Someone who has been isolated at home begins coming in twice a week. That's it. There may not be a graduation ceremony. There may not be a dramatic before-and-after story. They just start showing up. Except that isn't really "just" anything. Because now there are people who know their name. If they don't come in, someone notices. If they accomplish something, there are people around to see it. If they're having a difficult day, they don't necessarily have to explain everything before they can still be part of something.

I don't know exactly how we assign a dollar amount to the experience of being missed.

But after working alongside adults living with serious mental illness, I know it matters.

Mental health care cannot end with symptom management

Our behavioral health system is understandably built around treatment. We diagnose. We stabilize. We prescribe. We provide therapy. We respond when someone is suicidal or psychotic or otherwise in crisis. Those interventions save lives.

But recovery asks a different set of questions. Do you have somewhere you belong? Do you have meaningful relationships? Do you believe you have something to contribute? Can you imagine yourself working again? Going back to school? Living independently?Having people who expect to see you tomorrow? Those aren't side issues.They're part of having a life.

And this is where I believe Clubhouses fill a gap that our traditional behavioral health system cannot fill on its own. A therapist can help someone work through isolation. A Clubhouse can give them somewhere to go. A case manager can help someone identify an employment goal. A Clubhouse can provide a community where they begin rebuilding the confidence and routines necessary to pursue it. A psychiatrist can help stabilize symptoms. A Clubhouse can provide somewhere to return to afterward. These services shouldn't compete with one another. We need all of them.

But when budgets get tight, programs centered around community and long-term recovery can be easier to undervalue because their impact isn't always captured in a billable clinical encounter.

Washington is cutting funding when we should be strengthening these programs

That is why Washington's recent funding reductions concern me. Beginning July 1, four Clubhouses operated by HERO House NW had their individual Washington State Health Care Authority contracts reduced by $57,629 annually. Combined, that is a loss of more than $230,000 per year. For a large health care institution, $57,000 may not sound transformative. For a small community-based mental health program, it is. It can mean staffing. It can mean outreach. It can mean employment support. It can affect whether staff are spending their days working alongside members, as the Clubhouse Model intends, or trying to figure out how to keep an under-resourced organization functioning.

I understand that Washington faces difficult budget decisions. I also understand that asking for public money requires accountability. I don't believe Clubhouses should receive funding simply because their mission sounds good. Programs receiving taxpayer dollars should be expected to demonstrate outcomes. Clubhouses should be accountable to the standards of the model. They should have competent leadership, responsible financial practices and meaningful ways of evaluating whether members are actually benefiting.

But accountability and adequate funding are not opposites.

We should expect programs to work And then we should give effective programs enough resources to actually do the work. We spend a lot of money after things fall apart.

There is something strange about how comfortable we have become paying for crisis. We pay for emergency departments. We pay for psychiatric hospitalization. We pay for crisis response. We pay for shelters. We pay for jails and courts. And we should fund the systems people need when their lives have reached those points. But we also need to invest in what happens before someone reaches them — and what helps someone build a life after they leave them.

One member told me they didn't know where they would be without the Clubhouse. Jail. The streets. Or dead. That statement stays with me because those are not theoretical outcomes. They are exactly the systems our communities spend enormous amounts of money responding to.

What if we invested more aggressively in belonging before someone became homeless? What if we invested in meaningful work before someone had spent years believing they were unemployable?What if we invested in community before isolation became crisis? What if a piece of mental health infrastructure could be as simple (and as complicated) as creating a place where someone knows they are expected tomorrow?

I have also learned that Clubhouses aren't magic.

Working inside this model has made me believe in it. It has also made me understand that simply putting the word "Clubhouse" on a building doesn't create these outcomes. The model requires resources. It requires trained staff who understand that their role isn't to do everything for members, but to work alongside them. It requires enough organizational stability that staff can focus on members rather than constantly trying to build or sustain the organization around them. It requires fidelity to the model. It requires community partnerships.

And it requires time.

Recovery usually doesn't happen according to a funding cycle. Someone may come through the doors and barely participate at first. They might sit quietly. Then they start helping with lunch. Then they answer a phone. Then they join a meeting. Maybe months later they start talking about employment. Eventually, perhaps, they apply for a job. From the outside, it can look painfully slow. From inside the Clubhouse, you can see what is happening. A person is rebuilding a life.

People need to be needed.

The longer I work in mental health, the more I think we underestimate this. People don't only need services. People need to be needed. They need opportunities to contribute instead of always being the recipient of somebody else's help. They need places where their diagnosis isn't the most interesting thing about them. They need people who notice when they haven't shown up.

And sometimes the path into that kind of community begins in ways nobody could ever design into a treatment plan. Someone sees another person walking down a trail every day. They wonder where they're going. Eventually, they follow that curiosity through a door. And on the other side, they find people who know their name. Washington will continue spending money on serious mental illness. We should. But our choices about where that money goes say something about what we believe recovery actually means.

If recovery means only surviving the next crisis, then funding crisis care may be enough.

I don't think it is. Because what happens when we stop funding the places that exist between the crises? What happens when the person who finally started leaving their house twice a week has nowhere to go? What happens to the person rebuilding the confidence to work again? The person whose social circle exists largely inside those walls? The person who told me they don't know whether they would be in jail, homeless or alive without this community?

We don't make those needs disappear by cutting the program. We just change where they show up. Maybe they show up in an emergency room. Maybe in a psychiatric hospital. Maybe in a shelter. Maybe in the criminal justice system. Maybe they disappear back into their homes and nobody notices.

And eventually, we will pay for that too.

That's what I wish we understood when we talk about cutting funding for programs like Clubhouses. We aren't deciding whether people with serious mental illness will need support.

We're deciding whether we're willing to pay for that support while they're building a life or wait until we're paying for it after that life has fallen apart.

So if you live in Washington, ask your legislators where Clubhouses fit into our state's behavioral health priorities. Ask what happens to community-based recovery when funding is cut. Ask why programs are being asked to provide stability while struggling to afford the basics themselves. And if you've never heard of a mental health Clubhouse, find one. Learn what happens there. Talk to the people who choose to walk through those doors.

Because budgets can make these decisions feel abstract. They aren't. Every funding decision eventually reaches a real person. The person who finally went back to work. The person who finally left their house.

The person who knows someone will notice if they don't show up tomorrow.

Before we cut the places people come back to, we should be asking what happens to the people who still need somewhere to go.