Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
Kathleen Merriam started hearing voices as a high schooler in Seattle. She cycled in and out of psychiatric hospitalization, running away and getting picked up by police officers who returned her to the hospital. “In those days, there was no trauma-informed care — I felt misunderstood,” she said.
Her experience led to a career building programs run by staff and patients side-by-side. Merriam is the coordinator of Hawaii’s nine statewide clubhouses, community-based psychosocial rehabilitation centers started by Fountain House.
Twenty-two years ago, Merriam was living in New York and working as Fountain House’s director of international training when Hawaii state leaders called, asking her to lead the statewide initiative. “They wanted to transform their day centers into clubhouses,” she said.
A single clubhouse, Friendship House, already existed on Kauai, one of Hawaii’s islands.
When Merriam visited the day centers, she found people “washing cars for 50 cents and making ornaments out of tea leaves all day long without purpose.”
At that point in her career, she’d seen many peer-run programs nationally. Many drop-in centers only “consisted of a sofa and a coffee pot.” “Expectations were low, as if we could only do the simple stuff,” she explained. Regardless of whether day programs were professionally-run or peer-run, she says both were plagued with discrimination and not recovery-oriented.
The clubhouse model attracted Merriam as it doesn’t underestimate people’s abilities. “Go ahead and believe people can do a lot, have expectations,” she said. “We don’t have to start with these low, depressing ideas that people can’t do much.”
In the 1940s, a group of former patients from Rockland State Hospital in New York started the first clubhouse, calling it “We Are Not Alone.” According to the Fountain House website, they originally connected while in the hospital, spending time together doing activities and sharing their stories. After leaving the hospital, they decided to continue meeting.
They started a social club. The first Fountain House building was a brownstone in Hell’s Kitchen, with a fountain on the patio that inspired the name. The club initially functioned like a settlement house, providing academic and social programs to people after psychiatric hospitalization. It quickly became a model for how patients could successfully transition back into society.
“People would regularly come tour the clubhouse, and then Fountain House started a training program,” said Merriam.
The model grew. Now there are over 350 clubhouses in 33 nations.
In 2003, Hawaii’s Department of Health reached out to Fountain House for assistance in “taking the clubhouse model statewide.” Merriam started flying out to help pick out the sites and couldn’t refuse when state leaders offered her a position to coordinate the effort throughout the state.
“I thought, ‘This sounds too good to be true’ but then people told me, ‘You have the aloha spirit, we think you will do well here’ — and that sold me.” Aloha spirit is a way of life defined by mutual respect and caring, encouraging people to treat each other with compassion and kindness, a philosophy Merriam wanted the clubhouses to embody.
She began the statewide initiative by listening and reassuring people the Kauai clubhouse would maintain its existing recovery-oriented activities. “People had a lot of pride in what they were doing — I wanted them to know we weren’t going to eliminate anything but instead would expand opportunities for people.” The clubhouse soon added paid work and evening, weekend and holiday programming.
When starting a clubhouse, Merriam begins with the basics — work units, groups of members working together to support the clubhouse operations, that focus on members’ immediate needs. “We need to communicate, so we set up a newsletter. We have to eat, so we developed a food service unit.” Members choose the unit they work in and can change units when they want.
If a clubhouse plans to add a new program, like a unit on horticulture, Merriam immerses herself in the topic. She has stood in as acting director at clubhouses that didn’t yet have one. “I won’t ask people to do anything I wouldn’t do myself.”
Each clubhouse must feel like a recovery environment, says Merriam. “It must be warm and welcoming,” she explained, adding that all administrators working in crisis spaces should ask themselves, “Would I want to be there? Would I want my loved one to be there?”
As someone who experienced psychosis and adverse encounters with police as a teenager, she’s especially focused on improving interactions between police and people in mental health distress. “I had such horrible police interactions — they would just pick me up, throw me in their car and take me back to the psychiatric unit. I would run again.
“I thought my psychiatric clothing just kind of looked punk rock, so I didn’t think anyone in Seattle would notice, but sure enough, police would.”
Merriam conducts auditory hallucination simulations during Crisis Intervention Team training for the Honolulu Police Department, using a recording that replicates hearing distressing voices. “I walk around and give instructions and, of course, the officers get so disoriented they can’t follow them.
“They’re kind of shaken up and this is just a taste of what people experience. They seem to get it — they feel helpless sometimes, too — and they’re looking at me and thinking, ‘She was one of them.’”
Today, daily attendance at the clubhouses can run anywhere from 30 to 70 people, depending on location. Membership is voluntary. “You want people to want to be there, not be mandated to go,” she said. The objective is to create an intentional community run by “staff and members side-by-side as colleagues.”
Clubhouses are structured with diverse work units that “keep the day vibrant and active,” helping people engage in work they enjoy and make social connections. They often include units on business, clerical, food service, education, employment, horticulture and maintenance.
The employment model is simple, says Merriam. “If you want a job, we think that’s a pretty good indicator of success.”
The clubhouse offers three types of employment opportunities — transitional, supported and independent. The first two are part-time, while independent employment is mostly full-time and, as the name implies, separate from the clubhouse. “They might come in and talk about the work they’re doing.”
Clubhouses partner with local businesses to create transitional employment opportunities, jobs that last around six to nine months. If the employee can’t go into work, their placement manager will go in instead. “We provide guaranteed coverage. Employers like that; that’s a good deal for them.”
Part-time employment allows people to build their resume. “You get work experience and learn what you do and don’t like.”
The partnerships with businesses are ongoing. While employees will likely move on to another job after the designated duration, the position will remain and be filled by another clubhouse member seeking part-time employment.
Merriam has worked to ensure clubhouses also have supported education partnerships with colleges and trade schools. “Members might need to get their GED or want to take college classes — we should be helping them with that, too.”
In the future, Merriam would like to see improved technology for the clubhouses and more accessible bus routes. Each clubhouse has a van or two but providing transportation every day would be challenging. “We’ve had a couple of clubhouses actively speak to their legislators about bus routes, advocating for them to be changed.”
She also hopes to have reimbursement options soon. “There are billing codes for psychosocial rehabilitation; it’s just a matter of putting all the pieces together.” At present, Hawaii funds the clubhouses and each location has a nonprofit to help with fundraising.
People need a place to go and recovery opportunities, says Merriam. She’s helping create the safe space of community she deserved decades ago. “We all need friends and a job.”
