Clubhouse model

1. Introduction

Version followed: Clubhouse International, International Standards for Clubhouse Programs, revised October 2025 (37 standards). Where older material differs (e.g. the 36-standard edition cited by Phoenix Clubhouse in 2016), the difference is noted. [source: Clubhouse International Standards 2025; Phoenix Clubhouse HA Convention 2016]

What it is. The Clubhouse model is a community programme and service model for adults with serious mental illness, not a psychotherapy. A Clubhouse is a separate community where "members" (people with a history of mental illness) and a small staff jointly run the whole operation through a structured "work-ordered day", with routes into paid community jobs, education, housing and social life. The Standards explicitly exclude medication clinics, day treatment and therapy programmes from the Clubhouse itself. A psychotherapist therefore uses it in one of three roles: (a) referring clinician who works alongside a client's Clubhouse membership; (b) clinician employed as Clubhouse staff, where the job is generalist colleague work, not therapy; (c) clinician in a host service (e.g. a hospital department) converting or sponsoring a Clubhouse. This guide covers all three. [source: Standards 2025, Std 13, 15; Clubhouse International model page]

Origins (verified). The model began with a patients' group at Rockland (State) Psychiatric Center, New York (1943), named "We Are Not Alone" (WANA) in 1944, supported by psychiatrist Hiram Johnson and volunteer Elizabeth Schermerhorn; it became Fountain House on West 47th Street, Manhattan, in 1948. Social worker John Beard became executive director in 1955 and built the approach around members and staff doing meaningful daily work together. The Standards were first issued in October 1989 and are reviewed every two years by members and staff of accredited Clubhouses. [source: Wikipedia, Fountain House; Standards 2025]

Phoenix Clubhouse, Hong Kong. Run within the Hong Kong West Cluster and linked to the psychiatric day hospital of Queen Mary Hospital, it converted from a professional-led day-hospital style service to the Clubhouse model in 1998, is described as Hong Kong's first Clubhouse, and has been accredited by Clubhouse International since 2001. It adds a "Group Placement" employment step and acts as an orientation hub for Chinese-speaking Clubhouses. [source: Phoenix Clubhouse HA Convention 2016 presentation; Chui et al. 2016]

How change happens. Change is expected to come from belonging and from being genuinely needed: members contribute real work that the community cannot do without them, in relationships of colleagues rather than patient and treater, with high expectations and a focus on strengths. This restores self-worth, purpose and confidence and provides a base for paid work, education, housing and friendships in the wider community. Clubhouse International contrasts this with models centred on disability assessment, and names mutual work, mutual relationships and community opportunity as the vehicles of rehabilitation. [source: Standards 2025, Std 9, 15, 19; Clubhouse International model page; Doyle, Lanoil & Dudek 2013 publisher description ("the need to be needed")]

2. Framework

The Clubhouse has no treatment phases, sessions or end date: membership is voluntary and has no time limit (Std 1). What follows is the member's typical pathway as the sources describe it, plus the programme's own development cycle. Movement between elements is driven by the member's choice, never by a clinician's criteria. [source: Standards 2025, Std 1, 3]

Format and dose.

• Open at least five days a week during normal working hours, with evening, weekend and holiday social programmes; holidays are kept on their actual dates (Std 17, 32).
• A typical NYC day: 9 a.m.–noon breakfast, opening community and work meetings, choosing and doing tasks; noon–1 p.m. lunch; 1–5 p.m. unit meetings and tasks; some weekday evenings and weekends recreation and outings. Some NYC Clubhouses also allow virtual participation. [source: NYC Health, Clubhouses page]
• Members decide how often they come and which staff they work with; there are no contracts, attendance schedules or behavioural rules governing participation (Std 3). Phoenix Clubhouse reports 50–60 members attending daily. [source: Standards 2025; Phoenix 2016]

Member pathway.

Programme cycle (for a clinician or agency starting a Clubhouse). Join Clubhouse International → director, members, staff and others complete Comprehensive Clubhouse Training at an authorised Training Center (Std 31; the 2025 text gives two weeks [uncertain: earlier editions may differ]) → accreditation within four years of joining: members' and staff's written self-study against the Standards → 3–4 day site visit by a two-person faculty (one member, one staff) from other accredited Clubhouses, ending with verbal findings to the whole community → written report → one-year or three-year accreditation, or deferral if significantly out of compliance → re-accreditation. Clubhouse International membership requires accreditation, and the Clubhouse must also hold any licences required locally (Std 30, 36). Dates are usually booked 12–16 months ahead. [source: Clubhouse International Accreditation page; Standards 2025]

3. Guiding principles

All from the 2025 Standards unless marked. Each shapes what you, as staff or as a referrer, actually do.

• Voluntary, open-ended membership (Std 1). Never make attendance a condition of anything you control; no discharge date.
• The Clubhouse controls admission; inclusion is broad (Std 2, 4). Do not pre-screen clients as "not ready"; the only exclusion is significant current safety risk.
• Member choice without contracts or enforced rules (Std 3). No attendance plans, behaviour contracts or token rules; the member chooses work, staff and pace.
• Shared records (Std 5). Members may help write their participation records; both sign them. Write notes you would show the member.
• Right of immediate return (Std 6). After any absence, including hospitalisation or disengagement, welcome back without re-assessment or conditions.
• Active reach-out (Std 7). Absence is a reason to call or visit, not to close the file.
• No closed meetings, no exclusive space (Std 8, 14). No staff-only case conferences about members or programme decisions; no staff room.
• Deliberate under-staffing (Std 9). Enough staff to engage members, too few to run the place alone; if you can do the work without members, you are doing it wrong.
• Generalist staff (Std 10). Every staff member covers units, employment, housing, evenings, weekends and holidays; no specialist silos (TE is not run by "TE specialists", Std 22i).
• Shared responsibility (Std 11). Members and staff run operations together; the director holds final responsibility.
• Own identity and dignified space (Std 12–13). The Clubhouse has its own name, address, phone and building, separate from clinics.
• Side-by-side work, strengths focus, no therapy inside (Std 15). Your stance is colleague, not treater; clinical work happens elsewhere.
• Work for the Clubhouse only, unpaid, no artificial rewards (Std 16). No points, stipends or certificates for Clubhouse tasks; the reward is the work and the relationship.
• Purpose, not job training (Std 19). Units restore self-worth and confidence; do not frame tasks as vocational drills.
• Members in every function (Std 20). Include members in administration, research, enrolment, outreach, hiring, staff training and evaluation, PR, advocacy and evaluation.
• Real jobs in the community (Std 21). No sheltered workshops, in-house businesses or segregated enterprises.
• Work is a right; desire is the criterion (Std 22). Readiness is shown by wanting to work, not by symptom level.
• Consensus decision-making in open forums (Std 37). Policy and direction go through meetings anyone can attend.
• High expectations. Expect members to contribute and succeed. [source: Clubhouse International model page]
• Staff as "colleagues, workers, talent scouts and cheerleaders". Look for and develop members' talents. [source: Clubhouse International page as hosted by Nevada DPBH]
• Positive risk-taking. Encourage members to try new roles and opportunities. [source: Fountain House job posting, "Social Practice"]

4. Intervention inventory

The Clubhouse's "interventions" are the structures and staff practices set out in the Standards and Clubhouse International's descriptions. None is a therapy technique. Step-by-step detail beyond what the sources state is marked [synthesis]. Interventions A1–A3 are for a referring or partnering clinician; B1–B19 are for clinicians working as Clubhouse staff.

A1. Assessing fit and referring a client

• Purpose / when: For an adult with serious mental illness whose isolation, loss of role, unemployment or poor self-esteem is not addressed by treatment alone. NYC Health frames Clubhouses as addressing loneliness, isolation and low self-esteem, which medication does not touch. [source: NYC Health]
• Steps: (1) Check local eligibility. NYC, for example: age 18+, primary psychiatric diagnosis of serious mental illness, able to get there independently or take part virtually; insurance, immigration status, substance use, justice involvement and homelessness do not exclude. [source: NYC Health] (2) Prepare whatever documentation the funder requires (NYC: a psychiatric evaluation with diagnosis and psychosocial history, or an attestation signed by a licensed clinician; the Clubhouse supplies its own application). [source: NYC Health] (3) Explain the model honestly: it is not therapy, nobody will run groups on them, they will be asked to help run the place, and they choose how much. [synthesis based on Std 3, 15] (4) Help the client arrange a tour by phone, email or walk-in; offer to go with them if that is acceptable to the Clubhouse. [source: NYC Health; accompanying = synthesis] (5) If possible pick an accredited Clubhouse; Clubhouse International lists accredited programmes. [synthesis]
• Example language (illustrative): "This isn't a treatment programme. It's a place where people with experiences like yours run things together: the kitchen, the office, the newsletter. Nobody makes you go, and if you stop and come back, you're welcome straight away."
• Watch for: The client hearing it as a day programme or sheltered workshop; your own wish to make attendance a treatment goal you police. Working: the client tours, returns of their own accord, and starts talking about "my unit" or tasks.

A2. Working alongside a client's membership

• Purpose / when: Ongoing therapy while the client is a member. The Clubhouse helps members reach medical, psychological, medication and substance-use services but does not provide them (Std 15, 27). [source: Standards 2025]
• Steps [synthesis]: (1) Keep therapy outside the Clubhouse and do not ask the Clubhouse for attendance reports as a condition of care. (2) With consent, agree one contact person and use open, member-present communication; Std 8 rules out closed staff-only meetings about members, so expect the member to be invited to any conversation. (3) Use the Clubhouse experience in therapy: roles taken, reactions to colleagues, fears about TE, as material for your own model's work. (4) Coordinate around benefits reporting and job changes, since the Clubhouse and member prepare reports for benefit agencies (Std 22h).
• Example language (illustrative): "Would you like to be in the room or on the call when I speak to the Clubhouse? I'd rather we talk together than about you."
• Watch for: Pressure to turn the Clubhouse into a monitoring arm of treatment. Working: therapy themes move from illness to roles, work and relationships.

A3. Sponsoring or converting a service to the Clubhouse model

• Purpose / when: A clinician or hospital department wants to move a day programme to the model (as Queen Mary Hospital's day-hospital service did to form Phoenix Clubhouse in 1998). [source: Phoenix 2016; Chui et al. 2016]
• Steps: (1) Secure separate identity and space (own name, address, phone, email, building apart from clinics), Std 12–13. (2) Remove medication clinic, day treatment and therapy from the Clubhouse (Std 15). (3) Set up an independent board, or with a sponsoring agency a separate advisory board with finance, law, legislation, employment, membership and advocacy expertise (Std 33); own budget, reviewed before and through the year (Std 34); competitive salaries (Std 35). (4) Join Clubhouse International, send director, members and staff to Comprehensive Clubhouse Training (Std 31), and complete accreditation within four years. [source: Standards 2025; Accreditation page] (5) Phoenix built a "Friends of Phoenix Clubhouse" advisory committee of community members, professionals, carers and members. [source: Phoenix 2016]
• Watch for: Clinical staff keeping treatment roles inside the house; professionals dominating decisions. Phoenix reports going from 12 accreditation recommendations in 2001 to none in 2016, which shows that conversion takes years. [source: Phoenix 2016]

B1. Greeting and welcoming members

• Purpose / when: Every morning; it signals that each person is expected and wanted.
• Steps: Members are greeted at the door each morning by staff and other members. [source: Clubhouse International page (Nevada DPBH copy)] [synthesis:] greet by name; mention a concrete way they are needed today; for members back from an absence, welcome without questions about where they have been (Std 6).
• Example language (illustrative): "Good to see you. The newsletter team is short today, would you want to help with layout?"
• Watch for: Greeting turning into symptom check-ins. Working: members begin greeting newcomers themselves.

B2. Opening community meeting and unit meetings

• Purpose / when: Morning, and again after lunch; unit meetings build relationships and plan the day's work (Std 18). [source: Standards 2025; NYC Health schedule]
• Steps: (1) Open with a community meeting and work meetings after breakfast. (2) In each unit, list the real work to be done today. (3) Members and staff choose tasks. (4) Repeat after lunch with a unit meeting and task selection. [source: NYC Health] [synthesis:] Have members chair and take minutes where they want to; ask, don't assign; make sure tasks visibly matter to someone (lunch served, calls answered, newsletter printed).
• Example language (illustrative): "Here's what's on the board today: the reach-out calls, the lunch order, the attendance figures for the board report. Who wants what?"
• Watch for: Staff running the meeting as a lecture, or busy-work invented for engagement. Working: members bring their own agenda items and take the chair.

B3. Side-by-side work in units

• Purpose / when: The core of the work-ordered day; restores self-worth, purpose and confidence (Std 15, 18, 19).
• Steps: (1) Organise the house into units, each with enough staff, members and meaningful work to fill the day (Std 18). Examples named by Clubhouse International: clerical, reception, food service, transportation, outreach, maintenance, research, financial services, running the employment and education programmes. [source: Clubhouse International page (Nevada copy)] (2) Work only on the Clubhouse's own operation; no outside contracts, no pay for Clubhouse work, no reward systems (Std 16). (3) Staff work with members, not over them. [synthesis:] Do the task together, hand over the parts the member chooses, step back as skill grows; stay as colleague, not supervisor.
• Example language (illustrative): "Can you show me how you set up that spreadsheet? Mine keeps breaking."
• Watch for: Staff quietly doing tasks themselves because it is quicker (undermines Std 9); praise that sounds like reinforcement schedules. Working: members are relied on and know it; work would visibly fail without them.

B4. Daily invitation and engagement ("talent scouting")

• Purpose / when: For new, quiet or withdrawn members. Members are invited into the work daily, and staff act as "talent scouts and cheerleaders". [source: Clubhouse International page (Nevada copy)]
• Steps [synthesis]: (1) Notice interests and past skills in conversation. (2) Make a specific, low-stakes invitation tied to real need. (3) Accept a no without pressure and invite again later. (4) Build up responsibility as the member shows interest. Fountain House describes this as building relationships that encourage positive risk-taking, and observing members in everyday settings to shape individual rehabilitation plans. [source: Fountain House job posting]
• Example language (illustrative): "You mentioned you used to cook for your family. The kitchen unit is planning Friday's lunch. Want to sit in on the planning?"
• Watch for: Over-pursuit that breaches choice (Std 3). Working: the member starts choosing a unit unprompted.

B5. Co-written participation records

• Purpose / when: Whenever records are needed for funders or progress notes (Std 5).
• Steps: Members may take part in writing the records that reflect their participation; both member and staff sign. Fountain House staff write progress and outreach notes on time and to agency requirements. [source: Standards 2025; Fountain House posting] [synthesis:] Write together at a desk in shared space, in plain language about contributions and goals, not symptoms.
• Example language (illustrative): "Let's do your note together. How would you describe what you did in the unit this month?"
• Watch for: Hidden clinical notes kept separately. Working: members ask to see and add to their notes.

B6. Reach-out

• Purpose / when: When a member misses the Clubhouse, becomes isolated, or is hospitalised (Std 7). Clubhouse International describes it as a reminder that the member is welcome and missed, and as an early warning that someone may need extra help. [source: Clubhouse International model page]
• Steps: (1) The reach-out unit (staff and members) reviews who has not attended. (2) Call or visit members who have been away or are in hospital. [source: Clubhouse International model page] (3) [synthesis:] Keep the message to welcome and connection ("we miss you"), not compliance; offer a specific reason to come back; if the member describes a crisis, pass it to the appropriate service with the member's knowledge. (4) For hospitalised members, help them keep their housing (Std 29f) and TE job (absence coverage, B9).
• Example language (illustrative): "Hi, it's Sam from the Clubhouse. The office unit missed you this week. No pressure, we just wanted you to know your spot's here."
• Watch for: Reach-out becoming surveillance. Working: members returning and saying a call or visit mattered.

B7. Open forums and consensus decision-making

• Purpose / when: Any decision on governance, policy or direction (Std 37); any meeting on programme or member issues (Std 8).
• Steps: Hold open house meetings that members and staff both attend; aim for consensus. [source: Standards 2025] [synthesis:] Post agenda in advance; members chair; record decisions; bring unresolved issues back rather than overriding.
• Example language (illustrative): "We're not voting yet. What would need to change for everyone to be able to live with this?"
• Watch for: Decisions made beforehand in staff corridors. Working: members raise and win changes.

B8. Members in all Clubhouse functions

• Purpose / when: Continuously (Std 20).
• Steps: Involve members in administration, research, enrolment and orientation, outreach, hiring and training and evaluating staff, public relations, advocacy and programme evaluation. Phoenix members join decision-making, training, conferences, publicity, teaching, staff recruitment and research; the accreditation self-study is written by members and staff together. [source: Standards 2025; Phoenix 2016; Accreditation page] [synthesis:] Put a member on every hiring panel and give tours of the house through members.
• Watch for: Token membership on panels. Working: members' views change outcomes (a hire, a policy).

B9. Transitional Employment (TE)

• Purpose / when: A right of membership for any member who says they want to work, whatever happened in earlier placements (Std 22a–b).
• Published features (Std 22): At the employer's site; wage paid directly by the employer at the prevailing rate and at least minimum wage; a wide range of jobs; part-time and time-limited; the Clubhouse, not the employer, selects and trains the member; members and Clubhouse prepare reports for benefit agencies; placements are managed by Clubhouse staff and members, not TE specialists; no TE inside the Clubhouse; the Clubhouse covers the job whenever the member is absent. Hours: Std 22f gives about 12–20 hours a week for six to nine months; Clubhouse International's model page gives 15–20 hours. [uncertain: the two sources differ; follow your local Clubhouse's practice]. Examples at Phoenix include clerk and office assistant roles with employers such as banks and multinationals. [source: Standards 2025; Clubhouse International model page; Phoenix 2016]
• Steps: (1) Develop and keep relationships with employers to create placements (Fountain House lists this as a staff duty). (2) Staff learn each job so they can train members on it ("vocational training for transitional jobs"). (3) Match by the member's wish; the Clubhouse selects who goes. (4) Train and support the member on site at first, then off site. (5) Cover the job with a staff member or another member during absences, so the employer always has the work done. (6) Help with benefits reporting. (7) At the end of the placement, plan the next step: another TE, SE or IE. [source: Fountain House job posting; Standards 2025; Clubhouse International model page; step order = synthesis]
• Example language (illustrative): "You said you want to work. That's all it takes for TE. There's a mailroom placement starting next month, 15 hours a week. I'll learn it first, then we'll do the first days together."
• Watch for: Staff screening for "readiness"; ending TE rights after a failed placement (contrary to Std 22b); benefit loss fears. Working: members finish placements, move on to SE or IE, and talk about themselves as workers.

B10. Group Placement (Phoenix Clubhouse variant)

• Purpose / when: A first step before individual TE: members work in a group at a community employer for half a day to one day a week. [source: Phoenix 2016; Chui et al. 2016]
• Steps: The sources give only the format and the place in the ladder (GP → TE → SE → IE). Further procedure was not found [uncertain]. Note that the Standards do not list group placement as a separate element; check with your Clubhouse whether it fits Std 21–22 locally. [synthesis]
• Watch for: GP turning into a permanent segregated work crew (Std 21 forbids segregated enterprises). [synthesis]

B11. Supported Employment (SE)

• Purpose / when: For members seeking a permanent community job with support.
• Steps: The Clubhouse helps the member find, keep and progress in the job; the member gets it through a competitive interview at the prevailing wage, full- or part-time, not time-limited; member and staff decide together the type, frequency and location of support, on or off site; the Clubhouse keeps a relationship with both member and employer (Std 23). [source: Standards 2025; Clubhouse International model page] Phoenix reports a mean SE job tenure of 22.2 months (n=75), which shows how long-term this support is. [source: Phoenix 2016]
• Example language (illustrative): "How do you want support to look: me checking in at lunch, or meeting here after your shift?"
• Watch for: Support decided for the member rather than with them. Working: the member needs less support over time and keeps the job.

B12. Independent Employment (IE) and continued access

• Purpose / when: Members with their own jobs.
• Steps: Help members find their own jobs; support them at the Clubhouse or in the community but not at the workplace; keep full access to all supports and to evening and weekend programmes (Std 24). [source: Standards 2025; Clubhouse International model page]
• Watch for: Working members drifting away because nothing runs outside office hours. Working: employed members still use evening programmes and mentor others. [synthesis]

B13. Education support

• Purpose / when: Members with educational or vocational-education goals (Std 25).
• Steps: Help members use community education (from adult basic education and high-school equivalency to licence training and graduate study); offer in-house tutoring mainly taught by members. Phoenix runs in-house classes such as Putonghua. [source: Standards 2025; Clubhouse International model page; NYC Health; Phoenix 2016]
• Example language (illustrative): "Would you be up for tutoring the computer class? Three people asked for spreadsheet help."
• Watch for: In-house classes run by staff as a school. Working: members enrol in outside courses.

B14. Community support (entitlements, advocacy, service access)

• Purpose / when: Practical problems that threaten stability: benefits, health care, legal or housing issues.
• Steps: Done by members and staff within the work units (Std 27): help with entitlements and benefits, advocacy, healthy living, and access to medical, psychological, medication and substance-use services; Clubhouse International adds transport, financial management, crisis intervention and outreach. Fountain House staff, for example, help with food stamps, SSI/SSDI, Medicaid/Medicare, Ticket to Work, supplemental needs trusts, ADA accommodations and housing applications, and advocate across clinical, legal, housing and medication matters. [source: Standards 2025; Clubhouse International model page; Fountain House posting]
• Example language (illustrative): "Let's fill in the benefits form together in the office unit. Maria did hers last month and can show us the tricky part."
• Watch for: A separate staff "case management" desk forming (conflicts with Std 10, 14). Working: members help each other with paperwork.

B15. Housing support and Clubhouse-run housing

• Purpose / when: Members without safe, decent, affordable housing (Std 29).
• Steps: Help find housing, move, mediate with landlords, maintain apartments. [source: Clubhouse International model page] If the Clubhouse runs housing: members and staff manage it together; residents choose to live there and choose location and roommates; policies match Clubhouse culture; support varies with need; members and staff actively help residents keep housing, especially during hospitalisation (Std 29a–f). [source: Standards 2025]
• Watch for: Housing rules that require attendance (conflicts with Std 3, 29d). Working: tenancies survive hospital admissions.

B16. Wellness

• Purpose / when: Physical health and wellness (Std 28).
• Steps: Work with community partners and health providers; any in-house wellness activity must fit the work-ordered day and draw on members' own expertise. NYC Clubhouses report fitness classes and help finding low-cost care. [source: Standards 2025; NYC Health]
• Watch for: Wellness becoming a clinic-style treatment programme. [synthesis]

B17. Evening, weekend and holiday social programmes

• Purpose / when: Social life, friendship, recreation outside work hours (Std 32).
• Steps: Members and staff plan recreation at the Clubhouse and in the community; hold holidays on their actual dates. NYC examples: trips, film and game nights, arts and crafts, holiday gatherings; members plan, buy, cook and serve meals. [source: Standards 2025; Clubhouse International model page; NYC Health]
• Example language (illustrative): "Who's around on New Year's Day? Let's plan what we're cooking."
• Watch for: All staff being unavailable at evenings (Std 10 requires shared rotas). Working: members organise outings themselves.

B18. Accreditation self-study and site visit (programme level)

• Purpose / when: Every accreditation cycle (one or three years).
• Steps: (1) Members and staff review each Standard together in community meetings, unit meetings and forums. (2) Write the self-study report and send it to Clubhouse International and the faculty team. (3) Host the 3–4 day visit: faculty meet members, staff, board and stakeholders, watch daily work, visit housing, job and education sites. (4) Hear the verbal findings as a whole community on the last day. (5) Act on the written recommendations; consultations from the ten Training Bases are available at cost. [source: Accreditation page]
• Watch for: Staff writing the self-study alone. Working: fewer recommendations each cycle (Phoenix: 12 → 0 over 2001–2016). [source: Phoenix 2016]

B19. Comprehensive Clubhouse Training

• Purpose / when: For director, members, staff and others in a new or re-orienting Clubhouse (Std 31).
• Steps: Attend Comprehensive Clubhouse Training at an authorised Training Center, ideally during the four-year window before first accreditation. Content and daily format are [uncertain]. Length given as two weeks in the 2025 text as read [uncertain]. [source: Standards 2025; Accreditation page]
• Watch for: Sending only staff; the Standard names members too.

5. Handling problems

The Standards give the rules that bound every response (choice, return, reach-out, no closed meetings, no therapy inside). The concrete responses below are mostly practice guidance built on those rules and marked [synthesis] unless a source is named.

• Member stops coming or withdraws. Reach-out by call or visit, with a welcome message, not a compliance one (Std 7; Clubhouse International model page). The member may return at once with no conditions (Std 6). [synthesis:] Vary who reaches out (a member colleague is often more welcome than staff); keep contacts brief; mention a specific way they are needed.
• Member attends but does not take part ("stuck"). Participation is chosen, not enforced (Std 3). [synthesis:] Make small specific invitations tied to real need (B4); pair with a member they get on with; offer roles that do not require talking (data entry, cooking prep); check that staff are not doing all the work (Std 9: when staff can do it alone, members are not needed).
• "Resistance" to the model: client wants therapy, groups or a structured programme. The Clubhouse does not provide therapy (Std 15). [synthesis:] As referrer, keep therapy going alongside and explain the difference before the tour; as staff, help the member get therapy outside (Std 27) instead of starting groups in the house.
• Overwhelm or acute symptoms during the day. Community support includes crisis intervention and access to psychiatric services (Clubhouse International model page; Std 27). [synthesis:] Offer a quieter task or a break with a trusted colleague; link to the member's clinical team with their knowledge; follow your local risk procedures, including standard suicide-risk assessment by a qualified clinician outside the work-ordered day; never make continued membership depend on accepting treatment.
• Safety risk to others. Admission and immediate return are limited only by a significant, current threat to the community's safety (Std 2, 6). [synthesis:] Decide time-limited exclusions through an open, documented process involving members where confidentiality allows, review them promptly, and keep reach-out going.
• Hospitalisation. Reach-out to hospitalised members (Std 7); members and staff help the member keep their housing (Std 29f); TE job covered during absence (Std 22). [synthesis:] Visit if the member wants; agree with the ward how the Clubhouse can help discharge planning.
• Failed or abandoned TE placement. Further placements remain available regardless of past success (Std 22b); the Clubhouse covers the job so the employer is not let down (Std 22). [synthesis:] Debrief as colleagues, not as an assessment; offer another placement when the member wants one.
• Fear of losing benefits. The Clubhouse and member prepare benefit-agency reports (Std 22h); staff help with work incentives such as Ticket to Work (Fountain House posting). [synthesis:] Get accurate local benefits advice before the first placement.
• Ruptures between a member and staff. Members choose which staff to work with (Std 3); generalist staff are interchangeable within units (Fountain House posting). [synthesis:] Let the member work with someone else without making it a fault; address grievances in open forum where the member wants that (Std 8, 37); avoid private staff-only discussion of the member.
• Referring clinician or funder wants attendance as a condition (probation, housing, treatment plans). Conflicts with Std 1 and 3. [synthesis:] Explain that the Clubhouse cannot enforce attendance; with consent, offer the member-signed participation record (Std 5) instead of monitoring.
• Staff drifting into treater roles or a "day hospital" culture. The Standards exclude day treatment and therapy and require colleague relationships (Std 10, 15). Phoenix Clubhouse moved away from a professional-led day-hospital style over years of accreditation. [source: Phoenix 2016] [synthesis:] Use the self-study (B18) to name drift; remove staff-only spaces and meetings; have members sit on hiring panels.
• Paying or rewarding members for Clubhouse work. Prohibited (Std 16). [synthesis:] If members need income, move them toward TE, SE or IE rather than in-house stipends.
• Co-occurring substance use. In NYC this does not bar eligibility (NYC Health); the Clubhouse links members to substance-use services (Std 27). [synthesis:] Respond to intoxication on site as a safety issue for that day, not as loss of membership.
• Cultural and system adaptation (e.g. Hong Kong). Phoenix kept the Standards while adding Group Placement, local employer partnerships, Putonghua classes and links with the host hospital and day hospital. [source: Phoenix 2016; Chui et al. 2016] [synthesis:] Adapt units, meals, holidays and language to local culture, but check each adaptation against the Standards before accreditation.
• Virtual participation. Some NYC Clubhouses offer it (NYC Health). How it is run is [uncertain]. [synthesis:] Keep virtual members linked to a real unit task and to reach-out.

Sources

Sources:

• International Standards for Clubhouse Programs, revised October 2025 (Clubhouse International)
• Clubhouse International: Accreditation
• Clubhouse International: the Clubhouse model (programme description)
• Clubhouse Overview (Clubhouse International text, hosted by Nevada DPBH, 2018)
• MH Clubhouse (Standards-based requirements, LSF Health Systems)
• NYC Health: Clubhouses
• Fountain House: Mental Health Social Practitioner job posting
• Phoenix Clubhouse, Hong Kong: HA Convention 2016 presentation
• Chui MC et al. 2016, The Impact of the Clubhouse Model on Service Enhancement of a Psychiatric Day Hospital (HA Convention)
• Fountain House (nonprofit organization), Wikipedia
• Doyle, Lanoil & Dudek, Fountain House: Creating Community in Mental Health Practice (publisher page)

Books cited:

• Doyle, A., Lanoil, J., & Dudek, K. J. (2013). Fountain House: Creating Community in Mental Health Practice. Columbia University Press. Only the publisher description is drawn on here [uncertain].

Further reading (not drawn on): Beard, Propst & Malamud (1982), The Fountain House model of psychiatric rehabilitation, Psychosocial Rehabilitation Journal; the Comprehensive Clubhouse Training curriculum. Nothing here is drawn from them.