Members, not patients: how the Clubhouse model grew from one New York house to 370 Clubhouses in 32 countries | InkludX

In 1948, a group of former psychiatric patients in New York began meeting informally, as a kind of club. That group became Fountain House. The people who came were not patients there — they were members, and they ran the place together with staff. More than 75 years later, that idea has become the Clubhouse model: a network of 370 Clubhouses in 32 countries, with a structured route back into ordinary, paid work at its core.

From one house to a global network

Clubhouse International was founded in 1994 with 33 charter member Clubhouses in seven countries; by the end of that year there were 62. By December 2024 the network counted 370 Clubhouses in 32 countries, supported by 12 Global Training Centers and 28 coalitions and associations.

The network is still weighted towards the United States, where Clubhouses operate in 37 states and the District of Columbia. Of the 30 new Clubhouses that joined in 2024, 23 were in the US; the others were in France (3), Taiwan (2), Australia (1) and Norway (1). Of the 75 accreditations granted that year, 56 were in the US, 13 in Europe, 3 in Asia, 2 in Australia and 1 in Canada — making Europe the largest region outside the US.

Beyond Europe and North America, Clubhouse International's directory lists Clubhouses across:

Asia: South Korea, China, Hong Kong SAR, Japan, Taiwan, India and Nepal
Oceania: Australia, New Zealand and Papua New Guinea
Africa: Ghana, Uganda and South Africa
The Americas: Canada, Mexico and Argentina

The European network

Clubhouse Europe was formed in January 2007 at a meeting in Taastrup, Denmark, by representatives of seven European Clubhouses and three national coalitions. It began as the European Partnership for Clubhouse Development (EPCD), was registered as a European NGO under Danish law in 2011, and took the name Clubhouse Europe in 2013. Its mission is to promote the continuous development and dissemination of the Clubhouse model in Europe, as defined by Clubhouse International's Standards. Its early growth was EU-funded: the ELECT project (2007–2009) brought together ten Clubhouses from seven countries.

Clubhouse Europe uses the World Health Organization's definition of Europe — 53 countries, including the former USSR, Israel and Turkey. Its directory lists Clubhouses in around 20 countries and territories, from Ireland and Iceland to Italy, Poland, Romania, Kosovo, Kazakhstan and the Faroe Islands.

A few national snapshots:

Norway has 26 Fontenehus, co-funded through a dedicated state grant scheme administered by the Norwegian Directorate of Health (Helsedirektoratet), with NOK 85.2 million available in the 2026 grant round. The scheme's stated aim is to help more people with mental health and/or substance-use problems into work-oriented activity and ordinary jobs. In a 2023 survey by Oslo Economics reported by Fontenehus Norge, 39% of members were in work or internships and 16% were studying. Fontenehuset Oslo sentrum lists the Ministry of Health and Care Services, Lovisenberg Hospital and the Norwegian Medical Products Agency among its transitional employment partners.
Finland has 21 Klubitalo clubhouses, from Mariehamn in the south to Rovaniemi in the north. Roughly half their funding comes from STEA (the state funding centre for social and health organisations) and half from the wellbeing services counties. Yle reported in September 2026 that the government is cutting organisation grants by around €80 million next year, and that clubhouse funding is likely to fall.
Sweden has a national association of Fontänhus. The association summarises a 2021 socio-economic evaluation by the firm Payoff as: a Fontänhus pays for itself in seven months.
Denmark: Fountain House København, established in 1986, was accredited in 2023.
Germany: Schwalbennest in Munich has operated since 1986 and describes itself as Germany's first Clubhaus.
Ireland: the EVE Clubhouse Coalition has seven clubhouses within the HSE's EVE network of mental health services.
Iceland: Klúbburinn Geysir is certified against Clubhouse International's standards.
UK: in October 2021 the Health Secretary chose Mosaic Clubhouse in Lambeth, London, as the venue to launch the Office for Health Improvement and Disparities.

How a Clubhouse works

A Clubhouse is a community-based centre for adults living with serious mental illness:

Members, not patients. Membership is voluntary and without time limits.
The work-ordered day. Members and staff work side by side to run the Clubhouse itself, during ordinary working hours. Nobody is paid for this work and there are no artificial reward systems; the point is to be needed.
Shared standards. Every Clubhouse is measured against the same 37 International Standards for Clubhouse Programs, most recently revised in October 2025. Accreditation involves a self-study and a 3–4 day visit from faculty drawn from accredited Clubhouses — approximately half of whom are members with lived experience.

Three routes back to paid work

The Standards are explicit that a Clubhouse does not employ members in sheltered workshops or in-house businesses. Instead it offers three routes into the open labour market:

1. Transitional Employment (TE)

Members work at the employer's place of business, doing real jobs.
They are paid the prevailing wage — at least minimum wage — directly by the employer.
Placements are part-time and time-limited, generally 12–20 hours a week for six to nine months.
The Clubhouse selects and trains the member, and guarantees the employer that the job will be covered during any absence.
A setback does not close the door: placement opportunities remain available regardless of how previous placements went.

2. Supported Employment

The member holds their own job, and the Clubhouse keeps a relationship with both the worker and the employer. The type and frequency of support is decided together.

3. Independent Employment

Members working on their own continue to have access to everything the Clubhouse offers, including evening and weekend programmes.

For employers, Transitional Employment is an unusually low-risk way to start: the position is always covered, and recruitment and training are handled by people who know the worker well.

What the evidence says — honestly

The Clubhouse model has been studied for decades, but the employment evidence is more mixed than advocates sometimes suggest.

A randomised trial in Massachusetts compared a Clubhouse with an assertive community treatment (PACT) programme over 30 months (170 participants). Rates of getting a job were not significantly different (60% Clubhouse, 74% PACT), but Clubhouse members kept their jobs longer — 21.8 weeks per job versus 13.1 — and earned higher hourly wages ($7.38 versus $6.30) (Schonebaum, Boyd & Dudek, Psychiatric Services, 2006).
A 2018 systematic review of 52 studies concluded that randomised trials support effects on employment, hospitalisation and quality of life, but called the Clubhouse a "promising practice" that needs more rigorous research (McKay et al., Administration and Policy in Mental Health, 2018).
Costs: a small US study found Medicaid mental health costs of $10,391 per year for Clubhouse members versus $15,511 for 150 matched non-members (Hwang, Woody & Eaton, Community Mental Health Journal, 2017). This was an observational study with 30 members, so it cannot prove the Clubhouse caused the difference.
Transitional vs. supported employment: a 2017 Cochrane review found that, over the long term, supported employment clearly outperformed transitional employment in general, and found no evidence that transitional employment beat psychiatric care alone (low-quality evidence). The review looked at transitional employment programmes broadly, not only Clubhouses. No randomised trial has yet compared an accredited Clubhouse head-to-head with Individual Placement and Support (IPS), the best-evidenced supported employment model.

The fair reading: Clubhouses are strong at retention, community and keeping people connected to work over the long run; IPS has the stronger evidence for getting people into competitive jobs quickly. The Clubhouse Standards require supported and independent employment to be offered alongside TE, so the two approaches can complement each other.

International recognition

In 2021 the World Health Organization featured a Clubhouse — Phoenix Clubhouse in Hong Kong — as a good-practice example in its Guidance on community mental health services: promoting person-centred and rights-based approaches.
In 2014 Fountain House and Clubhouse International jointly received the Conrad N. Hilton Humanitarian Prize ($1.5 million).
In 2011 the Clubhouse model was accepted into the US SAMHSA National Registry of Evidence-based Programs and Practices (a registry that has since been discontinued).

Why this matters for inclusive employers

Many people living with serious mental illness want to work, but are kept out of the labour market. With Clubhouses across Europe, the model offers employers a practical, structured entry point:

Offer a Transitional Employment placement. A part-time, real job — covered by the Clubhouse if the member is absent.
Keep supporting workers who move on. Clubhouse support continues when members move into supported or independent jobs.
Find your local Clubhouse. See Clubhouse Europe's directory (clubhouse-europe.com) or Clubhouse International's global directory (clubhouse-intl.org).

Sources

Clubhouse International — What Clubhouses do; Mission & history; Accreditation; FAQ; International directory: https://clubhouse-intl.org/what-we-do/what-clubhouses-do/
Clubhouse International — 2024 Annual Report (data as of December 2024): https://clubhouse-intl.org/wp-content/uploads/2025/07/Final-2024-annual-report.pdf
International Standards for Clubhouse Programs (revised October 2025): https://clubhouse-intl.org/wp-content/uploads/2025/11/Standards_2025_english.pdf
Clubhouse International — 2014 Hilton Humanitarian Prize: https://clubhouse-intl.org/clubhouse-internationalfountain-houseny-receive-2014-hilton-humanitarian-prize/
Clubhouse Europe — History; What is Europe; Mission and vision: https://clubhouse-europe.com/history/
Schonebaum AD, Boyd JK, Dudek KJ (2006). A comparison of competitive employment outcomes for the clubhouse and PACT models. Psychiatric Services 57(10):1416–20. https://doi.org/10.1176/ps.2006.57.10.1416
McKay C, Nugent KL, Johnsen M, Eaton WW, Lidz CW (2018). A systematic review of evidence for the clubhouse model of psychosocial rehabilitation. Adm Policy Ment Health 45(1):28–47. https://pmc.ncbi.nlm.nih.gov/articles/PMC5756274/
Hwang S, Woody J, Eaton WW (2017). Clubhouse members' Medicaid costs. Community Mental Health Journal 53(1):102–106. https://doi.org/10.1007/s10597-016-0041-3
Suijkerbuijk YB et al. (2017). Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database of Systematic Reviews CD011867. https://doi.org/10.1002/14651858.CD011867.pub2
WHO (2021). Guidance on community mental health services. https://www.who.int/publications/i/item/9789240025707
South London and Maudsley NHS — Health and Social Care Secretary visits Mosaic Clubhouse (Oct 2021): https://slam.nhs.uk/pressreleases/health-and-social-care-secretary-visits-mosaic-clubhouse-in-lambeth-949
Fontenehus Norge — Finn fontenehus; Politikk og utvikling: https://www.fontenehus.no/politikk-og-utvikling
Helsedirektoratet — Tilskudd: Fontenehus og Fontenehus Norge: https://www.helsedirektoratet.no/tilskudd-og-finansiering/tilskudd/fontenehus-og-fontenehus-norge
Fontenehuset Oslo sentrum — Våre støttespillere: https://www.fontenehuset.no/no/vare-stottespillere
Suomen Klubitalot: https://suomenklubitalot.fi/
Yle (15 September 2026): https://yle.fi/a/74-20245162
Sveriges Fontänhus Riksförbund: https://www.sverigesfontanhus.se/
Fountain House København — accreditation (Nov 2023): https://fountainhousecph.dk/nyheder/et-akkrediteret-fountain-house-koebenhavn/
SPZ München — Clubhäuser: https://www.spzmuc.de/clubhaeuser
Cairdeas Clubhouse — About: https://cairdeasclubhouse.wordpress.com/about/
Klúbburinn Geysir: https://klubburinngeysir.is/hugmyndafraedin/