Our modern world is a paradox. We have access to unprecedented comforts, ease, and hyper-connection to others. Yet we report unprecedented amounts of stress and loneliness. We flood psychiatric clinics and hospitals in crisis, our minds and bodies in pain, neglecting the core essence of being human, what makes us survive and thrive.
And yet, “We have no money to hire new clinicians,” said the operations director of our mental health department, where I served as the newly minted department chair of an outpatient mental health department in the fall of 2023. This propelled me to a town hall meeting about mental health advocacy. We are in the middle of a mental health crisis, and we can’t afford to hire professionals to help?
The modest building hosting the town hall resembled a mashup of senior living and office cubicles. A soft-spoken individual at the front desk directed me to a cafeteria space with a large television screen that Zoomed additional people to the 30 or so of us in person. I squeezed into a chair next to an older man with a service dog and a polished silver-haired gentleman in a suit and overcoat.
A tall woman stood in the forefront, with cheery eyes and sturdy voice that radiated the kind of confident warmth I’d aspired to. “Welcome, everyone, to our Clubhouse.”
Clubhouse?
The majority of individuals introduced themselves as members of the Clubhouse, though a handful said they were Clubhouse staff, along with individuals from community mental health organizations. The members spoke boldly and proudly. There was a common theme to their stories.
The Clubhouse became my family.
The Clubhouse helped me return to school, find a home, and secure employment.
When I was depressed, Clubhouse members called me.
And when I didn’t answer, they came to check on me.
It’s been two years since I was hospitalized.
Their message to the representatives: Pay attention. This place saved our lives.
When I was a fresh graduate from my child psychiatry fellowship in 2015, wide-eyed and determined to heal those with a mental illness, I worked on the inpatient pediatric psychiatry unit of a large metro hospital. Yet six years later, I choked down tears inside my unit office, wrestling my emotions into a corner before running my caseload in morning rounds. The tears, on the surface, were about my caseload unexpectedly ballooning that morning to cover for a sick colleague. Underneath, it was the gnawing fear of complicity with a mental health system that protected profits over patient and physician satisfaction by cutting therapeutic programs and pushing medications.
I resigned shortly after, convinced the solution to my dissonance was a change of scenery, a new treatment setting. My renewed energy convinced me that patients, if managed correctly, would never need hospitalization. Surely the grass was greener on the outpatient side!
Six months later, confined to an office without a window (still no grass), interacting with more than half my patients through a computer monitor in strict blocks of time, the dissonance did not wane. Instead, my spirit tanked. Managed care was not the enemy. I grappled with larger existential questions of what truly defined mental wellness.
After the town hall, a few months later on a chilly winter morning, I returned to the Clubhouse to learn more. No one introduced themselves at first. I’d learn this is often intentional. A core principle of Clubhouse is that everyone is an equal contributor regardless of education, role, or reason for being there. They eschew the word patient. The only person who is an expert in your own mental wellness journey is you.
A young man, with cropped dark hair, wearing trendy shades and a black moto jacket, greeted everyone and said, “I’ll start the meeting.” He stood, went to a rolling whiteboard, and flipped it over to a grid with heading: WORK ORDER DAY. The grid broke down hours and tasks. He asked for volunteers to greet, organize the store room, prepare lunch, make phone calls to members who were sick or missing, write letters of encouragement, act as tour guide, and work the snack bar. We visited the humble building spaces — the library, lounge, storage room, kitchen, break room. “You don’t have to accomplish anything to be here,” one member shared. “For some, walking out their front door is the bravest thing they’ll do that day. We’re grateful for their presence, even if they spend the day just drinking coffee.”
In a systematic review of RCTs, quasi-experimental, and observational studies, members of Clubhouses demonstrated higher competitive or transitional employment rates versus participants of other comparison programs. They had reduced rates of psychiatric hospitalizations, and less utilization of ER services and mental health care dollars. Most importantly, clubhouse members report a higher quality of life, social relationships, and overall life satisfaction. These outcomes support research on the benefits of social capital. Humans need a community that offers physical and psychological safety, where they believe their contribution matters, and where hope and purpose abound.
A referral from a mental health care professional is needed to join, and once a member, always a member, free from dues or obligations. However, funding for clubhouses can be a challenge. As a social-practice model and intentionally nonclinical, insurance reimbursement can be challenging. Of the Medicaid and state programs that do reimburse, they require Clubhouse International accreditation, which is good for quality, but adds the barrier of time and cost for new clubhouses seeking support and reimbursement. Some states are exploring value-based or outcomes-driven contracts where Clubhouses — if shown to reduce hospital/ER use and improve employment — can be contracted as community-based partners. The remainder of funding comes through philanthropy, foundation grants, and local government contracts.
The tour finished with a video highlighting stories of Clubhouse’s impact and its mission, the tuning fork I needed to reharmonize my personal values with my professional duties. More than a resource for those living with mental illness, the Clubhouse model is a quiet beacon in our collective search for health and wholeness.
During my years on the pediatric inpatient unit, when a youth was genuinely ready for discharge, I asked many of them a variation of the same question: “What helped you?”
At the Clubhouse, listening to stories, I heard the same answers, each one coalescing into the most fundamental desire we all possess:
I know now I’m not alone.
Rebecca Krill, MD is a Minneapolis-based pediatric psychiatrist and department chair for HealthPartners and Park Nicollet outpatient mental health department. She tames her busy days and mind through writing, unplugged nature runs, and Britney Spears on repeat. Dr. Krill is a 2025-2026 Doximity Op-Med Fellow.
Image by stellalevi / Getty
