New Hope in Mental Health - A Different Kind of Therapy for Rehabilitation

Kenn Dudek - Brain & Behavior Research Foundation Productive Lives Award Winner
Kenn Dudek

Kenn Dudek talks about Fountain House in New York City and how it supports recovery in mental illness through its participative community model

From The Quarterly, Spring 2011

There is no question whether mental health services and rehabilitation and recovery programs in the nonprofit sector have undergone major changes and advancements, says Kenn Dudek, president of Fountain House in New York City. The 63-year-old organization he leads has seen many changes, though its core values remain. “The therapy of Fountain House is a working community,” Mr. Dudek says. His big question is how to get the appropriate recognition of the importance of this type of ‘therapy’ in recovery so that progress can reach the next level.

Fountain House is a working community in the heart of New York City that bustles with activity on any given day. Members, who are locals living with mental illness, share responsibility with staff to keep things running, from greeting visitors to reviewing new applications for membership to growing lettuce in their hydroponic grow room. Fountain House operates seven main activity areas – culinary, clerical, education, employment, horticulture, research, and reception and membership. Through this activity and participative model, Fountain House has come to be a community of its own for many mentally ill in New York City. It offers a supportive physical space, creates opportunities for productive contribution and enables the establishment of social ties and consistent relationships.

What Fountain House does not offer is medication or therapy services onsite. Members have access to referrals with partner organizations for those needs. Kenn Dudek, Fountain House president, explains this policy. He believes that medication and conventional therapy are only one step in the recovery process for those living with mental illness, and that need is met by psychiatrists and therapists. “Once you get medications you need to do something else with your life. People need to pay as much attention to the environmental side as the biological side of the illness.” And so, at Fountain House, the focus is on the environmental side of the illness.

Mr. Dudek has worked in the field of mental health since 1975. His first job was as an aid in a nursing home in Massachusetts. Patients included many young people who had been discharged from the state mental hospital. In 1985 Mr. Dudek was part of a group of professionals who visited Fountain House and studied its Clubhouse Model as part of a national training program funded by a grant from the National Institute of Mental Health (NIMH). Herb Pardes, M.D., president of the Brain & Behavior Research Foundation Scientific Council, was head of NIMH at the time and a supporter of the training program, Mr. Dudek said. In the years following his training, as director of Community Support for the State of Massachusetts, Mr. Dudek started 25 programs like Fountain House that are still in operation today. He became the director of Fountain House in 1992 and later its executive director and is president today.

Global Clubhouse Rehabilitation Model
The national training program that guided Mr. Dudek in replicating the Clubhouse Model has evolved into the International Center for Clubhouse Development (ICCD), founded in 1994. Collaborating with other Clubhouses, standards were developed to guide how a Clubhouse would function, and templates for management and organization were created, Mr. Dudek explained. Today, consultants work with individual clubhouses to officially certify each location. Certification teams are always composed of a member and a staff worker, drawn from a pool of specially trained clubhouse colleagues from all over the world.

There are currently 150 certified Clubhouses around the world in 30 countries, including Argentina, Germany, China and South Africa. The biennial international Clubhouse Seminar is planned for this summer in Stockholm, Sweden.

Replication of the Clubhouse model at Fountain House is also broadened through ongoing Colleague Training first originated with the NIMH grant. Trainings run
for three weeks and participants are immersed in the full community experience at Fountain House and stay in the Fountain House guest house, Mr. Dudek said. Since 1977, more than 2,000 people have come to Fountain House to learn how to establish a Clubhouse.

Treating the social isolation
Mr. Dudek stresses that the biggest problem with mental illness is the effect of social isolation on individuals. In the past, and even still today, people with mental illness are hospitalized, homeless or living at home with their parents, which limits interaction with peers. “You’re alone and have lost connections to friends,” he said. “Family is the last group you have connections with. Places like Fountain House connect you with others. Programs can help with job training, but that doesn’t change the fact that many people with mental illness are completely isolated. You can’t just do job training, education and housing for people with mental illness. You need to help create a community.”

And Fountain House does just that. Members are the receptionists, teachers, tour guides, chefs and more that keep the place going. Fountain House is purposefully understaffed in order to solicit the contributions of its members. “The illness is only part of your life,” Mr. Dudek said. “Recovery is about separating the person from the illness.”

And Mr. Dudek worries that this type of critical support isn’t recognized as essential. “There is still a major misunderstanding about what it takes to support people with mental illness in the state and federal government,” he says. Fountain House is 63 years old, a world leader and model for recovery in the field, and yet there is not a good funding stream in place to support it. “It’s completely ridiculous,” he says with frustration.

From his view at a nonprofit mental health organization, Mr. Dudek said that states have abandoned their role in major mental health. States need to reclaim control of mental health funding and fund the programs that are needed and most helpful, he said.

The role of research in recovery
Fountain House began in 1948, and its community-based approach predates the first generation of antipsychotic medications. Mr. Dudek is optimistic about the effects of medications in helping people with mental illness and realistic about the challenge of people staying on their medications. Many medications force people to make trade-offs, Mr. Dudek said. He pointed to side effects such as weight gain and loss of sex drive that often discourage people from staying on their medication.

“I have hope for the advancement of medications, but I believe you will always need environmental interventions as well as medical intervention,” Mr. Dudek said. He’s seen awakenings in people over his long career, but thinks it takes a combination of medications and environmental support for true recovery to be realized.

While scientific research has made advances in treating and understanding mental illness, Mr. Dudek would like to see more research into the effects of places like Fountain House and the working community model. “There is just as much to learn about the environmental side as the biological side, and it has a lot to teach people.”

One possibility, he suggests, would be to examine brain scans of members when they first arrive at Fountain House and brain scans of members after they have been a member for a year or two. His hope is that such research will reveal what he’s experienced on a day-to-day basis in his time at Fountain House: There is value in a working community approach and what the community does for social isolation and social networking is helping people recover.

“Recovery means you have the illness, but you have a life,” Mr. Dudek said. “I think we’re missing a piece of the puzzle by ignoring places like Fountain House. The brain is complex. Outside the brain is complex, too.” We need to treat the whole person to really get to recovery.