More than 1.5 million California adults have a serious mental illness (SMI) that affects their ability to carry out daily activities. People with SMI are at high risk for loneliness and social isolation. This is due in large part to public stigma about mental illness, which often results in discrimination in housing, employment, and other areas.
Clubhouses are an evidence-based model of community care designed to support the recovery of people living with SMI (or co-occurring SMI and substance use disorder). Many health care approaches neglect the social needs of people with SMI. To fill this gap in care, Clubhouses provide a nonresidential, nonclinical recovery environment that is based on the idea that “community is therapy.” Clubhouses are physical locations; some are freestanding, and some are connected to other community-based organizations. Clubhouses use a social practice model in which members and staff work together to design and to maintain the community. Social, wellness, and skill-building activities are available to members at Clubhouses. Membership is voluntary, free, and without time limits — people can participate in a Clubhouse for as long as they choose.
The Clubhouse concept was pioneered in the 1940s at New York’s Fountain House. There are now 29 Clubhouse-model programs in California. Beginning in 2025, California’s Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Medi-Cal waiver program — an initiative to strengthen community-based behavioral health services for Medi-Cal members who have significant behavioral health needs — permits California counties to opt in to cover Clubhouses as a Medi-Cal benefit. (See the BH-CONNECT and the Clubhouse Model box for more details.)
“Many people with serious mental illness struggle to believe they can have a meaningful life, and the Clubhouse community wraps around each person to help them see that they are valuable and capable,” said Tamara Hunter, one of the founders of Connections House in Concord, California, and executive director of Clubhouse Coalition California. “I’ve seen Clubhouses help members find jobs, graduate from school, build friendships, secure housing, get married, have children, and reconcile with their families.”
The Clubhouse Model
Shared leadership. The term “member” is used to reflect the voluntary, community-based environment where people with SMI are decisionmakers and lead daily operations and activities in the Clubhouse.
Strengths-based approach. Clubhouse members participate in a “work-ordered day” in which they learn new skills, hone their talents, build dignity, and develop a sense of belonging. Clubhouses also offer evening and weekend activities.
Holistic support. Members can connect with employment, education, housing, and relationship-building resources that support their basic needs.
Clubhouse Benefits
Reduced loneliness. People living with depression, bipolar disorder, schizophrenia, and other SMI are two to three times more likely to be lonely than someone without SMI. Loneliness is associated with a greater risk of cardiovascular disease, dementia, stroke, and premature death. According to a recent Fountain House report, 58% of members who identified as lonely when they first joined a Clubhouse were found to be less lonely at their follow-up (typically 12 to 18 months later).1
Reduced hospitalizations. A review of 10 studies showed that participation in Clubhouse lowers the likelihood of rehospitalization for people with SMI.2
Reduced medical costs. A 2017 study found that Fountain House New York members had 21% lower Medicaid costs than their peers did, largely due to the holistic benefits of psychosocial rehabilitation.3
Better housing outcomes. Research at Westside Clubhouse in San Francisco found that the program has helped members retain housing, find more secure housing, and transition from residential treatment to community-based housing.4
Clubhouse Expansion
BH-CONNECT offers counties a significant opportunity to expand access to high-quality behavioral health services by integrating sustainable Medi-Cal funding for evidence-based practices. Yet only 9 of California’s 58 counties have Clubhouses — meaning that many people who could benefit do not have access to these communities. Counties, health care providers, and community members can start Clubhouses, and opting in to Medi-Cal coverage of this service can help sustain it for the long term. Expanding this community-driven, evidence-based model is a concrete step toward a more equitable and effective behavioral health continuum in California.
In December 2024, the US Centers for Medicare & Medicaid Services approved California’s Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Section 1115 demonstration, a major statewide initiative to expand access to behavioral health care for Medi-Cal members with SMI.
The Clubhouse model was selected as one of the evidence-based practices under BH-CONNECT. Counties, which administer specialty mental health services under Medi-Cal, are not required to provide Clubhouse services but may opt in to do so.
Counties that do opt to cover Clubhouse services under Medi-Cal can bill for these services at a county-specific, daily bundled rate. The daily rate requires that a Clubhouse member participate for at least three hours on the day of service.
To be eligible for Medi-Cal payment, Clubhouses must ultimately be accredited by Clubhouse International, but they are allowed four years to reach that status. County behavioral health plans may bill Medi-Cal for Clubhouse services for up to one year before a Clubhouse begins the accreditation process, and for up to three years while the Clubhouse is actively pursuing accreditation.
Clubhouse International has been designated as a Center of Excellence for Clubhouse services, providing training and technical assistance to counties and providers in bringing to scale this model of recovery and community integration.
For more information about Medi-Cal coverage of Clubhouse services under BH-CONNECT, see the resource list below.
Amy Mehler, who has bipolar disorder with psychotic features and has paraplegia, was homeless and suicidal when she started visiting Connections House, a Clubhouse in Concord, California. She was frequently fearful because of disturbing visual and auditory hallucinations.
Mehler immediately felt welcomed by the staff and members as she started participating in the work-ordered day to help run the house. “At first I felt so confused by the hallucinations that I didn’t know if I was completing a task,” said Mehler, 58. “Over time, I learned how to quiet the voices in my head so I could complete a task and have a conversation with someone.”
She started by watering plants and cleaning the dining room, and eventually she learned to feel comfortable using a computer. The staff also connected her with case managers who could help her access mental health providers and medication. Now Mehler is working as a job coach for people with disabilities, renting her own apartment, and serving as a board member for her church. “Connections Clubhouse is like family,” said Mehler. “I feel accepted, and they helped me gain control over my life so I could live independently in my community.”
Learn More About Clubhouses and BH-CONNECT
Clubhouse Coalition California. Get a list of the Clubhouses in California, learn about the coalition’s mission, and discover ways to get involved.
Clubhouse International. Get information about how to receive training to start a Clubhouse.
“People with Serious Mental Illness Find Community in a Clubhouse.” Read or listen to this California Health Care Foundation blog post by Laurie Udesky and Kori Suzuki for real-life examples at a San Francisco Clubhouse.
“A Los Angeles Woman Was Lost. An Ambitious Mental Health Program Gave Her a Sense of Purpose.” Read or listen to this KQED article by Lee Romney to trace the recovery journey of a Los Angeles woman and her experience at Fountain House Hollywood.
How California’s 1115 Demonstration, BH-CONNECT, Will Impact Behavioral Health Care for Medi-Cal Members and Advocates’ Guide to the BH-CONNECT Initiative. Read these policy papers by Center for Health Care Strategies and National Health Law Program to learn what the BH-CONNECT initiative means for behavioral health care in California.
Endnotes