Clubhouses offer potential solutions for those with severe mental illness

NEW YORK — When Jordan Neely boarded the subway on May 1, 2023, he was homeless, ranting about having nothing to eat or drink and said he was willing to die, according to authorities. Perceptions of Neely's final moments differ, but each account tells a similar story at its core: Neely appeared to be experiencing a mental health crisis when Daniel Penny put him in the chokehold that ended his life.

Opening arguments are set to begin in Penny's trial in Neely's death Friday. Penny, a former Marine, was charged with second-degree manslaughter and criminally negligent homicide in Neely's death. He has pleaded not guilty. Jury selection began Monday.

Neely's loved ones believe his story could have been different. To experts, Neely, who was known to city mental health professionals and law enforcement officials, has become a symbol of the need to look toward effective solutions to get homeless and mentally ill people off the streets and into care.

"Our system does not prioritize the seriously mentally ill," Carolyn Gorman, a policy analyst at the public policy think tank Manhattan Institute, told ABC News. "Almost always, the individuals who are involved in these tragedies have a known mental illness, have been cycling through homelessness, through incarceration through the health care system. They're known to authorities, and they haven't fallen through the cracks. They've actually just been ignored by all of these systems."

New York City's clubhouses -- member-run facilities that offer support to those with serious mental health conditions -- are proving that recovery and rehabilitation are possible, with some lawmakers like Rep. Ritchie Torres, D-N.Y., hoping to expand the availability and access to these institutions for more residents.

Fountain House, which touts itself as the pioneer of the modern clubhouse model, aims to put an end to the "punitive, ineffective and costly" approaches to those with mental illness, who cycle through jails, emergency rooms, shelters and the streets without proper care or support to lead healthy and happy lives, the organization said.

The goal is to give members a sense of stability and community. At the clubhouses, they get a helping hand to obtain an education, find work, achieve health goals while readily having access to clinical care, housing assistance and other supportive services.

"What we are looking to do is to help people truly recover, and so that means help them return to jobs, be neighbors, and live out in the community and to have meaningful relationships," Ian Campbell, Fountain House's Senior Director of Employment and Learning, told ABC News.

However, Gorman, of the Manhattan Institute, said that despite their effectiveness, clubhouses won't be the solution for all people dealing with severe mental illnesses.

"Fountain House is definitely one model. And it's a model that works well. But some patients just do need a higher level of oversight and intensive care than a place like the clubhouse model can provide. And that is inpatient treatment," or hospitalization, said Gorman.

Clubhouses set an example for mental health care

What makes the clubhouse model so successful, Campbell said, is that they fill gaps not filled in a clinical setting. They support members with both economic barriers as well as the loneliness or isolation that patients are likely to also be experiencing.

"The U.S. has historically spent most of its mental health care dollars on clinical treatment, such as medication and therapy, with a fraction allocated to fund the community-based social supports people also need to manage their mental illness," read a Fountain House report.

About 15% of people with severe mental illness successfully return to work, according to the National Alliance on Mental Illness -- but at Fountain House, 25 to 30% of their active membership has returned to work.

A New York University study on Fountain House found that its services save Medicaid costs by up to 21% by reducing hospitalizations and ER visits as well as increasing primary care visits, increased outpatient mental health visits, and increased pharmacy visits – "essentially a better adherence to other forms of treatment that can further support members' recovery," Fountain House said in a statement.

Researchers at Fountain House also found that the roughly 60,000 people clubhouses nationwide serve each year yield an estimated savings of over $11,000 per person -- or at least $682 million total each year.

Fountain House also touts that members who enroll in degree or certificate-seeking educational programs have a 90% average semester completion rate.

For Torres, mental health care is personal.

"About 15 years ago, I found myself at the lowest point in my life. I had dropped out of college. I found myself struggling with depression. I even attempted suicide and underwent hospitalization for a period of time," Torres told ABC News. "I felt as if the world around me had collapsed, and I never thought seven years later, I would become the youngest elected official in America's largest city, and then seven years later, become a member of the United States Congress."

He has called for more federal funding for community-based programs like Fountain House.

"The challenge of mental illness is often compounded by the problem of loneliness, and clubhouses represent the creation of a community," he said. "It is an elegant solution to the problem of loneliness. It provides community where none exists. It fills the human gap that's often left by isolation, and so I would love to see the proliferation of clubhouses across the country."

And for those who may need more assistance than an outpatient resource can offer, Gorman believes the focus should be on the rehabilitative efforts, not punitive ones.

"Involuntary treatment and inpatient treatment are last resorts, they are only tried when everything else fails," Gorman said. "I think if we do not consider those options, then we have to be ready to admit that we already are institutionalizing the mentally ill, but in jails and prisons. These are punitive settings, not therapeutic settings. So it's hard to see how this is more humane."

A clubhouse success story

Carmen Murray-Williams, now 65, had been homeless on-and-off since she was 14, when she left her home amid a "rough" and "uncomfortable" living situation with her family.

"There were times where I couldn't find any help. I was so tired that I would get a cardboard box, flatten it down on the ground wherever I was, and sleep there. And once or twice, I woke up, and I found myself buried in snow," Murray-Williams told ABC News. "I said, I really have to get out of the situation. And I kept knocking on doors ... I prayed all the time. I mean, every chance I got, I prayed."

She said she lived on the streets until she was about 17, when her grandmother found her, took her in, and convinced her to continue her education. She got her GED and was excited to start college, but her grandmother's death left her both heartbroken and homeless once more.

"She's my everything," Murray-Williams said. "She got me to believe that life keeps going on and you don't have to worry about your age and whatnot. Just keep on trying. I love my grandmother. I miss her."

Life continued to present challenges for Murray-Williams, who had lost contact with the rest of her family. She recalls her past addiction to crack cocaine, an accidental fall from an apartment balcony that broke her back, and a boyfriend who opened credit cards from a joint bank account, putting her thousands of dollars in debt.

And one day, she said, "I absolutely lost my mind. I just started screaming and hollering or turn up things" and the police were called on her. She was diagnosed with bipolar disorder at the age of 42 following the outbursts.

After receiving inpatient treatment for her disorder, she was accepted as a member of Fountain House to get her back on her feet.

Fountain House members like Murray-Williams have access to supportive resources — including meals, job training, education, and housing assistance — while developing social supports to build relationships and reintegrate into their community.

"We'll have a morning meeting and we decide who does what chores. After that, we start doing the chores that they give us. Chores could be putting data entry into the computer or could be cleaning up the front of the clubhouse," Murray-Williams said. Clubhouse members help the organization function; they prepare meals, man the phones, and fundraise.

"If you're in the horticulture unit, which is now 'home and garden,' you do the gardens. And we do a lot here. I go to the gym and wellness unit twice a week," she said.

Murray-Williams has a jam-packed schedule, which includes running the Bingo gathering multiple times a week -- "my favorite days of the week" -- and helps lead a dance exercise group.

"Getting to 65 and still being here? I didn't think I was gonna make it to 65," Murray-Williams said. "But I'm just grateful for every day and every opportunity that I get."

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