Fountain House and Recovery Centers: In Reply

In Reply: Dudek and Aquila state that it is “discouraging that the authors felt a need to denigrate the source of many of the concepts for which they are advocating”—the source being the clubhouse model developed by Fountain House. They also take umbrage at our alleged “attempt to misclassify clubhouses.”

We simply do not agree that we denigrated or classified (let alone misclassified) clubhouses in any way in our Best Practices column. It is notable that Dudek and Aquila do not provide any evidence or direct quotes from our column to support their assertions. Thus we will present the evidence for their claims and allow the reader to judge whether we engage in denigration or misclassification.

Our column was an in-depth case study of a recovery center that is unaffiliated with the clubhouse movement. No data were collected from any form of clubhouse. In fact, we did not discuss Fountain House, and no inferences were made regarding clubhouses. In fact, the word “clubhouse” is used only twice in our column of more than 2,500 words. First, in the introduction we state that “clubhouses … often focus on providing a place of refuge and slow adjustment to living with a psychiatric disability.” We did not conjure up this statement. Our assertion was supported by a reference to a description of the Fountain House program published in this journal in 1999 (1), when Fountain House received an award from the American Psychiatric Association. The article states that clubhouses provide “services to ease the community adjustment of people with serious mental illness.” Dudek and Aquila themselves state in their letter that clubhouses “are not just places of respite,” implicitly acknowledging that provision of respite and refuge is an important component of clubhouse services. Thus we do not see how our original statement could be labeled as inaccurate, let alone denigrating or misclassifying.

The second (and final) time that we used the word “clubhouse” in our column was in the conclusion, where we state that “a focus on education, employment, and functional improvement overlaps with many of the activities provided by progressive day treatment centers and clubhouses.” This statement was empirically based, as one of us (RW) previously conducted evaluations of a clubhouse-type facility, as well as progressive day treatment settings, and found much overlap with the recovery center offered by Pathways to Housing (2,3). Again, we do not see how such a statement could be considered denigrating or misclassifying.

We absolutely agree that it is important to work together to create more and better places for people with mental illness. We also look forward to the authors' upcoming book on clubhouses. From our standpoint, Dudek and Aquila have made a stout and admirable defense of an effective organization that they have honorably served for many years. However, their defense is raised against a nonexistent attack.