“Grateful to be alive”: Clubhouse programs take pressure off overwhelmed Texas mental health hospitals

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When Jonathan Denhart was discharged from the psych ward at Austin Oaks Hospital last year, he was prepared to be back very soon.

For more than 40 years, Denhart has cycled through rehabs, sober housing, mental health hospitals, and 12-step programs to treat his bipolar and substance use disorders, but nothing worked.

The 60-year-old Austin resident couldn’t find or keep a job, and he knew once he left the hospital, the temptations of the outside world would be too much again.

As Denhart was about to walk out the door a hospital staff member stopped him and suggested he stop by a place called Austin Clubhouse to try a vocational rehabilitation program.

“I had never heard about this, but they told me they might give me the structure and purpose I needed once I left,” he said. “I had to give it a shot.”

When Denhart walked into the small facility in Central Austin, he said he felt an immediate sense of acceptance. He looked around the rented space owned by Hyde Park Christian Church and met other people dealing with their own mental illness or substance abuse problems. He had finally found a community for people like him.

The Austin Clubhouse provides services to help people once they leave state mental health hospitals. Credit: Montinique Monroe for The Texas Tribune

Today, Denhart has been sober for more than a year and works in the snack bar for around six hours a day at Austin Clubhouse, passing out coffee and snacks. He said the work has given him a renewed sense of purpose in life that had been missing.

“I like what I see when I look in the mirror now,” he said. “Instead of self-doubt and hatred, I feel happiness. It’s not easy, and I still have days that are hard, but I am happy now.”

Denhart is one of over 100,000 people who are discharged from mental health hospitals every year in Texas, according to a 2019 study, and face multiple barriers to successfully transitioning back into the community. The biggest challenges are a lack of suitable housing, limited financial resources, issues with daily living skills, involvement with the criminal justice system and a lack of confidence or sense of purpose. Those are amplified in rural and remote regions where services, support, and housing are even more difficult to find.

The state responded in 2021 when lawmakers directed Texas Health and Human Services to produce a study on step-down services that can be used to help people once they leave state mental health hospitals. The result was the Texas State Hospital Step-Down program, which provides pre- and post-transition services, including short-term residential placements, to support individuals with severe mental illness.

The program is expected to add approximately 65 beds, bringing the total to 80 beds, by the end of August. Even with the additional beds, the program is nowhere close to addressing the demand for services for a state with more than 30 million residents, where 98% of the 254 counties are designated as Mental Health Professional Shortage Areas — where there’s only one mental health clinician for every 30,000 residents. The state’s behavioral health worker shortage is expected to grow.

During the fiscal year that ended in August 2023, the program had only facilitated the transition of 23 people from state hospitals, most of them people waiting to have their competency restored to stand trial in a criminal case.

Meanwhile, privately-run step-down programs like Austin Clubhouse — which is part of Clubhouse International, a global nonprofit organization — have been doing similar work for decades, working to prevent people from returning to a hospital after they are discharged by helping them make new friends, get jobs, enroll in school, and live healthier lifestyles via a multitude of different programs.

The state has contracts with seven clubhouse programs located in Richmond, Austin, Plano, Dallas-Fort Worth, Richardson, Houston, and San Antonio. Depending on membership, they can help nearly 2,000 people a year. .

"I think the main problem we deal with is that most people don’t know we are even here,” said Jennifer Cardenas, executive director of Austin Clubhouse, which has helped over 1500 since opening in 2010. "We are here to show people that they have a lot to offer society after leaving the hospital. Clubhouses effectively help people build self- confidence and end the social and economic isolation t"hat is often associated with mental illness."

A second chance

Abdul Majid Badini looks back on his life, regretting the first time he picked up drinking alcohol.

Badini, a 58-year-old from Balochistan, a region divided between Pakistan, Iran, and Afghanistan. He said he fled his home after being arrested for belonging to a political organization in Pakistan called the Balochistan Student Organization. He said he witnessed a friend being hanged by the Pakistani government for belonging to the organization and decided to head to Russia to study medicine.

“I came from an Islamic, fundamentalist, tribalistic society to a socialist, free society. I finally had freedom,” he said. “I was able to drink and have friendships with women. I gained freedom and forgot my aim of struggling for my nation.”

His newfound freedom and the allure of Russian clubs, eventually turned him into an alcoholic. He dropped out of medical school, and said his girlfriend left him due to his drinking. By the time he migrated to the United States in 2011, settling in Texas, he was dealing with depression and anxiety due to his addiction.

“I started to hallucinate and was paranoid. I thought I was being controlled by the KGB. I was mentally sick, and when I wasn’t drinking, I felt pain all over my body,” Badini said.

Badini spent several decades in Russia and America trapped on the vicious merry-go-round of addiction and mental illness. In his home country, he was a writer for a local newspaper and an aspiring medical professional, but in America, he was a homeless alcoholic dealing with depression who felt like he was a burden on society.

“I felt like a parasite,” Badini said. “Alcohol took my abilities. I didn’t want to look at myself anymore.”

Cardenas, the Austin Clubhouse director, said those who are hospitalized may find it difficult to integrate back into the larger community. She said unemployment rates are high for people with severe mental illness and many rely on disability or Supplemental Security Income to survive.

“People may not yet believe in themselves after leaving the hospital, which often leads to isolation,” Cardenas said. “This can make matters worse. The Clubhouse is proof that people with mental illness can and do lead fulfilling, productive lives.”

Patients created their own program

Step-down programs became popular in the early 1990s when states transitioned from housing people in state hospitals to offering services in community-based mental health centers. But the idea of a club for people with mental illness goes back to the late 1940s, when seven patients at Rockland Psychiatric Center in New York formed a self-help group that met in a hospital club room.

Soon after leaving the hospital, they began meeting on the steps of the New York City Public Library to recreate the “club room” experience, believing that it would sustain their recovery and provide a mutual support system. This eventually led to them purchasing their own building, the Fountain House, which was initially staffed and operated solely by ex-psychiatric patients and volunteers.

This was an unconventional idea in the medical world at the time, but as the years went on, the movement grew into a worldwide network after receiving a grant from the National Institute of Mental Health in 1977 to establish a training program that others could adopt to create their own clubhouse facilities. Today there are more than 350 clubhouse programs in 32 countries, with 186 in the United States.

For someone like Rebekah Johnson-Carson, who was diagnosed with schizophrenia in the eighth grade, the clubhouse model provides a community for those who often feel ostracized by the general public.

“In high school, I often ate lunch in the special education classroom instead of the cafeteria because a lot of the regular students didn’t understand what I was going through or thought I was faking,” she said.

Then, one day last summer, Johnson-Carson toured Austin Clubhouse and found the community she had been looking for all this time.

“The clubhouse gives people a chance to connect and learn how to socialize and feel love and support,” she said.

People at the Austin Clubhouse are referred to as “members” instead of clients or patients because the organization chooses not to focus on mental illness but instead on their strengths.

Membership is open to anyone 18 or over with a history of mental illness. The services are free, voluntary, and lifelong, paid for through public and private grants, corporate donors and a state contract.

The Austin Clubhouse offers programs in employment, education, housing, and health and wellness. It doesn’t offer mental health treatment because they are an add-on to clinical assistance, not a replacement.

Johnson-Carson credits the clubhouse program with helping her graduate last year from Austin Community College with a recreational therapy degree. She is ready to help others, but said her attachment to the clubhouse will never fade.

“Sometimes, when you are going through a hard time when you can’t see the light at the end of the tunnel, all you need is someone to get you through the tunnel, not point out the light,” she said. “That is what this program provides.”

“I am grateful to be alive”

Those who choose to join one of the programs work side-by-side with staff by volunteering their time gardening, working phone lines, helping people at the front desk, cooking, or other tasks. The goal is to allow those who have undergone treatment for a severe mental illness to develop a sense of purpose and re-enter the community and the workforce.

Badini decided to participate in one of the programs at Austin Clubhouse on the recommendation of his doctor. When he first arrived a couple of years ago, the clubhouse helped him get a job at a small business in Austin doing tasks like keeping the shelves stocked, but this was a responsibility he said he wasn’t ready for yet.

“I was still dealing with my addiction, and I missed my job and was fired. I was doing bad. I couldn’t move or even get myself to the restroom. I had thoughts of suicide,” Badini said.

Badini said when he started going to the clubhouse daily late last year, he began to notice a difference within himself as his confidence grew.

“I began to take care of myself, making sure to eat and sleep enough and save money. I stopped listening to the voices, and my depression and anxiety seemed to go away,” he said.

The man from Balochistan now works at an Austin Goodwill and has been sober for almost 100 days. He said he has been able to send money back to his family, who still live in the Balochistan region. He is also looking to become a translator and get back into writing.

“I want to be a productive member of society for myself and for my family,” Badini said. “I lost so much time, but I am grateful to be alive. I thought I had wasted 35 years of my life, but I can still help my country and my father. I appreciate the time I still have left now.”

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