On a recent Friday, a visitor walked through the front door of a nondescript building off of busy Fredericksburg Road. Noting the absence of an attendant at the front desk, she followed the sound of conversations into what appeared to be the main room.

“I’m looking for someone who works here,” the visitor asked a young woman.

“Well, everyone works here,” the woman replied with a smile.

She’s right. Everyone works at San Antonio Clubhouse, which has been giving its members — people living with mental health issues — a sense of community and volunteer opportunities for 19 years.

“People need to be needed,” Eric Estrada, SA Clubhouse’s executive director, said of what the nonprofit provides. “When it’s not happening kind of naturally in the community, [this is] a place where people can go where people care about you, they support you, you are valuable, and you can do meaningful things. We create that little microcosm for that to happen.”

The local clubhouse is part of a national network of centers organized under Fountain House, a nonprofit based out of New York that aims to improve health, increase opportunity and end social and economic isolation for people living with serious mental illness. There are more than 300 clubhouses around the world, about two-thirds of which are in the U.S.

As part of that network, SA Clubhouse has emerged as the leading center in Texas, training hundreds of mental health specialists and recently dipping its toe into public policy advocacy.

“San Antonio Clubhouse is one of our flagship partners because it’s got a demonstrated track record of innovation,” said Dr. Ashwin Vasan, president and CEO of Fountain House. “You’ve got a very strong community in the San Antonio Clubhouse that has a desire to have their voices heard.”

The day-to-day operations of the Clubhouse are carried out by paid staff and member volunteers. Daily tasks include data entry, working the register at the snack bar, cleaning the facilities, running to the grocery store or bank, tending the hydroponic farm, organizing activities and cooking meals.

Staff also help members apply for paying jobs in the community, a key part of recovery, Estrada said. Many have become peer support specialists on staff at SA Clubhouse.

About 30-35 members visit the center each day; before the coronavirus pandemic, it was closer to 45, Estrada said. SA Clubhouse has about 2,900 members, of which about 1,200 are active. Membership lasts a lifetime, regardless of how often members stop by. Another 600 people didn’t become members but received other services.

Anyone with a history of mental illness can join, as long as they aren’t a danger to others.

Lee Hernandez has been a member of SA Clubhouse since it opened in 2003 as a program at Travis Park Church (then known as Travis Park United Methodist Church). He keeps coming back for one simple reason: the people.

“I like teaching people new things to do … how to not isolate,” he said. “We get nothing from isolating.”

For Michael, who became a member in October, SA Clubhouse has given him a welcome respite from his struggles with depression.

“I used to suffer from major depression and anxiety, but whenever I walk in [here], it seems like I just leave it outside,” he said. “Everyone is friendly.”

An alternative approach to mental health emergencies

Earlier this year, SA Clubhouse participated in a national training program for alternative emergency responses to mental health calls that have historically been answered by the police. It focused on models used in Eugene, Oregon, and Denver that deploy physical and mental health clinicians rather than police for low-risk 911 mental health calls.

After that training, the clubhouse produced a report that recommends a similar policy for the San Antonio Police Department. For higher-priority and higher-risk calls, SA Clubhouse recommended augmenting a police-paramedic-clinician team with a specialist who has firsthand experience with mental issues.

San Antonio’s multidisciplinary team approach, which is still being developed, will likely include a police officer responding to all mental health calls, though activists are pushing to preclude that.

The clubhouse will serve as a neutral “Switzerland” when it comes to such debates, Estrada said, but will always advocate for the well-being of its members and the broader community living with mental illness. “We want to provide the information and the space for these important conversations.”

Meanwhile, Fountain House wants to strengthen its ability to give local clubhouses the tools they need to participate in public policy advocacy.

“It’s not that they don’t want to, it’s that they’ve got other responsibilities” associated with operating a nonprofit, Vasan said. “So that’s where we come in,” with technical assistance, connections to training programs and analysis from its national network.

Fountain House has a political advocacy team and soon will establish a 501(c)(4) nonprofit political advocacy arm, he said.

“We need to start politicizing [mental health] … not in the awful [way] of dividing people, but bringing people together and holding people accountable to form good policies,” he added. “This issue may be one of the few or last bipartisan issues still out there.”

Sticky notes with positive quotes populate a whiteboard at SA Clubhouse on Wednesday.
Sticky notes with positive quotes populate a whiteboard at SA Clubhouse on Wednesday. Credit: Nick Wagner / San Antonio Report

U.S. Sens. John Cornyn (R-Texas) and Catherine Cortez Masto (D-Nevada) introduced a bill this summer that would fund an expansion of mental health services, shifting the burden from police, Vasan noted.

Fountain House and Inseparable, another mental health advocacy organization, will lead a national campaign to get that bill passed, he said.

“Groups like San Antonio Clubhouse and other groups around the country are going to be a key part [of] lifting up their voices,” he said.

Learning how to ‘hold space’

While its recent work on emergency responses was public-facing, a majority of SA Clubhouse’s most important initiatives take place on the second floor of its headquarters, called the Connection Center.

Waiting at the top of the stairs are Cynthia Romo and Mary Tolle. They are mental health specialists who supervise other peer support specialists — individuals with firsthand experience with mental illness who have been trained to help others recover.

“We’re not doctors, we’re not counselors; however, we have that lived experience that we can actually understand and empathize and be someone to talk to,” Romo said. Existing and new members can come to them “and talk about whatever’s on their mind.”

Romo is in recovery from drug and alcohol abuse and mental health issues. Years ago, she saw her children taken away and served time in prison.

“We have to give them a little snippet of our story,” she said. “Just so they know that, hey, I know ’cause I’ve been there, done that.”

Peer specialists also connect members to resources such as housing or food assistance, but most of the job is simply listening to members, Tolle said. “We call it ‘holding space,'” a term used in therapy for being physically, mentally and emotionally present for someone.

The Connection Center offers weekly specialty support groups, such as the Hearing Voices Network, tailored for people who report hearing voices or other extreme or unusual experiences.

SA Clubhouse recently was awarded a four-year, $1.4 million federal grant that will provide $200,000 each year in stipends for people training to become certified peer support specialists. The rest of the funding will be used to expand its training capacity.

Once they complete at least 44 hours of training and 250 hours of supervised peer support, specialists can receive state certification and find jobs or internships, Tolle said. “We just recently hired a couple of our previous interns to work here.”

Estrada wants to see peer support specialists work in the community beyond clubhouses and hospitals. “It shouldn’t just be the clinical setting.”

“I envision that, by this time next year, there’s going to be a peer specialist in places that seem obvious in hindsight, but that we’re not thinking about now,” he said, such as in housing programs, libraries and other places of social interaction.

Taking targeted mental health approaches, such as peer support, out of clinics and into the community can also help reduce the stigma associated with mental illness, Vasan said.

“We have overmedicalized mental health,” Vasan said. “Mental health at the end of the day is social — it’s about our social relationships.”

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Iris Dimmick

Senior Reporter Iris Dimmick covers public policy pertaining to social issues, ranging from affordable housing and economic disparity to policing reform and workforce development. Contact her at iris@sareport.org