by Tom Malamud

The movie “Shawshank Redemption” tells the story of two long-term convicts and their respective battles for identity, dignity, respect and personal freedom. Faced with an endless sentence, one uses his training and talent to maintain his individuality and to live as a “free” man, at least in his mind, not letting prison enslave him. This modeling affects the second man who is then able to move from feelings of fatalistic despair to those of hope and a future. In the end, both gain their freedom.

This theme could also describe many people who are currently long-term patients of state mental hospitals. Despite an image of shuttered hospital doors and deinstitutionalized patients after the 1970s, state hospitals still account for the care and treatment of more than 30,000 people. Many of them are buried in a deep sense of hopelessness, which is compounded by neglect from having been forgotten.

Yet, with help, interest, and inspiration, they might gain hope, look to the future and plan for their post-hospital life.

A project at Fountain House, a New York City organization helping people with psychiatric disorders regain a satisfying life in the community, and Manhattan Psychiatric Center (MPC), a New York State psychiatric hospital, addresses this as it helps hospitalized patients make a successful transition to independent living. Fountain Huse is part of the larger Clubhouse movement.

The relationship between Fountain House and the hospital dates many years. Prior to 1998, between five and ten patients would be bussed every day from from MPC, on Ward's Island, to Fountain House, in mid-town Manhattan, where they acquired skills and confidence to make the most of hospital discharge. To participate, they first became club members of Fountain House.

After the tragic death of Kendra Webdale the daily trip for members was cancelled. New York officials believed the best way to “protect” residents of New York City was to prevent patients from leaving the grounds until and unless they were discharged. In effect, they were incarcerated.

About three years ago, however, Steve Rabinowitz, MPC’s Director of Inpatient Services (now Acting Executive Director) invited Fountain House to present its model for working with club members to the staff at Grand Rounds. We were told that MPC was setting up new initiatives for “reaching-in” to patients, looking for ways to get the best possible transition to help people leave. It was something for which the Fountain House model is ideal and a consulting psychiatrist, a staff worker, a clubhouse member, and this columnist, accepted the invitation for a presentation.

We must have clicked because by March 2006 we were invited back to speak to four hundred patients from ten wards. Some had been hospitalized for as little as three months. In most cases they had been there for years – several for a quarter-century or more (one had been there for thirty years). We described the program and how it has helped those coming out of hospitals. “I know what it feels like to be at MPC,” Michael M. told them. “I was here for about seven years. . .Fountain House helped me get out of the hospital setting and get a new lease on life.” He spoke of the “importance of work…in helping me and you to get ahead and feel good about ourselves.” *

Reminiscent of “Shawshank Redemption” another member, George, said:

If it was not for Fountain House, I too would be at MPC, with doctors ready to throw away the key for life. Remember, dare to dream. I’m here to say that if I can make it in life, you can too. Don’t let your past stand in the way of you having a better future for yourself.*

At the conclusion of each presentation that night, we invited MPC patients to join a group we would be starting. Other hospital activities available for those able to leave their wards included a movie, a group for those with a dual diagnosis, and library activities.

A team from Fountain House has been going on Tuesday evenings ever since. It consists of staff and Clubhouse members from the Seabiscuit project (previously discussed on this MIWatch). Lina, for example, is an aspiring actress who currently is working as a real estate agent. George is a school-trained arc welder, currently working with an agency to secure a union-based welding job. Michael G. came to Fountain House after being “a patient at this center," he said. "Now I’m working, and I go (on) Tuesday to influence…people who are on their way out. Believe me, Fountain House is the best thing that happened to us.”* All have had in-patient experiences similar to those at MPC, and can therefore serve as working models. Daneen, a graduate of the MPC Children’s Unit, says “we go Tuesday evenings and we all talk with the patients about joining Fountain House to get a second chance.”*

From six to eight o’clock on Tuesday evenings this Seabiscuit team meets with inpatients who come to “Meyer Mall” (located in the hospital), where they have a nutritious snack – salad, vegetables and fruit. Sometimes the talk is one-on-one, other times there are clusters of people. We move and talk freely, break into small conversations. Or we sit in a circle. There is no agenda. It is just conversation with four to six Fountain House members, and twenty to forty MTC people..

The purpose is to develop relationships as we discuss plans and hopes, using small talk and jokes. At the beginning this was a quiet inward group, despondent. As the weeks go on, we see more and more engagement. The discussions usually focus on the setting of future plans; what people would like to pursue vocationally, academically, residentially and socially; and how Fountain House or another program might help in achieving those goals. Greg put it this way:

I believe we all have our stories to tell. That is one of the reasons we go, to listen to (their) stories. How they got there, why they are (still) there, what do they want to do when they get out? Our weekly conversations run the gamut…and give those who may never get a chance to be heard…While I can not offer a lot…I can give them the attention they need, even if only for a few minutes a week.*

The first of these Tuesdays the clubhouse team found about twenty patients wanting more information about Fountain House and other community-based opportunities. The mood of the early meetings was dominated by inertia, depression, relative silence, hopelessness and despair. But they came back, and new people joined in. As time went on, there were significant increases in conversations, laughter, engagement and, yes, glimmers of hope and planning for post-hospitalization. We got to know Gabriel, Bert, Judy, Ralph, Yamil, Hurm, Mustafa (already a member), and Chris, among others.

At the end of the second month, the first application for Fountain House membership was submitted. Others have followed and participants of the Seabiscuit project are their sponsors. Michael M. put it thusly: “So far we’ve received at least 30 applications and …I’ve presented three of (them) to the Fountain House Intake Committee and all of them have been accepted. This has been a very rewarding experience for me.”*

One of the first applicants, Chris, said:

After hearing about the years that some had been there [MPC], I began to think that I would never be discharged. One way the time went quickly was looking forward to Tuesday night meetings…with Fountain House staff and members. Learning about Fountain House was new to me. I was attracted to what Fountain House had to offer in terms of housing, employment and education. While at MPC, I filed an application and was accepted. Soon after, I was discharged. I am presently seeking full-time work. Future plans also include graduate work in Fine Arts. It has been a blessing becoming a member and being a part of the family.*

As of this writing, fifteen patients have been accepted to Fountain House, of whom five are currently attending, while seven others are awaiting hospital discharge (and, therefore, are not free to attend meetings at the Manhattan location). The remaining three selected other programs. We are working with MPC on ways to facilitate the transition process.

We have been delivering a constant message taken from the “Shawshank Redemption” to those who are attending the Tuesday evening meetings: “get busy living.” We all believe that “something extraordinary is possible.” Each time another patient leaves the hospital and joins an active community-based program, like Seabiscuit, we are all winners.

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*Member comments were first recorded in the Fountain House Weekly, the official newspaper of Fountain House