Vail Place poised to open mental health ‘clubhouse’ in St. Paul

Margaret Humphrey first heard about Vail Place’s potential move to St. Paul a couple of years ago when a group of leaders from NAMI Ramsey County came to the member-run mental health clubhouse’s Minneapolis location to find out more about its programs.

“They went on a tour and ate lunch,” Humphrey said. When the visitors mentioned their desire to replicate Vail’s programs on the other side of the river, Humphrey, a St. Paul resident and 10-year Vail Place member, was all in: “I said ‘If you need help, let me know. I’m here for you. I live in Ramsey County.’”

Those words were all the NAMI Ramsey group, which included ex-officio board member and retired state Rep. Mindy Greiling, needed to hear. “Before I knew it,” Humphrey laughed, “they sucked me in.”

An ardent fan of Vail Place and the clubhouse model of mental health support, Humphrey is committed to spreading the word about the approach’s benefits. Since that fateful meeting, she’s become a member of NAMI Ramsey’s board of directors and has devoted much of her time to planning this long-desired expansion.

“I’m a successful graduate of Vail Place and I am doing everything that I can to support them and to help them open this new clubhouse,” Humphrey said. “It’s giving me great glee to get this going.”

Humphrey’s life hasn’t always been filled with glee. Before she found Vail, she struggled with major depressive disorder until a serious episode when she was in her 40s put her in HCMC’s psychiatric day treatment program. At the hospital, a therapist encouraged patients to try Vail once they were discharged, and so, when she felt her mental health begin to slip just a few months after coming home, Humphrey decided to give Vail a try.

Stepping into the Uptown clubhouse for the first time felt hard, Humphrey said, like finally admitting that she was living with a serious illness: “The first time I went there I just sat in the community room. I was totally overwhelmed. I didn’t know what to do. Just going in that front door was an admittance that, ‘I am really that ill. I have to deal with this now.’”

A few visits in the community room led to washing dishes and attending clubhouse meetings and eventually joining Vail’s board of directors. Humphrey believes the time in the clubhouse has supported her mental and physical health, helped her build social connections, kept her involved in the world and made her feel like her life had a purpose.

“Without Vail, I don’t know where I would be,” Humphrey, now nearly 70, said. “I’d be sitting at home and probably would have gone through multiple hospitalizations, running up huge bills and still not knowing what to do with myself. Because I’m at Vail, that hasn’t happened to me.”

Vail members and staff have long hoped to open a clubhouse in St. Paul, but several hurdles stood in the way, said Chad Bolstrom, Vail’s director of clubhouse programs and public policy.

“Vail Place has wanted to build other clubhouses since we opened,” Bolstrom said. “It’s just the financial climate has always been a challenge. And the reality is that community mental health programs like Vail are still a struggle for folks to support versus funding acute mental health programs like treatment centers and hospital beds.”

The enthusiasm and support coming from NAMI Ramsey County helped kick start the process of the St. Paul expansion, said Karina Forrest Perkins, Vale Place president and executive officer. The nonprofit is on track to open a St. Paul location by April, she said; right now, staff and board members are touring potential clubhouse locations with a goal of finding a comfortable, welcoming space in the city with easy access to public transportation.

“We’ve looked at spaces that churches are willing to offer us,” Perkins said. “We’ve looked at spaces in strip malls. We’ve looked at co-locating with other social services environments.

We’re really open.” One deciding factor will also be affordability, she added. 

Vail wants to pick a place that will be successful so it can become a model for future expansion. “My assumption is this will be the first of many more clubhouses in Minnesota,” Perkins said.

For her part, Greiling can’t be happier that Vail St. Paul’s opening is only months away.

“It is actually happening and we are incredibly, incredibly excited about it,” she said.

Catching up to ‘average’

The road to opening Vale Place St. Paul has been bumpy. On her first day heading up the organization, Perkins got bad news from Hennepin County, Vail’s lead funder. 

“Last year, our Minneapolis site was de-funded by Hennepin County,” Perkins said. The county, she explained, “made a decision to only fund one of our clubhouse locations. They chose to support our Hopkins location.”

This was a major setback, but Perkins and her Vail colleagues were determined not to shut down the Minneapolis clubhouse. They continued virtual clubhouse offerings and shuttled members between the two locations in a van. Then, Perkins turned to the Minnesota Department of Human Services‘ Office of Medicaid’s medical director, asking them to consider making clubhouse services in Minnesota eligible for Medicaid coverage. If members’ time at the clubhouse was deemed eligible for state reimbursement, she explained, the programs could survive.

“We explained that this is an evidence-based practice that could help people with mental illness in a whole-health concept,” Perkins said. Office of Medicaid staff were receptive to this idea, she continued: “The medical director was particularly interested in our ability to test this model for its efficacy in populations that have been historically marginalized and gate-kept away from excellent care.”

Over its more-than-40-year history, Vail Place has been funded by a combination of grants from county government, foundations and individual donors. If Minnesota chooses to add clubhouse services to its list of Medicaid-approved programs, the state would be joining a growing list. “There are many states where clubhouses are already a Medicaid-funded service,” Bolstrom said.

In the end, Vail was granted a DHS contract that gave the organization an opportunity to demonstrate the effectiveness of the clubhouse model. “The state was able to fund us for two years,” Perkins said. “We could pick two sites of our choice.” Since the Hopkins clubhouse retained its Hennepin County funding, this was an opening for expansion, she explained: “We decided to refund Minneapolis and finally fund a site in Ramsey County.”

With the promise of two years’ funding, Perkins said that she and her Vail Place colleagues are now focused on securing Medicaid funding for clubhouses statewide. Because clubhouse services are evidence-based and have been shown to reduce members’ need for more-expensive emergency mental health care, she is feeling confident that state legislators will approve Medicaid coverage this session. The state’s rising rates of mental illness demand such action, she said.

“My next push would be to get gap funding between now and the time when Medicaid funding is in place so people can set up clubhouses that serve their communities,” Perkins said.

“Without a place to be where you are wanted and respected and valued, you will end up going from crisis to crisis —  and while therapy and hospitalization and med management are all very important, they are point-in-time responses, not relationships. Clubhouses are relationships.”

Bolstrom added that he is working with representatives from several Minnesota towns and cities that are interested in starting their own clubhouses but have felt limited by financial constraints. Organizers say that their friends and neighbors living with mental illness could use this kind of support, and Medicaid funding would make opening these clubhouses possible.

“I have a coalition of 15-17 different communities that subscribe to this philosophy,” Bolstrom said. “They believe in clubhouses but they really struggle to find the funding to make the clubhouse go.”

Bolstrom is well aware of his state’s aim to be above average in national rankings. So he finds it surprising that Minnesota has been so late to adopt Medicaid coverage for clubhouses. In states with Medicaid coverage for their programs, clubhouses are thriving, he said.

“Michigan has a clubhouse in every county. Indiana has a thriving clubhouse community. Ohio just opened seven new clubhouses in the last two years. This clubhouse movement is growing,” he said, and Minnesota is at risk of falling behind.

These days, Perkins speaks about the concept of Medicaid coverage for clubhouse services in Minnesota as a done deal. It is her way of manifesting the future.

“I’m going to push until it does come through,” she said. “The confidence I’m showing is based in our tenacity.” It also may have something to do with timing, she admitted: “I think we have the right people at the right time at our Legislature who are advocating for this and know the value that this will bring to our state. It is a magic combination.”

This session could be their moment, Perkins said. “We are asking for the approval to build a Medicaid benefit. We know this takes a long time. We just need the permission to build this benefit so Minnesota can finally join the join the 28 other states that are already doing this for their communities.”

‘Very much a community’

What sets the clubhouse model apart from other mental health treatment is its focus on self-governance, on people with mental illness determining their own destiny and on the underestimated power of community to help people live with and recover from mental illness.

Bolstrom, who worked as a therapist in HCMC’s adult day treatment program before making the move to Vail Place, knows this well. He believes that clubhouses can be a better option for many people with mental illness.

“There are lots of ways that clubhouses are helpful in helping people navigate their recovery journey,” Bolstrom said. “They provide a connecting point for all of those other services like case management and ACT services. Members have more ownership in where they direct their own recovery.”

Too often, when he worked in a hospital setting, Bolstrom said he’d see people with mental illness get shuffled from one approach or program to the next with little or no say in their treatment. He explained that he was drawn to the clubhouse model by its “egalitarian, ‘You tell me how you need to heal,’ approach.” Clubhouses are, he added, “an international model that has been replicated in 33 different countries, 355 different clubhouses built on member input, consensus generation. They were client-centered before client-centered was cool.”

Perkins explained that clubhouses are more than just another treatment option for people with mental illness. “A clubhouse is not a service,” she said. “It is a community. We have members who have been here for 37 years. This is part of their home environment. It is a phenomenal model, connecting people to employment and homes and transportation and financial literacy, helping them understand and access what they want to see happen in their own communities.”

It’s also affordable, Bolstrom said. “The cost of a week and a half in the hospital is roughly equivalent to what it would take to have somebody have clubhouse services for a year.” In a clubhouse, Perkins said, members build relationships that last a lifetime. “It is an opportunity to engage at no cost with no waitlist and no invasive assessments. There is nothing else like it in the state.”

Humphrey knows this better than anybody. She wants as many people as possible to be able to experience the benefits of being part of a clubhouse. “Vail Place is very much a community that has a building attached to it,” she said. 

She’s excited to open a new clubhouse and welcome more St. Paul-area members. “Vail Place saved my life,” she said. “I’m out here spreading the word so we can save other people’s lives, too.”