After 15 years of working with people battling homelessness, substance abuse, and mental health disorders, when Brian Blevins became the new executive director of Breakthrough House in Topeka, he thought it would be business as usual. He planned to put people in the right environment and get them the right support, the right balance of medication versus therapeutic interventions, etc. But what he discovered was a model that both surprised and encouraged him.
Breakthrough House, Inc. is a nonprofit agency in Topeka established in 1978 to support the recovery of individuals with mental illness by providing services, support, and opportunities to improve the quality of their lives. Their services can be divided into three programs - financial (helping people manage their money), residential (providing people with specialized housing that is structured to their needs, as well as finding affordable housing for those who can live more independently) and social (providing a place where people can connect). It is this last program, known as the Clubhouse, that has proven to be so surprising.
The Clubhouse is a place where people who struggle with mental health issues can gather, talk, socialize, relax, and get to know each other. It is one of more than 300 clubhouse programs operating in 24 countries around the world. Participants are called members, not patients. The environment is a welcoming one where members experience a sense of community. Members are missed when absent and the community pulls together for support should a member suffer a setback. There’s really nothing inherently clinical about it. But Blevins soon came to realize that of all the services Breakthrough House provides, Clubhouses could make the biggest difference in the lives of their members.
“When I went to work for the Breakthrough House, my initial thoughts were to put some clinical services in place for people who had various mental health conditions. What I think I'm good at is problem-solving by asking what people need in order to get better,” Blevins shared. “I'm very much a scientist, so I base most of my research on scientific outcomes. I started learning about the Clubhouse and I found out that none of my ideas were gonna be applicable.”
So what is it about the Clubhouse that makes it so effective? “One of the things that started in our country is twelve-step programs like AA (Alcoholics Anonymous) designed for people who have substance use disorders with alcohol,” Blevins said. ”Now, there's something fascinating about these programs. Twelve-step programs are responsible for 23 and a half million people who are in long term recovery in the world today!” he continued excitedly. “Twenty three and a half million people is the largest scientific outcome I've ever seen as far as a therapeutic intervention goes. It's phenomenal!”
Blevins went on to explain that the twelve-step programs aren’t just effective, they have a universal application. It doesn't really seem to matter what group of people this type of intervention is applied to - age, ethnicity, culture, gender... there's no one who doesn't seem to benefit. In fact, it doesn't really even matter what problem it is applied to. Whether it's drugs, alcohol, sex, smoking, gambling… it works. “So when I got over to Breakthrough House, I discovered that, lo and behold, the Clubhouse model is kind of like AA for those with mental health concerns,” Blevins said. “But the interesting thing is that it has God at its core, it doesn't cost a penny, and it's the most powerful therapeutic outcome ever. That's just got God written all over it. There's just no way, even as a scientist, that I can come out and say that man did this.”
“Now, when it comes to spiritual matters, you have to look at science from a different point of view. Sometimes all you get is the outcome and not necessarily the cause. And that's an interesting thing for a scientist to have to resolve,” Blevins explained. “So, I've looked into why it works and there's good science behind it. One of the fields of science that supports it is called interpersonal neurobiology.” The science of interpersonal neurobiology studies how the body and brain are developed and how they function and change in the context of relationships with others throughout life. “Basically, when people are in supportive environments, their physiology changes; their neurobiology changes,” Blevins explained. “It’s absolutely fascinating and you see it in the outcome. It’s undeniable.”
“The Clubhouse doesn't necessarily need much from us other than some direction and that we make sure that it's there and that we get people to meet and talk with each other,” Blevins said. “Much like one alcoholic helps another alcoholic, one guy with bipolar disorder will be able to help another guy struggling with bipolar disorder in ways nobody else on the planet can. Dr. Kelly McGonigal, a health psychologist at Stanford University, quoted a Harvard study that demonstrated that people who reach out and find support at times of stress have better health outcomes than people who have no stress at all. It's extremely impressive!”
As a country, Blevins believes we don't give enough weight to therapeutic interventions. “We definitely have ways of making these interventions in the lives of people. Unfortunately though, the culture in our country is more medicine, medicine, medicine,” he said. “They don't give therapeutic interventions the same level of medical significance, yet we know for a fact that therapy works. Anybody who's taking medication should be involved in therapy.”
Blevins pointed out that psychiatry is the only field of specialized medicine that never looks at the organ they treat, a quote he heard from psychiatrist Dr. Daniel Amen of the Amen Clinics. Dr. Amen further stated that, “They diagnose by talking to people and looking for symptom clusters. So they're treating the symptoms and not the cause.
“And that is not medicine,” Blevins noted. “Medicine actually is a causal model. You should always be working on the cause of the problem, not just dealing with the symptoms.”
One of the trickier aspects of mental health is timing. When people enter crisis mode and they are ready to finally get the help they need, the staff at Breakthrough House has to be ready. “We have to provide something for them where they get enough of an outcome in that initial intervention that they have hope, and they see that the possibility for change does exist,” Blevins said. “So we wanna hit 'em with everything we can right from the get go and see what happens. If we miss those opportunities, we're blowing it.”
Blevins gives a lot of credit to the staff at Breakthrough House for the success they’ve had.
“We've got a lot of people who are just really passionate about what they do. If you come ask for help from us, you're gonna get it,” he said. “There's this ‘No Wrong Door’ policy that our staff is really dedicated to. As long as people engage with us, then we’re gonna try and find a way to get them stable and living a life that gives them some meaning and purpose. We might need to put them through treatment, but needing treatment won’t prevent us from providing other services such as a safe place to live. And if that's the case, we get them set up to get the treatment and then we move to the next phase. We wanna see them get better.”
He is optimistic about mental health care though, especially when it comes to state politics. “Breakthrough House is just phenomenal at what they do, but it's not just Breakthrough,” he said. “The folks at the state level, Andy Brown, our Behavioral Health Commissioner, what he's done for KDADS (Kansas Department of Disability and Aging Services) is amazing. Charlie Bartlett, who runs the adult programs for KDADS is an amazing provider too. He’s been there for years, and he's just really good at what he does.” Blevins is hopeful that with good people in place with the right agendas, their mission will make an even bigger difference in the lives of those with mental health issues. “It's a rare time in history that you get aligned with the political winds of time. That doesn't happen very often. Usually they're the stumbling block, you know?”
Blevins said the challenge in this nationwide mental health crisis is that people see the homeless/the problem, but have no exposure to the success stories/the solution. “We have got the biggest heart as a nation that there is. Americans are wonderful, but they are just tired of not seeing the fruits of their efforts,” he said. “Mental health, substance use, and homelessness go hand in hand. This is a public health catastrophe that’s not gonna go away if we ignore it,” he warned. ”But if we do it right, we can make a huge impact on our culture.”
“The good news is the people that you see out on the streets with the signs - you give one of those people the right circumstances to heal and get better and a year later you won't even recognize that person. It'll change your heart in a minute when you talk to somebody who has actually gotten better, gotten their life back. There are 23 and a half million wonderful stories out there that I’d give anything to tell people about. The majority of people don't get to hear the narrative coming from the mouths of those people. Even Alcoholics Anonymous… it's anonymous! These are stories of helping, healing, and most importantly hope that nobody really knows. People get better. No matter how far down the scale they've gone, they can get better. There's always hope. So I think of our group at Breakthrough House as hope brokers. We broker hope - both for those with mental health issues and all of the people trying to help them.”
Breakthrough House is holding their "Voices of HOPE" 9th Annual Golf Tournament and fundraiser on September 7th, 2023. Get more information at breakthroughhouse.org. “We're very good at what we do,” Blevins said. “So whatever support the community provides, I promise it goes toward some really positive outcomes.”