House was the first program of its kind. The model was spread across the US and eventually internationally starting in the 1950s, led largely by the National Council of Jewish Women. The model spread further with funding from the National Institute of Mental Health in 1977 for the National Clubhouse Training Program. In the mid-1990s New York City added "16 new clubhouses" that were funded, in part by "savings from the closing of several state mental hospitals into community programs." In 1999, film maker Torstein Blixfjord directed a short performance piece to celebrate the 50th Anniversary of the Fountain House organisation in New York City. A block of the city was closed down, and portraits of Fountain House members by photographer Charlie Gross were projected onto buildings from windows. Saxophonists then descended from different fire escapes, each playing compositions by Briggan Krauss. Model Membership in a club is open to anyone with a serious mental illness, is voluntary, and never expires. In contrast to traditional day-treatment and other day program models, clubhouse participants are called "members" (as opposed to "patients" or "clients") and restorative activities focus on their strengths and abilities, not their illness. Clubhouses are community-based, and strive to help members join and remain part of society, with educational, prevocational, health, and mental health support. Members and staff work together to run structured day programs that follow the workday of the community where a given club is located. Programs are based on assumption that people have individual strengths that can be built on and that meaningful relationships and work are the essential; members have the right to choose staff to work with and the kind of work they do. Evening programs facilitate having a place to go after work hours. One such program collects people's of-the-moment writing, before they can edit and self-censor. There is an international clubhouse network, to which member clubs pay dues and which provides accreditation; standards were developed in 1989 and accreditation began in 1992. Effectiveness A review of research on the effectiveness of the clubhouse model in helping people, found that evidence based was limited by lack of randomized controlled trials, wide differences in the kinds of outcomes that were studied, and by lack of long-term follow-up; these limitations make it difficult to generalize the results. Outcomes that have been measured include time to find full-time employment, earnings, and workplace integration; life satisfaction; psychiatric