State-funded clubhouses for those with severe mental illnesses are trimming costs and re-examining programs in an effort to avert bigger cuts and even clubhouse closures.

"We're hoping we're going to survive," said Kathleen Rhoads, the state clubhouse coordinator. "We're very concerned. Yes, we're bracing."

In the midst of significant reductions to mental-health services statewide, the clubhouses — which house day treatment, vocational and other programs for 1,100 mentally ill members — have so far been largely spared. But some worry that might not be the case for much longer.

Though clubhouses get a small portion of the state Adult Mental Health Division's total spending — just $2.9 million in fiscal year 2008 out of $174 million in expenditures on mental services — they are considered a core service delivered to the severely mentally ill.

Marya Grambs, executive director of Mental Health America of Hawai'i, called clubhouses the backbone of all the services mental-health clients receive. Just like taking medications and getting therapy, going to a clubhouse puts someone with a mental illness on track to recover.

The difference with clubhouses, she said, is clients often enjoy showing up at the centers every morning and are likely to return once they join up. Participation in clubhouses is voluntary.

"They are completely a bright spot in the landscape of mental-health services," Grambs said.

She also pointed out that the state's system of mental-health clubhouses has received recognition, and added that Hawai'i has had one of the highest proportions of clubhouses per person in the country.

The state opened its first clubhouse — the Friendship House — in 1988 on Kaua'i, but put more emphasis on the centers in the mid- to late-1990s as a way of beefing up community-based mental health services after complaints about conditions at the Hawai'i State Hospital.

TRIMMED SPENDING

Clubhouses can be found around the world, and get certification to ensure they follow standards, including offering an array of services and connecting members with vocational, recreational or other opportunities.

Advocates pointed out that clubhouses in other states have already seen deep cuts because of the economic downturn, and some clubhouses, including several in Massachusetts, have closed or could be forced to close.

The cuts seen in other states have Hawai'i mental-health advocates worried. Already, advocates are raising concerns about how clubhouses will fare in the coming fiscal year, pointing to a proposed state House budget that cuts at least three clubhouse specialists and makes other reductions to mental-health funding that could affect clubhouses.

Michelle Hill, deputy director for behavioral health at the state Department of Health, said the state House budget will decrease "the amount of funding available for clubhouse activities." But she said the "extent of decreases will not be known" until the budget is passed.

Meanwhile, the state is already looking to trim spending on clubhouses. In recent months, staff members have been asked to examine programs at the centers to see if cuts can be made without decreasing services.

The state is also eyeing its rental expenses for mental health clubhouses in private buildings and is considering moving its Hale o Honolulu clubhouse on South Beretania Street. Though Hill said the move "is still under discussion," staff members at the clubhouse have already started packing and are being told to be prepared to leave in May.

It's unclear how much the move would save.

Annual rent for the Hale o Honolulu clubhouse is about $90,000.

FUTURE OF CLUBHOUSES

In an e-mailed response to questions from The Advertiser last week, Hill declined to comment on potential cost-saving measures in store for clubhouses. When asked if any clubhouses would close, she said, "These issues are still under discussion and not determined at this time."

At a legislative hearing last month, Hill told lawmakers she is committed to the clubhouse model and said efforts to trim costs are "about seeing where we can streamline its cost of operation." Hill then added, "There is no plan to wipe the clubhouses off our service array."

Talk about the future of clubhouses comes as state officials are grappling with how to retain the safety net for the mentally ill in tight fiscal times. Some advocates have warned that the safety net is fraying in the wake of big cuts to case-management hours and service programs.

In January, reimbursable case-management hours for clients were capped at 3.5 hours a month, from three hours a day. The cutbacks also included a plan to take about 325 people with private insurance off state-funded services. The state is still investigating how many of those are clubhouse members. So far, no members have been asked to leave.

At the Hale o Honolulu clubhouse on a recent weekday, about 30 clients were busy with a myriad of different activities. Some read, some cooked, some were on computers and some just talked or sat with friends.

Guinevere Melemai, 47, was sifting through a list of clubhouse members who hadn't shown up in a few days. She was going to do one of the many jobs she has taken on at the clubhouse — calling each one to see how they were doing and encourage them to get to the clubhouse.

The Mo'ili'ili resident, who suffers from post-traumatic stress disorder, said she "didn't get out much" before coming to the Honolulu clubhouse in November 2007. Now, her friends and responsibilities at the clubhouse get her out of the door and to the center every morning.

"I come to meet new people, learn new skills," she said.

There are 10 clubhouses statewide, half of which are on O'ahu. The centers, Hill said, are designed "to offer individuals with mental illness an environment to meet, as much as possible, their occupational, educational and social needs." She added that each clubhouse partners with a community mental-health center, where a client can be linked up with services.