Designing Mental Health Services People Want to Use
Michael D. Rosberg, Ph.D., for ASC Treatment Group
Mental health systems across the country share a costly problem: inconsistent engagement in care. For individuals with serious mental illness, particularly those with treatment-refractory schizophrenia (TRS), the issue is rarely a lack of available services. It is the lack of services that people want to participate in. When treatment environments are uninviting, overly restrictive, or disconnected from daily life, individuals disengage. Relapse and hospitalization follow, and long-term stability becomes harder to reach with each cycle.
The argument of this essay is that we need to move beyond models built around containment and compliance, and toward services that people actually want to participate in. That means designing environments and programs, both residential and outpatient, that treat engagement as the goal rather than a precondition.
At ASC, this principle guides our model. When individuals are offered environments that feel safe, engaging, and respectful, participation rises. Services such as horticulture, creative arts, animal-assisted care, and structured vocational programming are not amenities. They do the work of building connection and giving people reasons to stay engaged with their own recovery. These are the kinds of services that draw people toward care rather than away from it.
Equally important is the design of the spaces in which these services are delivered. Therapeutic environments need to balance stimulation against the risk of overload, offer access to nature and natural light, and provide both private and shared spaces. A recent systematic review of the built environment as a therapeutic intervention in mental health facilities found that design elements of this kind are associated with improved patient outcomes and reduced behavioral tension (Rodríguez-Labajos et al., 2024). In both residential and outpatient settings, these design choices form the foundation of a culture in which participation is expected and supported.
ASC’s East Los Angeles campus renovation is a concrete test of this approach. Originally developed as a convalescent facility, the campus is being re-engineered into a therapeutic environment that takes seriously what we now know about how setting shapes recovery. The redesign is not only about aesthetics. It is about clinical function, with spaces built to support engagement, reduce behavioral tension over time, and make long-term stability easier to sustain.
A central feature of this redesign is the integration of the Clubhouse model, a community-based approach that emphasizes belonging, shared responsibility, and meaningful daily activity. A systematic review of evidence for the Clubhouse model found consistent support for its effectiveness across domains including quality of life, employment, service use, and social relationships (McKay et al., 2018). By incorporating Clubhouse principles into both residential and outpatient programming, ASC is building a model in which structured care and real-world participation are not separate phases but parts of the same daily routine. Clients engage in daily routines, contribute to the operation of their community, and build social and vocational skills in a setting that mirrors life beyond treatment.
This integration is especially important for individuals with TRS, who often require both stability and opportunity. The Clubhouse model offers a path back into community life that does not require the person to give up the support they still need. Research on clubhouse programs has shown that participation is associated with stronger and more reciprocal social networks, which in turn support recovery and community functioning (Pernice-Duca, 2008). It reinforces a culture of adherence not through enforcement, but through shared expectations and peer engagement. When individuals see others participating, contributing, and succeeding, it reshapes what feels possible for their own recovery.
Most mental health systems rely on existing residential and outpatient infrastructure, much of which was not designed with therapeutic engagement in mind. ASC’s approach suggests that re-engineering these environments is both feasible and clinically worthwhile, with immediate improvements in participation and, over time, reductions in the use of more expensive acute services.
The path forward is not simply to expand services but to make them worth using. If we are serious about the mental health crisis, we have to build systems that people want to be part of. At ASC, we are working to show that when services are designed for engagement and environments are designed for recovery, what was once treated as chronic instability can give way to something steadier.
References
McKay, C., Nugent, K. L., Johnsen, M., Eaton, W. W., & Lidz, C. W. (2018). A systematic review of evidence for the clubhouse model of psychosocial rehabilitation. Administration and Policy in Mental Health and Mental Health Services Research, 45(1), 28–47. https://doi.org/10.1007/s10488-016-0760-3
Pernice-Duca, F. (2008). The structure and quality of social network support among mental health consumers of clubhouse programs. Journal of Community Psychology, 36(7), 929–945. https://doi.org/10.1002/jcop.20265
Rodríguez-Labajos, L., Kinloch, J., Grant, S., & O’Brien, G. (2024). The role of the built environment as a therapeutic intervention in mental health facilities: A systematic literature review. HERD: Health Environments Research & Design Journal, 17(2), 281–308. https://doi.org/10.1177/19375867231219031