American Journal of Psychiatric Rehabilitation, 10: 149162

Taylor & Francis Group, LLC # 2007

ISSN: 1548-7768 print=1548-7776 online
DOI: 10.1080/15487760701508201

The Fairweather Mental Health

Housing ModelA Peer Supportive
Environment: Implications for
Psychiatric Rehabilitation
Kristine L. Haertl
Occupational Science and Occupational Therapy,
College of St. Catherine, St. Paul, Minnesota, USA
Recent emphasis on consumer empowerment and recovery in psychiatric
rehabilitation is uniquely suited to peer-supported service delivery models.
The Fairweather mental health housing models basic tenets of peer support,
empowerment, community, and productive work align well with recovery
models. This article outlines the major principles of the model, recent research,
fidelity standards, and outcomes supporting the model. A case site example is
presented, along with a discussion regarding implications for future research
and development of the model.
Keywords: The Fairweather model; Peer support

As psychiatric rehabilitation increasingly emphasizes principles of

values-driven, evidenced-based practice, service delivery models
are under greater scrutiny and pressure to demonstrate evidencebased outcomes. Family and human science fields continue to stress
the importance of bridging gaps between research and practice

The author would like to thank Tasks Unlimited, the Coalition for Community Living, John
Trepp, and Esther Onaga for their valuable support and contributions to this project and the
article.
Address correspondence to Kristine L. Haertl, Ph.D., OTR=L, Associate Professor,
Occupational Science and Occupational Therapy, College of St. Catherine, 2004 Randolph
Ave, St. Paul, MN 55105, USA. E-mail: klhaertl@stkate.edu

149

150 K. L. Haertl
(Small, 2005) as policy makers and service providers seek effective
means to provide quality, person-centered care. Focus within
mental health rehabilitation emphasizes life outcomes including
measures of independent living, community participation, and
successful employment (Bolton, 2001). As service delivery shifts
from dependent models of care towards independence, the Fairweather model offers a unique focus on interdependence within a
peer-supported structure.
Mental health service delivery models are often driven by multiple perspectives pertaining to theoretical approaches and beliefs
related to the etiology of mental illness (Schnittker, Freese, & Powell,
2000). As conceptual frameworks and paradigm shifts have moved
away from medical models and towards a biopsychosocial emphasis,
a more holistic view of the etiology and treatment of mental illness
includes the recognition of genetics, the environment, situational
events, and personal factors in their influence on mental health
(Mowbray & Holter, 2002). Biopsychosocial views of mental illness
recognize the complex dynamics influencing mental health and are
conducive to models that emphasize consumer empowerment and
involvement within service delivery to persons with mental illness.
Personal empowerment is enhanced through engagement with
others within residential, occupational, and community contexts.

FAIRWEATHER MODEL
Studies emphasize the importance of meaningful social relationships for persons with mental illness (Ruesch, Graf, Meyer, Rossler,
& Hell, 2005; Tan, Choo, Doshi, Lim, & Kua, 2004). The creation of
such relationships in society involves interdependence at the microinterpersonal level and the macro-agency level. Often within the
mental health system persons with serious mental illness are
expected to live autonomously in their own apartments, yet a
review of our society reveals most people within the U.S. living
with family members, friends, or partners (United States Census
Bureau, 2005). Within the familial structure, individuals rely on
one another for day-to-day social support, interaction, and household maintenance. Paradoxically, persons with serious and persistent mental illness are often expected to live independently with
little opportunity for social contact. Such expectations of autonomous independent living are a viable alternative for some, but

The Fairweather Mental Health Housing Model 151

may not always be the healthiest for individuals who struggle with
social interaction and the formation of positive, healthy relationships. Peer support models offer an alternative by creating a community culture that promotes interdependence, empowerment,
and interpersonal engagement.

Historical Roots
The Fairweather model encourages persons with mental illness to
take an active role in the decision-making and provision of mental
health services through the use of a peer-supported, communitybased residential and work environment. The original model as
designed and studied by Dr. George Fairweather, was developed
in the 1960s under a National Institute of Mental Health grant
(Fairweather, 1964; Fairweather, Sanders, Cressler, & Mayard,
1969). The program was designed as a community living lodge that
emphasized interdependence. Persons in the program lived
together, worked together, and learned skills necessary to function
in a peer supported environment empowering them to function
and make decisions relatively autonomous from staff. Onaga,
McKinney, & Pfaff (2000) identified three main goals of a lodge to
(1) form a cohesive interpersonal group with the establishment of
norms and roles, (2) to foster mutual responsibility within the peer
group, and (3) to provide an environment enabling lodge members
to take an active role in the decision-making regarding the structure
and function of the lodge. Given the active interpersonal roles, the
nature of autonomous decision-making, and the emphasis on
productive work and community living, the model has sought to
combat stigma associated with mental illness and to provide opportunities for productive personal, interpersonal, and communitybased living. Key concepts of interdependence and productive
meaningful engagement in everyday life have continued from the
models inception to present.

Current Fairweather Models

Today lodge programs throughout the nation have aligned themselves through the National Coalition for Community Living, a
nonprofit organization that unites providers, consumers, and
families involved in Fairweather Model programs. Core concepts
within Fairweather programs include the following: (1) members

152 K. L. Haertl
have a stake in the system, (2) members are given much autonomy,
(3) their role is voluntary, (4) there are opportunities for advancement in the system, and (5) they fulfill roles expected in society
(Onaga, 1994). While lodge programs differ some throughout the
country, personal satisfaction of residents living within the lodge
is high (Onaga et al., 2000; Tasks Unlimited, 2005, 2006). The unique
community culture within a peer-supported environment seems
to contribute to satisfaction and retention (Haertl, 2005; Haertl &
Minato 2006; Onaga et al., 2000).
Recent research on the Fairweather model has largely focused on
factors contributing to success, satisfaction, and personal life
enhancement within the lodge (Haertl 2005; Haertl & Minato,
2006; Onaga et al., 2000). A qualitative study of persons residing
in 58 lodges throughout the United States (Onaga et al., 2000)
sought to identify what made members proud of being part of a
lodge and how the lodge helped improve their lives. Lodge residents were interviewed and staff members were surveyed regarding perceptions of lodge living. A key theme identified within the
study was the family-like culture that often evolves within the
lodge. Additional themes included the importance of resource sharing, common goals, mutual support, a nurturing safe environment,
and a sense of community. Similar results were found in a mixed
design study that sought to identify factors that influence success
within a Fairweather model program (Haertl, 2003, 2005). Interviews of 49 past and current members, surveys of 25 past and
current employees, and chart audits of residents admitted during
a three-year time frame (n 47) identified multiple factors leading
to success in the model including the importance of (1) consumer
motivation to live in a peer-supportive environment and work
competitively, (2) a level of stability in mental and chemical health,
and (3) support from family members regarding the viability and
efficacy of the model. Persons whose family members felt strongly
about the importance of apartment or autonomous living did not
do as well in this model as those whose families upheld the value
of peer-supported housing. Programmatic factors leading to success, satisfaction, and retention included the (1) comprehensive
wrap around services, (2) strong sense of community, (3) high quality of living, (4) safety and security, (5) family-like culture, and (6)
the fact that lodge members may live there as long as they want.
In the organization studied, many of the members had resided at
the program and had remained out of the hospital for over 20 years,

The Fairweather Mental Health Housing Model 153

a rarity in todays mental health system as persons with mental
illness are often expected to rehabilitate and move onto independent apartments or other living arrangements. Within this
model, long term healthy community based living is encouraged.
Dominant themes in lodge member feedback included the importance of peer support and the community culture (Haertl, 2003).
Interview content analysis revealed numerous statements demonstrating the collaborative culture that emerges within the lodge.
One individual stated, You arent lonely here and you have companionship; they are friends. Another woman stated, We care for
each other . . . its like a family. Members indicated the community
atmosphere contributed to the cohesiveness of the group as well as
to personal growth. A newer gentleman who had been in the program for less than a year stated, Cohabitation with other people
is a learning process all the time.
As the theme of community was discussed, members emphasized the importance of peer expectations and sharing in the daily
household management. A quote representative of this theme,
You may be self-conscious, which is a barrier; really it is a joint
effort all the time. If something isnt going right, by golly, someone
will speak up soon!
In addition to the lodge members, staff quotes taken from
the surveys demonstrated the importance of peer accountability.
One staff member wrote, I have found over the years that client
improvement=accomplishments are directly linked to holding each
other accountable. Clients seem to be more motivated by each other
than by staff expectations. This is the first place people have been
given a voice and expectations of responsibility.
As the members proceed through the training phase of the
program, they learn living skills, assertiveness skills, and vocational
skills, all in preparation for lodge living. Continuation in the training phase results in increased freedom and expectations. One of the
staff members emphasized the importance of this transition in stating, Teaching peer support, group dynamics, independent living
skills, and vocational values and skills is (our) strength . . . moving
from a dependence=independence type of thinking to a groupthink
or interdependence way of thinking is our greatest challenge and
our greatest strength. The high expectations, community culture,
and peer support, appear integral to the success of the Fairweather
model. Once members successfully complete training, they may
live with a few others in a peer-supported environment (lodge)

154 K. L. Haertl
relatively autonomous from staff. The collective group lives and
works together assuring the functions of the lodge are met.
CASE EXAMPLE: TASKS UNLIMITED
Tasks Unlimited is a large Fairweather model corporation in the
Twin Cities metropolitan area, of Minnesota. The organization provides residential, vocational, recreational, wellness, living skills, and
mental health services to between 200 and 300 individuals on an
annual basis. The organizational mission states, Tasks Unlimited
provides supported employment and housing for people in recovery from mental illness or brain injury so that they achieve a full life
with the rights and responsibilities of adults in society (Tasks
Unlimited, 1999). Participants may either enter a training program
with the eventual goal of living in a lodge (residential home housing
four to five persons in the program) and working for the organizational business (janitorial, mailroom, and building services); or they
may enter the JOBS training program, designed for clients who have
alternative living situations but would still like to receive vocational,
recreational, and mental health services from Tasks Unlimited.
Training focuses on teaching vocational, assertiveness, living, and
social skills necessary for peer-supported living. Participants are
encouraged to take an active role in the decisions, home maintenance, recreational planning, and household management. Members proceed through a series of steps with increasing privileges
and responsibility working towards completion of the training
phase. Persons in the program that successfully complete lodge
training go through a formal graduation and may then live in a
lodge and receive services for as long as they continue to meet programmatic expectations. Member satisfaction is high, as evidenced
by annual satisfaction surveys, and the impressive number of residents who have lived and worked in the program for over 25 years
(Haertl, 2003). Once individuals transition to a lodge, they live in a
peer-supported, fairly autonomous environment.

Lodges
Lodges are residential homes, typically housing four to six persons.
Each lodge is assigned a coordinator who assures the household is
functioning well. Coordinators are at the lodge about two to ten

The Fairweather Mental Health Housing Model 155

hours a week and serve as work site supervisors for competitive
janitorial, mailroom, and building services. Job responsibilities of
the coordinator include (1) the assurance that the peer group is
functioning well; (2) the offering of personal and group support,
training, and advice when needed; (3) serving as a collaborator with
clients on their personal goals; and (4) serving as a supervisor at the
assigned work site. The relationship between the coordinator and
lodge members is collaborative and seeks to enable maximal autonomy and decision-making on the part of the members. Lodge members take an active role in the decisions regarding the budget, house
rules, assigned chores, and living environment. All members work
competitively for Tasks Unlimited and have opportunities to work
up a career ladder towards supervisory positions. Everyone in the
program is expected to work and take an active role in the household maintenance and social atmosphere of the lodge.

Programmatic Services
In addition to residential services, all persons serviced within Tasks
Unlimited have access to vocational, recreational, mental health,
and wellness resources. There is a consultant psychiatrist available
to clients, as well as case managers for psychosocial support. Members also have the opportunity to engage in recreational offerings
including league sports, community outings, and trips. Recent trips
attended included local and national trips, and a ten-day international trip to Europe. Members work in consultation with the
recreation director to plan activities and decide upon vacation destinations. In addition to recreational offerings, those in the program
have access to a wellness coordinator and may work on personal
wellness goals and engage in weekly exercise and Tai Chi offerings.
As part of the work benefit package, members earn points and
redeem them for a variety of wellness related services or products
such as community classes, personal care items, and relaxation
CDs. The program is unique and services a high percentage of
persons in the Tasks Unlimited program.

Programmatic Outcomes
A review of the 2005 Tasks Unlimited Statistical Management
report indicates service delivery to 279 individuals with mental

156 K. L. Haertl
illness, the majority of whom (185=76%) had schizophrenia.
Consumer satisfaction in all areas of the program was reported as
high and 100% of those who went through training in 2005
(n 18) reported that their mental health was improved as compared to the day they entered the program. Ninety-eight consumers
received services through the Lodge Program, 101 through the
JOBS program (the program that includes person living externally
and receiving services through Tasks Unlimited).

Vocational and Mental Health Outcomes

of the Fairweather Program
Long-term data was collected on 248 adults who successfully graduated from either the Lodge Training Program or JOBS training
program between 1990 and 2003. The data was collected on all
graduates regardless of whether they continued in the programs.
The following is a synopsis of the outcomes:

Hospitalization
Five-year follow-up data on consumer hospitalization found a 90%
reduction in hospitalization days as compared to preadmission,
with the average days of hospitalization prior to intake at
38 days=12 months and the average at 5 days=12 months at the
five-year follow up. Of existing consumers, the organization has a
designated outcome of mental health program participants spending less than 1% of their time in psychiatric hospitalization. The
2004 data showed mental health participants spent 244=64,015 days
of service (client days) indicating only .4% spent in hospitalization.
Data for 2004 paralleled results from 2002 and 2003.

Work
Of 248 consumers, the average income 12 months prior to intake
was $1,090. The average income the first 12 months post graduation
was $5,468 (n 245=247) and available data of 148=183 clients five
years following graduation found the average income of $6,708,
reflecting a 515% increase in income. The organization set an
outcome to increase employment options to six different types of
work (currently three), yet barriers were encountered in finding
work opportunities that pay well, are attractive and successful
for participants, and are available under a contractual basis.

The Fairweather Mental Health Housing Model 157

The organization has also identified a target outcome of 65 participants working full-time (currently 59).

Additional Goals and Outcomes

Since the onset of the tracking of the outcome data reported, and
since the original study, Tasks Unlimited has opened the first Fairweather Lodge for women and children in the country. The lodge
is set up similarly to other lodges in the communal sharing of
decision-making, household maintenance, and work responsibilities, yet dynamics differ within this program due to the presence
of children.
The goal of this program is to work with women at risk for losing
their children and to provide a supportive environment by which
they can develop parenting skills and learn to live, work, and
parent their children in a peer-supported environment. Initial outcomes in 2004 resulted in 99.1% of days clients were not psychiatrically hospitalized and 96.2% days the children were not placed in
emergency shelters or foster care. Organizational challenges within
the new Lodge have included developing a community, peersupported environment with the women and children, and maintaining fiscal viability.

Challenges
Given the longevity and retention of clientele, a key challenge for
Tasks Unlimited is the aging demographics of the consumer base
(Haertl, 2003). Strategic outcomes have focused on meeting the
needs of the aging population resulting in 100% of consumers over
55 receiving services from regular programmatic activities, and
retention of 81% of program participants that reached the age of
55 by December 1, 2001 (retention to December 32, 2004). The participants have also self initiated a retirement support group that
meets on a regular basis to discuss topics such as retirement planning, volunteer opportunities, and senior resources. Rather than
moving to a specific designated Senior Lodge, participants have
chosen to stay in their own lodges and residences and receive services through the central support group and through outside contracted services with occupational therapy, physical therapy,
nursing, and home health. Additional challenges include serving
persons of diverse ethnic backgrounds and an increasing number

158 K. L. Haertl
of clients with a history of chemical abuse=chemical dependency.
Current efforts include a partnership project with the county in
order to increase the number of persons of African American
decent served, and the development of a program to address
chemical health needs of clients.
As a case site, Tasks Unlimited is the largest current Fairweather
model program in the country. It represents the diverse structure
and services offered by Fairweather programs, but may not be representative of all programs given its scope and breadth of services.
The site does however demonstrate the utility of peer support
models in the provision of mental health services.

DIRECTIONS FOR THE FUTURE OF FAIRWEATHER PROGRAMS

As the number of Fairweather Model programs throughout the
country expands, the National Coalition for Community Living
has identified the importance of developing standards for newer
programs. Fidelity scales are instruments used to measure the
implementation of a program of practice (Bond et al., 2002), and
help provide a structured means by which to assess program
design and service delivery. The Fairweather Lodge Model as originally developed (Fairweather, 1964) emphasizes comprehensive
services in a peer-supported environment with emphasis on mutual
support, a nurturing environment, and empowerment in daily
activities including work, home maintenance, leisure, and mental
health management.
In 2004 the Coalition adopted Fairweather Lodge Fidelity Standards as authored by Trepp and Onaga (2004). The standards
emphasize eight principles uniquely suited to the Fairweather
model including: (1) providing safe environments, (2) promoting
good health and symptom management, (3) providing long-term
services, (4) promoting productive work, (5) fostering meaningful
social roles, (6) providing a community culture resembling a healthy
family, (7) working to foster autonomy, and (8) securing resources
from multiple avenues. An example of the Fidelity Standard checklist is included in Table 1. Currently plans are underway to test the
fidelity standards to assure their reliability, validity, and fit with
the model. As additional Fairweather model programs emerge,
the development of these standards is seen as integral to maintaining quality and consistency with the foundations of the model.

The Fairweather Mental Health Housing Model 159

TABLE 1. Implementation of lodge practices (from the fidelity standards)
Housing
The Lodge has a plan for controlling the use of alcohol
and street drugs.
Participation in the Lodge guarantees good quality
psychiatric care, available in a timely manner.
The Lodge has a standard mechanism (adjustable in response
to earned autonomy) for ensuring medication compliance.
There are no minimum or maximum time limits on
participation in the Lodge.

Yes

No

Employment
All participants are employed at least 15 hours per week.
Employment begins immediately upon entry into the lodge.
The more participants work, the more disposable income they have.
If employment through an affirmative business is provided:
1. Work opportunities include a range of tasks from simple to
complex, with appropriate accommodations for the illness.
2. Participants are be paid commensurate with their contribution
to the business.
3. There are frequent and realistic evaluation of performance and
an opportunity to advance.
4. Participants should have a choice between working in the
affirmative business and outside employment.

Yes

No

Social
Every participant contributes to the collective good of the lodge.
Equity of contribution from one participant
to the next is of secondary importance.
The Lodge (or the members) contribute to society.

Yes

No

Autonomy
Lodge participants, as a group, make decisions about:
Finances
Home maintenance
Meal planning and preparation
Social life
Transportation
Rules related to interaction between members
Symptom management, including the taking of medications
Training is available to develop individual and
group skill related to:
Finances
Home maintenance
Meal planning and preparation
Social life
Transportation
Rules related to interaction between members
Symptom management, including the taking of medications

Yes

No

(Continued)

160 K. L. Haertl
TABLE 1. Continued
A special communication system is used during training.
This system provides feedback to individuals and group
at least once per week.
This system promotes autonomous group decision-making.
Fidelity to Autonomy Principles
1. Both the Lodge and the Sponsoring Agency
endorse full autonomy as the ultimate goal.
2. A system is in place which adjusts autonomy
commensurate with Lodge performance.
3. The Lodge is dependent on resources from a single source.
a. If yes, a plan exists to diversify.

Yes

No

Reprinted with permission, Coalition for Community Living (Trepp & Onaga,
2004).

CONCLUSION
As the nation moves towards emphasis on recovery in psychiatric
rehabilitation (Anthony, 1993; Jacobson & Curtis, 2000), tenets of
the Fairweather model fit parallel themes found in the recovery
literature. General principles of recovery focus on client transformation of the future (Miller, 2000), and the construction of a positive identity within individual self-image (Pettie & Triolo, 1999).
The Fairweather model promotes autonomy, social interaction, productive living, and meaningful social roles within an interdependent, peer-supported culture. Data from the case site and
percepts outlined in the fidelity standards emphasize the importance of long-term comprehensive consumer driven care. Western
cultural practices that emphasize individual living situations for
the majority of consumers fail to recognize the merit of community-based living in creating a family-like, supportive network.
Adherence to principles of recovery and individualized services
must consider all levels of residential and community-based intervention in order to more effectively meet the needs of persons with
serious and persistent mental illness.
A paradigmatic shift from emphasis on independent apartment
living for all towards an inclusive view of a variety of housing
models fosters consumer-centered care. The inclusion of peersupported, interdependent models in the spectrum of mental health
services is vital in order to provide long-term residential options

The Fairweather Mental Health Housing Model 161

incorporating quality, comprehensive services to persons with
serious and persistent mental illness.

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