Does Competitive Work Improve Quality of Life for Adults with Severe Mental Illness? Evidence from a Randomized Trial of Supported Employment

Abstract

A randomized trial comparing a facility-based Clubhouse (N=83) to a mobile Program of Assertive Community Treatment (PACT; N=84) tested the widely held belief that competitive employment improves global quality of life for adults with severe mental illness. Random regression analyses showed that, over 24 months of study participation, competitively employed Clubhouse participants reported greater global quality of life improvement, particularly with the social and financial aspects of their lives, as well as greater self-esteem and service satisfaction, compared to competitively employed PACT participants. However, there was no overall association between global quality of life and competitive work, or work duration. Future research will determine whether these findings generalize to other certified Clubhouses or to other types of supported employment. Multi-site studies are needed to identify key mechanisms for quality of life improvement in certified Clubhouses, including the possibly essential role of Clubhouse employer consortiums for providing high-wage, socially integrated jobs.

A Systematic Review of Evidence for the Clubhouse Model of Psychosocial Rehabilitation

“… p < 0.05 Proportion Re-hospitalized: A smaller proportion of Clubhouse members were re-hospitalized at 6, 12, 18, and 24 months. Persons referred to other community services 74 (40 Clubhouse, 34 comparison); all had been hospitalized in the prior 4 months p < 0.05 (6, 12, 24 months) p < 0.02 (18 months) Gold et al ( 2016 ) Global Quality of Life: Clubhouse participants reported greater global quality of life improvement, particularly with the social and financial aspects of their lives, as well as greater self-esteem. Clubhouse participants who worked a competitive job reported greater service satisfaction compared to other Clubhouse participants.…”

“… p = 0.327 Employment hours: Clubhouse members worked less hours. p = 0.003 Evidence on Effects of Clubhouse * Clubhouse Accredited by Clubhouse International ** Clubhouse Adheres to Standards and/or had Fidelity Check a Participants from a single study, (the EIDP), were used in separate analyses for all five publications: (Macias et al 2001 ) n = 166, (Macias et al 2006 ) n = 174, Schonebaum et al ( 2006 ) n = 170, (Schonebaum and Boyd 2012 ; Schonebaum et al 2006 ) n = 43, (Johnsen et al 2004 ) n = 175, (Gold et al 2016 ), n = 167 …”

“…a Participants from a single study, (the EIDP), were used in separate analyses for all five publications: (Macias et al 2001 ) n = 166, (Macias et al 2006 ) n = 174, Schonebaum et al ( 2006 ) n = 170, (Schonebaum and Boyd 2012 ; Schonebaum et al 2006 ) n = 43, (Johnsen et al 2004 ) n = 175, (Gold et al 2016 ), n = 167…”

“… * Nine articles provide evidence in multiple domains # Supportive a Beard et al ( 1963 , 1978 ), Booth ( 1994 ), Crowther et al ( 2010 ), Grinspan ( 2015 ), Henry et al ( 1999 ) b Baker (2012), Barry ( 1982 ), Beckel ( 1998 ), Donnell ( 2001 ), Gold et al ( 2016 ), Hancock et al ( 2015 ), Johnsen et al ( 2004 ), Macias et al ( 2001a , b ), Macias et al ( 2006 ), Schonebaum et al ( 2006 ), Schonebaum and Boyd ( 2012 ), Stein et al ( 1999 ), Tsang et al ( 2010 ), Yau et al ( 2005 ) c Boyd and Bentley ( 2005 ), Gold et al ( 2016 ); Jacobs ( 1999 ), Jung and Kim ( 2012 ), Mowbray et al ( 2009 ), Warner et al ( 1999 ) d Adler ( 1976 ), Biegel et al ( 2013a , b ), Booth ( 1994 ), Carolan et al ( 2011 ), Mowbray et al ( 2005 ), Spence ( 2014 ), Warner et al ( 1999 ) e Pelletier et al ( 2005 ) …”

Short Review of Self-Esteem Components with Individual Placement and Support (IPS) Strategy in People with Severe Mental Illness

“…Since it connotes a contribution to society, it breaks the selfstigma, offers the opportunity to free people from financial dependence on others (or non-contributory pensions), opens the door to more rewarding relationships based on reciprocity and shared responsibility and the effective exercise of the adult role. Competitive employment, from the health perspective, has been linked to a series of psychosocial benefits, such as improving personal income, increasing self-esteem and developing social skills, as well as improving symptoms, decreasing the number of hospital admissions and eliminates stigmatization [2][3][4][5][6][7].…”