Does Competitive Work Improve Quality of Life for Adults with Severe Mental Illness? Evidence from a Randomized Trial of Supported Employment
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.
KeywordsSevere Mental Illness Assertive Community Treatment Competitive Employment Program Assignment Support Employment Program
This research was funded by grants from the National Institute of Mental Health to the first and second authors (MH01903 and MH62628, respectively). The views expressed herein are those of the author and do not necessarily reflect the policy or position of any federal agency.
Conflict of Interest Statement
The authors do not report any conflicts of interest.
None for any author
- 4.Strauss JS, Harding CM, Silverman M, et al. Work as treatment for psychiatric disorder: A puzzle in pieces. In: Ciariello JA, Bell MD, Eds. Vocational rehabilitation of persons with prolonged psychiatric disorders. Baltimore: Johns Hopkins University Press; 1998, 47–55.Google Scholar
- 11.Fabian ES. Supported employment and the quality of life: Does a job make a difference? Rehabilitation Counseling Bulletin. 1992;36(2):84–97.Google Scholar
- 12.Kukla M, Bond GR. A randomized controlled trial of evidence-based supported employment: Nonvocational outcomes. Journal of Vocational Rehabilitation. 2013;38:91–98.Google Scholar
- 17.Roberts MM, Murphy A, Dolce J, et al. A study of the impact of social support development on job acquisition and retention among people with psychiatric disabilities. Journal of Vocational Rehabilitation. 2010;33(3):203–207.Google Scholar
- 18.Schutt RK, Hursh NC. Influences on job retention among homeless persons with substance abuse or psychiatric disabilities. Journal of Sociology & Social Welfare. 2009;36(4):53–73.Google Scholar
- 19.Gold PB. Family contact moderates association of competitive work with quality of life for adults with severe mental illness. Psychiatric Services. 2013;64(12):1218–1224.Google Scholar
- 26.Allness DJ, Knoedler WH. The PACT model of community-based treatment for persons with severe and persistent mental illness: A manual for PACT start-up. Arlington, VA: National Alliance for the Mentally Ill; 1998Google Scholar
- 27.Anderson S. We are not alone: Fountain House and the development of clubhouse culture. New York: Fountain House, Inc.; 1998.Google Scholar
- 29.Lehman AF, Kernan E, Postrado L. Toolkit for evaluating quality of life for persons with severe mental illness. Baltimore, MD: The Evaluation Center at HSRI, 1995Google Scholar
- 30.Rosenberg M. Society and the Adolescent Self-Image. New Jersey: Princeton University Press; 1965.Google Scholar
- 36.United States Code of Federal Regulations. 34CFR361.5(b)(11) (i–ii). 2013.Google Scholar
- 37.SAS Institute, Inc. SAS/STAT. Cary, NC: SAS Institute, Inc.; 2010. Available online at: www.sas.com.
- 47.Clubhouse International. 2012 International Directory. Available online at: http://www.iccd.org/search_form.php. Accessed June 10, 2013.
- 49.Waghorn G, Collister L, Killackey E, et al. Challenges to implementing evidence-based supported employment in Australia. Journal of Vocational Rehabilitation. 2007;27(1):29–37.Google Scholar