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

  • Paul B. Gold
  • Cathaleene Macias
  • Charles F. Rodican


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.


Severe Mental Illness Assertive Community Treatment Competitive Employment Program Assignment Support Employment Program 
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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


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Copyright information

© National Council for Behavioral Health 2014

Authors and Affiliations

  • Paul B. Gold
    • 1
  • Cathaleene Macias
    • 2
    • 3
  • Charles F. Rodican
    • 2
    • 3
  1. 1.Department of Counseling, Higher Education, and Special EducationUniversity of Maryland at College ParkCollege ParkUSA
  2. 2.Community Intervention ResearchMcLean HospitalBelmontUSA
  3. 3.Harvard Medical SchoolBostonUSA

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