A six-month prospective case-controlled study of the effects of the clubhouse rehabilitation model on Chinese patients with chronic schizophrenia

Abstract Objective: To investigate the effects of the 'clubhouse' model of rehabilitation on various psychosocial issues for Chinese patients with schizophrenia living in the community. Methods: A longitudinal, case-controlled and naturalistic design was used. A total of 92 participants were recruited via criteria-guided systematic sampling for a study lasting 6 months. Forty-six participants attending a local clubhouse programme were matched for sex and age with a control group of patients recruited from a regional outpatient clinic who were not attending a clubhouse programme. Case note reviews, standardised assessments of psychotic symptoms, depressive symptoms, quality of life, selfesteem, and locus of control were performed at baseline, 3 and 6 months. Results: Clubhouse participants showed significant improvements in their positive and negative scales, general psychopathology, and total scores after attending the clubhouse for 6 months. The clubhouse participants' employment rate also improved. Conclusion: The clubhouse model of rehabilitation may have beneficial effects on various psychiatric symptoms in Chinese patients with schizophrenia living in Hong Kong. Key words: Community mental health services; Employment, supported; Program evaluation; Quality of life Introduction The 'clubhouse model' is a psychiatric rehabilitation system providing social, educational, and vocational training for adults recovering from chronic mental illness.1 It facilitates consumer empowerment and has become an option in the community rehabilitation of patients with schizophrenia in Hong Kong.2 Consumer empowerment is an important element of rehabilitation for people with schizophrenia as empowered patients have better self-esteem,3,4 better quality of life,3-5 fewer psychotic symptoms,6 and fewer depressive symptoms.7 Work is the main tool used for achieving rehabilitation in the clubhouse model8,9 and the 3 keystones of this model are meaningful relationships, meaningful work tasks, and a supportive environment.8 Clubhouse membership is voluntary10 and the members have free choice over their use of the service.11 Member and staff relationships develop through the work they do together in a work unit in the clubhouse, which has structured daily activities called 'the work-ordered day' to maintain the clubhouse function.12 Clubhouse members also join various types of employment training like transitional employment / group transitional employment, supported employment, independent employment, and group placement. The clubhouse also provides recreational programmes, an outreach service and community support for its members. All members and professional staff have equal authority to operate the programme and are considered co-providers.11 Several studies have investigated the clinical benefits of the clubhouse model. Case-controlled and longitudinal studies have found that clubhouse members adhere better to psychiatric medication13 after attending a clubhouse programme for 6 months and have shorter inpatient stays.13,14 Clubhouse members were also found to have a better quality of life5,15,16 and better social functioning, better emotional-coping abilities and work personalities2 in longitudinal and case-controlled studies on patients attending clubhouse programmes for 3 to 12 months. A longitudinal study showed that patients with schizophrenia who attended a clubhouse programme for 8 months had fewer positive and negative symptoms of schizophrenia.16 Methods This study aimed to investigate the effects of the clubhouse rehabilitation model on the psychosocial functioning of Chinese patients with schizophrenia. This was a longitudinal, case-controlled and naturalistic study using a matched sampling method. Measurements were taken at baseline, then at 3 and 6 months after the intake. Subject Recruitment There were 2 groups of participants in this study. …