Running head: Clubhouse model and schizophrenia

An Evidence Based Review of the

Clubhouse Model and Schizophrenia
Daniel B. Cheever & Melanie R. Francis
University of Utah

Clubhouse model and schizophrenia

INTRODUCTION
It is estimated that over 2.5 million people living in the United States have been
diagnosed with schizophrenia (Pernice-Duca, 2008). This number is approximately 1 in a 100
when compared to the population of the United States which makes it one of the most commonly
diagnosed disorders in the United States. It most often manifests in early adulthood and begins
for many of these individuals to be the only thing they can focus on: essentially robbing them of
the dreams they may have as they start to discover who they are. It starts to become the only
thing that they are identified from (Jung & Kim, 2012).
According to the National Institute for Mental Health in 2002, 62.7 billion dollars was
spent to help treat patients with schizophrenia. There are currently over 36 different kinds of
medications that are being used to treat schizophrenia and 15 more are being developed. The
money that is being spent each year is divided up amongst several different categories in health
care. The main categories that the money is being spent on is pharmaceuticals, out-patient
treatment, and inpatient treatment. It is important that as the United States begins to focus more
and more on affordable healthcare that works on all types of individuals that research is done to
find out the most affordable and beneficial means of treating schizophrenia as well as all other
disorders.
Research that has been done on social networking ability and people living with
schizophrenia consistently shows that these individuals lack the ability to socialize. These studies
go on to explain how this is the biggest barrier for these individuals to effectively integrate into
communities, hold a job, and that the social isolation exacerbates both their positive and negative

Clubhouse model and schizophrenia

symptoms (Pernice-Duca, 2008). One of the main problems with this population is coming up
with a mode to help treat them that is both cost effective and beneficial for these individuals in
the long run. Ideally they would be able to enter into the workforce, support themselves, and
become productive members of society. This review of the literature will aim to look at the
clubhouse model with patients of schizophrenia and to answer if it truly can provide an
affordable and realistic means of treatment that occupational therapists should be encouraging
clients to seek out. This paper will aim to look at the goals of this model to see if it directly
addresses the symptoms of people living with schizophrenia and can have a positive effect on
them in the long run.
METHODS
To begin this literature search, key terms were identified to target the most pertinent and
up to date research. Searching with the key terms clubhouse model AND schizophrenia yielded
few results so the terms were altered to clubhouse AND schizophrenia. While it was intended
to gather the most recent studies there were very few overall so the date criteria of within the last
10 years was dropped. Articles which were not published online, not published in English, or
were unavailable to students for free were also eliminated from the search results. The final
search which targeted studies with direct reference to the clubhouse model and schizophrenia
yielded only five articles.
A limited number of more searches were conducted to find supporting background
articles by which one could become more familiar with the clubhouse model and aspects of
schizophrenia better equipping readers to make an informed decision about the five articles.

Clubhouse model and schizophrenia

These background articles gave the foundation of how the clubhouse model is being used today
and what kind of research is being done to evaluate its effectiveness.
From the five articles that were found, the common subject researched was how
clubhouse model addresses the negative symptoms of schizophrenia. The articles mentioned how
medications are traditionally aimed to regulate the positive symptoms and do not do much to
address the negative symptoms such as flat affect, few gestures, monotone speech, and the
inability to feel pleasure and act spontaneously. This review of the literature looks to evaluate if
this change in the negative symptoms of schizophrenia supports a healthier and more productive
lifestyle based on the individual's ability to return to work, self- manage, and overall sense of
self-worth. The goal of this review is to inform occupational therapists about a treatment model
and its efficacy for persons with schizophrenia.
RESULTS
The clubhouse model decreases negative symptoms of schizophrenia through group
psychotherapy. It is be beneficial in decreasing feelings such as guilt, tension, anxiety, and
attention (Tsang, Ng, & Yip, 2010). Through the clubhouse model, the participants demonstrated
increases in speech skills and their social activity scores. The clubhouse model looks to
incorporate psychotherapy, medications, and group activities to increase the effects upon
psychosocial skills lacking for many persons with schizophrenia. This overarching principle of
the model is directly in line with promoting occupational wellness.
Individuals with schizophrenia tended to stick with the clubhouse model more than other
treatment methods that have conventionally been used. According to Tsang, Ng, and Yip (2010),

Clubhouse model and schizophrenia

individuals are much more likely to participate in the activities and take their appropriate
medications if they are participating in the clubhouse model. Members of clubhouse groups have
shown increases in their ability to self-manage their disease in particular as well as other
instrumental activities of daily living (Naoki, Nobuo, & Emi, 2003). They also reported
significantly lower scores of perceived stigma and higher scores when asked to rate their quality
of life which is a benchmark of occupational satisfaction (Jung & Kim, 2012). One of the main
factors that may contribute to the fact that the clubhouse model is successful is the fact that the
range of opportunities are varied and tailored to be neither too demeaning nor too stressful
(Shean, 2013). Participants in the clubhouse model were also much more likely to recognize their
family as forms of social support which helped them participate better in treatment (PerniceDuca, 2008).
The main success that seems to come with the clubhouse model is the ability of
participants to gain employment. According to the National Institute of Mental Health one of the
main struggles with this population is to find employment where they feel safe, are productive,
and which can be maintained for a long period of time. Members who participated in the
clubhouse model were shown to have a higher employment rate after 6 months (Tsang, Ng, &
Yip, 2010). It was also shown that clubhouse participants worked significantly more hours than
before, and were able to earn more money when compared to participants in other treatment
types (Macias, et al., 2006). The ability to provide better for themselves through increased wages
and hours allows participants to more independently engage in instrumental activities of daily
living such as financial management, improved nutritional opportunities, and shopping.

Clubhouse model and schizophrenia

It is also important to address the fact that while the clubhouse model was very successful
with helping with the negative symptoms of schizophrenia it strongly encourages the use of
therapy in conjunction with antipsychotic drugs which treat the positive symptoms that
accompany schizophrenia (Shean, 2013). Evidence showed that after 6 months, participants
reported a decrease in positive symptoms when the therapy was used with antipsychotic drugs
(Tsang, Ng, & Yip, 2010). Thus if participants are adhering to the core beliefs of the model then
engagement in occupations is further improved as the positive symptoms are treated by
medications.
Shean (2013) identified several key characteristics of an effective treatment for persons
with schizophrenia in the pursuit for the ideal treatment. Many of these characteristics are
inherent in the clubhouse model which makes it one type of treatment model that appears to be at
the top of the list in efficacy for persons with schizophrenia.
DISCUSSION
There are many other treatment models that address varying issues associated with
schizophrenia. Because of this fact and the facts laid out in this review, the clubhouse model can
be an effective treatment when all aspects are applied by the participant. Unfortunately, there is
little research done on the clubhouse model and schizophrenia from which to make
recommendations. For this reason there should be more studies conducted in the future to build
up the base of evidence so that occupational therapy practitioners can better educate and refer
persons with schizophrenia to effective treatment programs whether clubhouse or another. The
articles used in this review are predominantly Level B Class IIa on the American Heart
Associations level of evidence scale. This level of evidence indicates that they research data is

Clubhouse model and schizophrenia

the result of individual randomized trials and is enough magnitude to encourage the
implementation of this model but is not definitive in its success.
As mentioned, future research is required to bolster or reject the claims of these studies.
Replicating the studies included in this review would be one approach which could help inform
practitioners of the efficacy of the clubhouse model with persons with schizophrenia. Also it
would be beneficial to this area of study if research were conducted wherein the aspects
researched here such as perceived stigma, self-management, negative symptoms, etc. were
examined together. From this research one could glean conclusions on similar topics whereas the
research in this review looked at a variety of dependent variables which resulted in little to no
overlap in the specific conclusions. As the limited research currently suggests, the clubhouse
model is capable of providing a statistically significant improvement for persons with
schizophrenia in the occupational areas of instrumental activities of daily living, work, and social
participation; as such it can be recommended as a viable treatment model for occupational
therapists to suggest to their clients with schizophrenia.

Clubhouse model and schizophrenia

REFERENCES
Di Masso, J., Avi-Itzhak, T., & Obler, D. (2001). The clubhouse model: an outcome study on
attendance, work attainment and status, and hospitalization recidivism. Work, 17(1), 2330.
Jung, S. H., & Kim, H. J. (2012). Perceived Stigma and Quality of Life of Individuals Diagnosed
With Schizophrenia and Receiving Psychiatric Rehabilitation Services: A Comparison
Between the Clubhouse Model and a Rehabilitation Skills Training Model in South
Korea. Psychiatric Rehabilitation Journal, 460-465.
Macias, C., Rodican, C. F., Hargreaves, W. A., Jones, D. R., Barreira, P. J., & Wang, Q. (2006).
Supported Employment Outcomes of a Randomized Controlled Trial of ACT and
Clubhouse Models. Psychiatric Services, 1406-1415.
Mastboom, J. (1992). Forty Clubhouses: Model and Practices. Psychosocial Rehabilitation
Journal, 9-23.
Naoki, K., Nobuo, A., & Emi, I. (2003). Randomized controlled trial on effectiveness of the
community re-entry program to inpatients with schizophrenia spectrum disorder,
centering around acquisition of illness self-management knowledge. Seishin Shinkeigaku
Zasshi, 1514-1531.
Pernice-Duca, F. M. (2008). The Structure and Quality of Social Network Support Among
Mental Health Consumers of Clubhouse Programs. Journal of Community Psychology,
929-946.
Raeburn, T., Halcomb, E., Walter, G., & Cleary, M. (2013). An overview of the clubhouse model
of psychiatric rehabilitation. Australasian Psychiatry, 376-378.
Shean, G. D. (2013). Empirically Based Psychosocial Therapies for Schizophrenia: The
Disconnection between Science and Practice. Schizophrenia Research and Treatment, 18.
Tsang, A., Ng, R., & Yip, K. (2010). A six-month prospective case-controlled study of the effects
of the clubhouse rehabilitation model on Chinese patients with chronic schizophrenia.
East Asian Arch Psychiatry, 23-30.
Yau, E. F., Chan, C. C., Chan, A. S., & Chui, B. K. (2005). Changes in psychosocial and workrelated characteristics among Clubhouse members: a preliminary report. Work, 287-296.