Recovery-promoting factors in day centres and Clubhouses for people with psychiatric disabilities. A comparative study

Sammanfattning: The thesis aims to compare two approaches to psychosocial rehabilitation – day centres and clubhouses – and to explore if either appears better suited to support people in mental health recovery. The recovery focus is on opportunities for engaging in meaningful daily occupations, accessibility to social interaction and factors pertaining to perceived health and well-being. The thesis consists of four quantitative studies based on self-report questionnaires administered to users of day centres (DC) and clubhouses. Study I showed that there was an association between occupational engagement and motivation to attend the DC/clubhouse in the study group as a whole. Albeit that there were few differences between DC and clubhouses regarding the studied factors, the clubhouses appeared to be somewhat more beneficial in terms of users’ opportunities for choice and decision-making in the programme. Furthermore, the clubhouses also appeared somewhat more beneficial for stimulating socialization among the participants. The results from Study II showed that the clubhouse group had larger social networks and more often someone they would nominate as a close friend compared to the DC group. Moreover, the results of Study II showed that a high level of self-esteem and having seen a friend recently were strong predictors of belonging to the group with a larger network in a cross-sectional perspective (baseline). Strong indicators of belonging to the group with a larger social network at follow-up were being a woman and attending a clubhouse programme, and also having scored high on social network at baseline. The result from Study III showed that, in the total sample, subjective quality of life (SQOL) at follow-up was associated with baseline self-esteem, social network, satisfaction with daily occupations and the SQOL at baseline. The strongest indicator for belonging to the group with the highest scores on SQOL at follow-up was attending a clubhouse, indicating that attending clubhouse programmes is beneficial for SQOL in the long term. The relationships between various subjective perceptions of everyday occupations and recovery were explored in Study IV. Self-reward occupational value showed a bivariate relationship with recovery at both baseline and the follow-up. These results suggest that self-reward occupational value and recovery mutually influence each other. Although a number of bivariate associations were established between subjective perceptions of occupation and recovery, none of these became statistically significant in the regression analyses. The findings suggest the importance of providing valued and engaging occupations in clubhouses to maximize opportunities for recovery.The results of this thesis add to previous knowledge of DC services and clubhouses and discern some strengths of the Clubhouse Model. The results may be used when developing community-based mental health services.