Occupational Engagement of People with Mental Illness Participating in Center Based on Club House Model: A Pilot Randomized Controlled Trial

Abstract

Background: Severe mental illnesses profoundly impair quality of life and impose substantial healthcare and socioeconomic burdens. In Iran, psychiatric disorders affect over 30% of the population, highlighting the need for effective psychosocial interventions. The clubhouse model — a community-based, member-driven approach — aims to enhance social inclusion, autonomy, and meaningful participation among individuals with chronic mental illness. Objectives: This study tested the hypothesis that participation in a clubhouse model–based program leads to greater improvements in occupational engagement compared to standard day center services among individuals with severe mental illness in Iran. Methods: Thirty-one participants diagnosed with severe psychiatric disorders were randomly assigned to an intervention group (clubhouse services; n = 15) or a control group (standard day center services; n = 16) using computer-generated block randomization (block size = 4). Allocation concealment was maintained through sequentially numbered, opaque, sealed envelopes. Both groups attended sessions twice weekly for 12 weeks. Outcomes were assessed using the Canadian Occupational Performance Measure (COPM) and the Profile of Occupational Engagement in people with Severe Mental Illness (POES) at baseline and post-intervention. Data were analyzed using paired-samples t-tests (within-group) and independent-samples t-tests (between-group), following verification of normal distribution. Results: The intervention group demonstrated significantly greater improvements in COPM performance (mean increase = 1.59, SD = 0.56, Cohen’s d = 2.84, P < 0.001) and satisfaction (mean increase = 0.92, SD = 0.65, Cohen’s d = 1.42, P < 0.001), while the control group showed no significant changes. On the POES, only the Initiating performance dimension differed significantly between groups at follow-up (P = 0.045). Conclusions: Clubhouse-based services significantly enhance self-perceived occupational performance and satisfaction among individuals with severe mental illness in Iran. The large effect sizes underscore the clinical relevance of this model. These findings support its integration into mental health rehabilitation services in similar contexts.