CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud
CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud
CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud
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RCT (1-)<br />
There are signs that <strong>in</strong>dicate that <strong>in</strong>tegrated cl<strong>in</strong>ical services and supported<br />
hous<strong>in</strong>g approach is more favourable than standard treatment <strong>in</strong><br />
“homeless” patients with diagnosis of SMI and/or substance abuse, <strong>in</strong> results<br />
of substance consumption at 36 months, us<strong>in</strong>g a multiple imputation<br />
system <strong>for</strong> handl<strong>in</strong>g lost data (use of alcohol p = 0.047; <strong>in</strong>toxications p=<br />
0.053; consumption days p = 0.028; spend<strong>in</strong>g on alcohol and drugs p =<br />
0.048 212 .<br />
The <strong>in</strong>tegrated cl<strong>in</strong>ical service and supported hous<strong>in</strong>g approach appears<br />
to be more favourable too compared with case management and with<br />
standard treatment <strong>in</strong> “homeless” patients with diagnosis of SMI and/or<br />
substance abuse, with a shorter stay <strong>in</strong> <strong>in</strong>stitutions ( p < 0.05) 212 .<br />
Summary of evidence<br />
1+<br />
1+<br />
1-<br />
1-<br />
1-<br />
There are no differences between long-term <strong>in</strong>tegrated treatment (36 months) and standard<br />
treatment (that <strong>in</strong>cluded the same <strong>in</strong>terventions, except <strong>for</strong> Assertive Community<br />
Treatment, which were not developed and coord<strong>in</strong>ated by the same team, but by different<br />
teams) with respect to the use of substances 52 .<br />
There are no differences between long-term <strong>in</strong>tegrated treatment (36 months) and standard<br />
treatment with respect to abandonment of treatment and rehospitalisations 52 .<br />
There are no differences between <strong>in</strong>tegrated assertive community treatment (ACT) and<br />
standard ACT with respect to satisfaction and hous<strong>in</strong>g stability at 24 months, although<br />
there is between both <strong>in</strong>terventions when compared with standard treatment 211 .<br />
The <strong>in</strong>tegrated cl<strong>in</strong>ical services and supported hous<strong>in</strong>g approach improves the consumption<br />
of substances when compared with standard treatment, <strong>in</strong> homeless patients with<br />
diagnosis of SMI and/or substance abuse at 36 months 212 .<br />
Integrated cl<strong>in</strong>ical services and supported hous<strong>in</strong>g approach seems to be more favourable<br />
compared with CM and with standard treatment <strong>in</strong> “homeless” patients with diagnosis of<br />
SMI and/or substance abuse, respect to a shorter stay <strong>in</strong> the <strong>in</strong>stitutions 212 .<br />
Recommendations<br />
B<br />
B<br />
C<br />
<br />
People with SMI with dual diagnosis must follow psychosocial <strong>in</strong>tervention programmes<br />
and drug-dependent treatment programmes, both <strong>in</strong> an <strong>in</strong>tegrated manner and parallel.<br />
The treatment programmes offered to people with SMI with dual diagnosis must have a<br />
multi-component nature, be <strong>in</strong>tensive and prolonged.<br />
For people with SMI and dual diagnosis and <strong>in</strong> a homeless situation, the treatment programmes<br />
should <strong>in</strong>corporate sheltered hous<strong>in</strong>g as a service.<br />
When the care <strong>for</strong> people with SMI and dual diagnosis is provided <strong>in</strong> parallel, it is necessary<br />
to guarantee cont<strong>in</strong>uity <strong>in</strong> the care and coord<strong>in</strong>ation among the different health and<br />
social levels.<br />
104 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS