CPG for Psychosocial Interventions in Severe Mental ... - GuíaSalud

In the study by Tsemberis et al 220 (n = 225) the sample to be studied is assigned either to
the continuity of care group (housing and clinical care following continuum model) or housing
with no clinical conditioning factors (housing fi rst model).
The systematic review by Coldwell & Bender 221 , where 6 RCTs and 4 observational studies
are assessed (940 and 4854 patients, respectively), ACT is compared with standard Case
Management or standard treatment in “homeless” people.
Nelson et al 222 carries out another SR with 16 assessments of controlled studies on housing
and support for people who have been homeless. In this study, ACT, Case Management and supported
housing are compared with each other. No information is provided about the magnitude
of the effect.
Caplan et al 223 (n = 112) randomise the sample (all receive ICM) and assign it to an individual
residential housing programme without clinical personnel or housing with 6 to 10 residents
with individual room and assigned clinical personnel.
There are several problems regarding the generalisation and application of the results of
these studies, which have been conducted in Anglo-Saxon countries:
• The variability in the prevalence of psychotic disorders in the homeless population, already
mentioned.
• The differences in social and health support between the different areas where they are
conducted, with a greater degree of protection in European countries.
• Derived from the above, the problem of the homeless population has determined the need
to create specific teams to care for them in certain contexts; this may create differences
regarding the comparative intervention and the generalisation of the results to settings
such as ours, where the existence of these resources is not so usual.
• Most of the studies focus on the greater efficiency of the ACT compared with CM. In our
context there are a few ACT teams disseminated in certain autonomous communities,
compared with the absence of teams that focus on the traditional CM model (broker), due
mainly, once again, to the different social support and health systems.
• With respect to the housing provision systems, the prevailing model in our context is
similar to the model of housing + supporting (assisted flats), whilst the housing in parallel
to the clinical care model is difficult to find as there are no agencies that provide economically
accessible individual or group housing for people with SMI.
As there are differences between the social environment and the support of homeless people
in our context and that of the countries where the studies have been conducted, there will also be
differences in the need to develop and/or adapt resources for them. Therefore, the relevance of
the intervention for the Spanish social and health system is linked to the prevalence of homeless
with SMI, possibly not as high as that of the Anglo-Saxon countries. However, there is a benefit
derived from the application of programmes in a group for which the only alternative is conventional
treatment. The necessary resources to start up integrated housing and care programmes for
homeless people are multiple and involve the start-up of assertive community treatment teams,
only available today in some health sectors of some autonomous communities.
People with SM and “homeless”
RCT (1++)
Patients who are in an integrated housing system (housing + clinical services)
spend less time homeless (p