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

2. What is SMI
When we refer to Severe Mental Illness (SMI) we are referring to a series of clinical diagnoses
that fall within the group of psychoses (mainly Schizophrenia and Bipolar Disorder), but also
other related diagnoses.
For the people with these diagnoses to be considered as pertaining to the group of SMI, they
must also satisfy two requirements: persistence in time (2 years by consensus) and present serious
difficulties in personal and social functioning due to this illness.
Thus, it can be stated that not all people who have been diagnosed with a psychosis (such as,
for instance, schizophrenia) enter the group of SMI and that not all people with SMI suffer from
schizophrenia. As indicated, apart from the diagnosis, the persistence of the disorder in time and
the existence of a disability are required.
3. Why do we talk about a bio-psycho-social approach
The main treatment for people with SMI has been pharmacological interventions since its introduction
in the 50s. However, the partial and limited control of the symptomatology with the
medication, the difficulties for certain patients to adapt to the pharmacological patterns, the need
to work in areas such as awareness of the illness, the short and long term side effects, the difficulties
in co-existence and the difficulty to carry out a productive activity and be independent,
among others, pose the need to use a more far-reaching approach than pharmacological treatment,
an approach that permits including biological, psychological and social aspects of the treatment
(“bio-psycho-social approach”). So, other psychotherapeutic and psychosocial interventions must
be incorporated which, in many aspects, are included in the psychosocial rehabilitation concept.
The sole objective of these interventions and this approach is to improve the personal and
social functioning and the quality of life of people with SMI, as well as support their integration.
This means doing more than just controlling symptoms and considering overcoming the illness;
in other words, foster the possibility of people with SMI to lead a significant and satisfactory life,
being able to define their own objectives and finding help to develop them in the professionals.
This concept has been called recovery in scientific literature and at the same it becomes a channel
and an objective to work with each patient.
These programmes, framed within a bio-psycho-social approach and aiming towards recovery
have their maximum expression in Community Mental Health, whose aim is to care for patients
in their normal environment, contrary to hospital (psychiatric hospital) care. As referred to
in other chapters of this manual, this community model is the direct consequence of the changes
in mental illness care over the last few decades and that foster a shift from the psychiatric hospital
to the community and which have been reflected in, among other documents, the General Law on
Health and the Strategies document of the Spanish NHS.
CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 121