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

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Several protocols have been published that set out the involuntary hospitalisation procedure. The majority coincide in urgent cases in general lines, although some points may differ in the different health services: – Initial approach by the general Emergency services or Primary Healthcare services (on request of the family or of close friends who detect a serious decompensation of the patient, who does not accept any approach of his or her clinical situation). – With support of security forces if necessary, and – Transfer to a hospital of reference with psychiatric emergency services where admission is decided upon, following the regulation of article 763 of the aforementioned Law. 2. Civil Incapacitation and Tutorship. Incapacitation is the legal mechanism foreseen for those cases where persistent, physical or psychic illnesses or impairments prevent a person from coping on their own, and where the aim is to protect the interests and rights of the incapacitated person, both personally and for hereditary purposes. Its legal regulation is included in articles 199 to 214 and following of the Civil Code and 756 to 763 of the Civil Procedure. The declaration of incapacitation is the competence of the Judge of First Instance, by virtue of verification of the causes that cause incapacity. Causes of incapacitation are persistent, physical or psychic illnesses or impairments that prevent a person from coping on their own (art. 200) and, in the case of minors, when this cause is foreseen to persist after the coming of age (art. 201). The following are legitimised to start the incapacitation process: – Spouse or descendants. – And when absent, ancestors or brothers/sisters of the assumed incapable person. – The Public Prosecutor when the persons mentioned do not exist or they have not requested it. Any person is empowered to inform the Public Prosecutor’s Office of the facts that may be decisive for the incapacitation. The incapacitation of minors may only be fostered by those who exert custody or guardianship. This process gives rise to a judicial judgement, which will determine its extension and limits, as well as the guardianship that the incapacitated person must be submitted to. – Tutorship: will require the attendance of the guardian for any activity. – Curatela (guardianship): needs the attendance of the tutor only for those acts established in the judgement. The incapacitation judgement will not prevent any new circumstances that may occur from leaving the scope of the incapacitation without effect or modify it. Tutorship is the consequence of an incapacitation process, which is established and constituted as a duty that is established in benefit of the tutored person, always under the supervision of the judicial authority. Tutorship is a legal institution whose aim is to guard and protect the person and the goods of the incapacitated person. The tutor is the representative of the incapacitated person. The following may hold this position: – Spouse, children, parents, brothers or sisters: – Any physical person considered appropriate by the Judge. – Non-profit legal persons, whose purposes include the protection of incapacitated people. The Autonomous Community is one of these legal persons. 124 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
3. Other Regulation on Incapacitation and Tutorship: – Creation of the Tutorship and Judicial Defence Commission for Adults (Decree 168/1998, 6 October). – Patrimonial protection of persons with disabilities (Law 41/2003, 18 November). – Update of the Commission for Tutorship and Judicial Defence of Adults (Decree 13/2004, 27 February). 5. Therapeutic mechanisms and resources As recommended in the 2006 Strategic Mental Health Plan, all citizens who require it must have access to a rehabilitation process, and in their territory (Basic Health Area, Health Sector of Autonomous Community), they must have the following devices at their disposal: • Unit / Centre / Community Mental Health Service • Hospitalisation unit in general hospital • 24 hour a day emergency care • Interconsultation and liaison in general Hospitals • Daytime hospitalisation for adults • Children- adolescents daytime hospitalisation • Children- adolescents hospitalisation in general and/or paediatric hospital • Community rehabilitation programmes (including community monitoring programmes and/or assertive community treatment programmes or similar) • Daytime regime rehabilitation • Rehabilitation with residential or hospital support • Extended care unit • Therapeutic community for adults • Therapeutic community for teenagers • Residential alternatives with grading support and therapeutic or rehabilitation activity • Home care programme • Home hospitalisation (intensive care) • 24-hour community care (including community monitoring programmes and/or ATC programmes or similar) • Employment programmes with support People with SMI may use these resources at different moments of their illness, in some cases successively, in other simultaneously. The way in which the interventions are coordinated and in which circumstances one resource or another is used, may vary from one Autonomous Community to another. In any case, it maintains a series of constant factors that are aimed at what is called continuity of care, and which are based on situating the Community Mental Health Centre in the decision-making centre, with respect to each patient and at there being no interruptions or sudden changes in the level and intensity of the care. CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 125
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Clinical Practice Guidelines for Ps
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This CPG is an aid for decision mak
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Table of Contents Presentation 7 Au
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Presentation Healthcare practice is
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Authorship and collaborators CPG de
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José Manuel Lalana Cuenca. Special
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c) SERVICE LEVEL INTERVENTIONS •
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A B A A B B B C Psychosocial inter
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B B B C A C C 5.3. SERVICE LEV
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20 CLINICAL PRACTICE GUIDELINES IN
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independence, quality of life, pers
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This guideline is aimed at mental h
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Figure 1. Search Strategy Search fo
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The highest evidence level found wa
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4. Characteristics of the CPG 4.1.
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The main focus of rehabilitation is
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5. Psychosocial type rehabilitation
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From another point of view, social
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defined as “standard care” or
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General global state In the short r
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Specific symptoms: when CBT was com
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In the systematic review by Kurtz a
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Summary of evidence 1- 1- 1- 1- 1-
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People with SMI and a diagnosis of
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5.1.3. Interpersonal therapy The li
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weekly or fortnightly sessions. The
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5.1.5. Family interventions There a
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In the RCT carried out by Hogarty e
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A family intervention of more than
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After two years’ treatment, and b
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Family intervention vs. other psych
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1- 1- 1- 1- 1- 1- 1- 1- 1+ No diffe
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Question to be answered • Are pys
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Summary of evidence Pyschoeducation
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with schizophrenia and that the tre
Page 75 and 76: With reference to the type of train
Page 77 and 78: would normally receive and which in
Page 79 and 80: Hypnosis vs. relaxation No improvem
Page 81 and 82: Supervised fl ats are a community h
Page 83 and 84: 3 Programmes directed to leisure an
Page 85 and 86: SMI (schizophrenia, affective schiz
Page 87 and 88: When PVT is compared with standard
Page 89 and 90: Patients included in the individual
Page 91 and 92: 1+ 1+ 1++ 1+ 1+ 1+ 1+ The people in
Page 93 and 94: Music therapy Music therapy + stand
Page 95 and 96: A series of Case Management systems
Page 97 and 98: • The satisfaction data originati
Page 99 and 100: Loss of contact With respect to the
Page 101 and 102: There is not sufficient evidence, e
Page 103 and 104: 1+ 1+ 1+ 1+ Respect to ICM teams or
Page 105 and 106: Finally, in the RCT by Cheng et al
Page 107 and 108: 5.4.2. “Homeless” with SMI The
Page 109 and 110: Patients who access housing with no
Page 111: ceptive disorders. This series of c
Page 115 and 116: 7. Recommendations for Future Resea
Page 117: Appendices
Page 120 and 121: Appendix 2. Information obtained fr
Page 122 and 123: Appendix 4. Information for people
Page 124 and 125: 4. Regulatory and legal framework 1
Page 128 and 129: The coordination of these resources
Page 130 and 131: Social protection systems Pursuant
Page 132 and 133: Specifi c regulation • (SPANISH)
Page 134 and 135: Service Management: The first anti-
Page 136 and 137: on Mental Health and the future Eur
Page 138 and 139: Spanish Society of Legal Psychiatry
Page 140 and 141: Appendix 5. Abbreviations ACT Asser
Page 142 and 143: Appendix 6. Glossary Therapy adhere
Page 144 and 145: Appendix 7. Declaration of interest
Page 146 and 147: 15 Rossler W. Psychiatric rehabilit
Page 148 and 149: 53 Graeber DA, Moyers TB, Griffi th
Page 150 and 151: 86 Schooler NR, Keith SJ, Severe JB
Page 152 and 153: 117 Sohlberg MM, Mateer CA. Effecti
Page 154 and 155: 154 López M, García-Cubillana P,
Page 156 and 157: 190 Bond GR, Drake RE. Predictors o
Page 158 and 159: 225 Hurley AD. Individual psychothe
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