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

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Specifi c regulation • (SPANISH) LAW 7/1985, 2 April, regulating the bases for the local regime. (BOE no. 80, 3 April 1985) whereby reference is made to specific care competences linked to local type administrations: Councils, regions, communities, provinces and other types of similar administrative structures) http://www.boe.es/aeboe/consultas/bases_datos/doc.php?coleccion =iberlex&id= 2003/03596 • (SPANISH) LAW on Promotion of personal autonomy and care for dependent people (with special reference to people with mental health problems) Law 39/2006, 14 December, on Promotion of Personal Autonomy and Care for dependent people http:// www.imsersomayores.csic.es/landing-pages/ley-autonomia-personal.html • (SPANISH) LAW 13/1982, 7 April, on Social Integration of the Disabled. http://noticias.juridicas.com/base_datos/Admin/l13-1982.html 7. The stigma and Severe Mental Illness and how to cope with it Despite the advances in the development of human rights, an analysis of social behaviour indicates that there are still discriminatory attitudes towards people with mental illnesses, especially if these are severe, resulting from stereotypes and prejudices that form an often insurmountable barrier for the development of their rights as citizens, for their social integration, and they add new suffering not attributable to the actual illness per se. • Stereotypes are definitions about the illness and its evolution, resulting from partial analyses or false beliefs: incurability, the unpredictability of their actions, non-responsibility, lack of interests, inability to make decisions and a whole life is qualified by one diagnosis or by the symptoms at a time of crisis. • Prejudices are irrational attitudes derived from those beliefs: fear, disdain, aggressiveness, annulment of the other, paternalism, etc. • Discriminatory behaviours: social exclusion actions, segregation, non-access to services, to work, to enjoyment of cultural benefits, leisure, personal enrichment, etc. The stigma is the mark that these beliefs, attitudes and behaviours leave on the person who suffers the illness and on the family. The social origin of this stigma dates back to times gone by, so overcoming it is a slow process and it still has an impact on all social fields, to a greater or lesser extent: families, neighbours, work, media and also in the health fields and mental health professionals. Thus, the person has to work to overcome the illness in a precarious situation of personal impoverishment that compromises the progresses of the recovery process. As a whole, the group of affected people has no power to recruit influence: either at work, in their environment and sometimes not even in the services. This is one of the reasons for the limited resources in budgets and the slow development of the services. Facing the fi ght against stigmatisation The fight against the stigma means adopting a conscious and active change in outlook: respect for human rights, personal dignity and the right of people with SMI to develop their potentialities and to contribute to society. Working in this direction is one of the basic responsibilities of the public 130 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
Administration, of the health and social services system, of the family and of the social environment, and it is in this direction that progress is being made. Support to the person affected This change in outlook is inefficient if the person suffering the illness is not counted on, as this person must overcome the internalisation of any negative beliefs that he or she may have about him/herself (self-stigma). Positive experiences in this field indicate that progress occurs when the following concur: • awareness of their own difficulties (pyschoeducation) • development of individual abilities (self-esteem) • knowledge of one’s own rights • decision-making in agreement with their interests and preferences (Empowerment) (selfassertion), and when this approach is integrated continuously and early on in the care and rehabilitation programmes, counting on the family and situating the anti-stigma action in the actual fields of life (residence, work, leisure…), procuring the collaboration of the environment. The person can leave his or her role as a patient and integrate significant roles, becoming a neighbour, a worker, a citizen who mixes, has fun, etc. and has his or her own life project. The close knowledge of the environment and stable social exchange decrease rejection. The impact of the illness on a family presents tragic characteristics at the onset, something that is not unlike the stigma. That is why the family must be actively integrated right from the start in the information processes and in the rehabilitation programmes, establishing suitable strategies regarding the way in which each family has to cope with the illness. Programmatic Statements: In all democratic countries, and especially in Europe, there are programmatic statements that foster cross-section policies to fight against stigmatisation that contain the principles to be taken into account in the applicable legislation of each country Europe: • “Conclusions of the Council of Employment, Social Policy, Health and Consumers”, June 2003, on the fi ght against stigmatisation and discrimination in connection with mental illness • “European Declaration on Mental Health”. Ministerial Conference of the WHO. Helsinki, January 2005 • Green Paper “Improving the mental health of the population. Towards a European Union strategy on mental health” Commission of the European Communities COM (14.10.2005) 484, page 11 • “From exclusion to inclusion. The road to promoting social inclusion of people with mental health problems in Europe” Mental Health Europe 2008 Trad. FEAFES In Spain • “Strategy in Mental Health of the National Health System” Strategy line 1 “Promotion of mental health of the population, prevention of mental illness and eradication of the stigma associated with people with mental disorder” Ministry of Health 2007 • “Model for care of people with severe mental illness” Ministry of work and social affairs. General Catalogue of Offi cial Publications, Chapter 15: Fight against social stigma. CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 131
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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
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With reference to the type of train
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would normally receive and which in
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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
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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 126 and 127: Several protocols have been publish
Page 128 and 129: The coordination of these resources
Page 130 and 131: Social protection systems Pursuant
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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