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

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20 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
1. Introduction Mental disorders are a problem of extreme importance, due to their high prevalence (there are estimations that suggest that between 15 and 25% of the general population suffer from them) and due to the impact of suffering and disintegration in the people, their families and their closest environment 1 . It can be said that in Spain, excluding the disorders caused by the improper use of substances, at least 9% of the population suffer from a mental disorder at the present time, and a little over 15% will suffer from it throughout their lives. An increase in these figures is predicted in the future 2 . Improving mental health care in Spain is one of the strategic objectives of the Ministry of Health and Consumer Affairs, the Quality Agency of the Ministry, and with the coordination of the Autonomous Communities, scientific societies and associations of people and families have developed the Strategy in Mental Health of the National Health System (2006) report, whose aim is to provide an answer to the population’s health needs in mental health-related matters. One of the suggestions it includes is “the standardisation of the following care processes: common mental disorder of adults, Severe Mental Illness in adults, Severe Mental Illness in the elderly, Severe Mental Illness of the personality, common mental disorder in childhood and adolescence, severe child-youth mental illness and generalised development disorder” 3 . The Spanish terms “trastorno mental grave (TMG)” or “trastorno mental severo (TMS)” are broadly implemented in our context and come from the Anglo-Saxon Severe Mental Illness which is being replaced by the term Severe and Persistent Mental Illness, which refers to a theoretic construct that groups together a series of clinical conditions with high prevalence and considerable repercussion in healthcare practice, and which would coincide with the term of chronicity, with more positive connotations1. In addition, the Strategy in Mental Health of the National Health System (2006)3 report points out the need to differentiate it from “Trastorno mental Común” (Common mental disorder) and includes interventions aimed at integrating the care given to people with SMI among its best practices. All the definitions of SMI2 make reference –apart from referring to the clinical diagnosis and to the duration of the illness- to the social, family and job functioning of the person affected. The greatest level of consensus was reached with respect to the definition formulated by the United States National Institute of Mental Health (NIMH) in 1987, which defines this group as “a group of heterogeneous people who suffer from severe psychiatric disorders together with longterm mental disturbances, which entail a variable degree of disability and social dysfunction, and who must be cared for by means of different social and health resources of the psychiatric and social healthcare network” 4 . Despite the fact that the main treatment for people with SMI has been pharmacological interventions since they were introduced in the fifties of the last century, the partial and limited control of the symptomatology, the short and long-term side effects, and the poor treatment adherence of quite a considerable percentage of people affected, pose the need to use a broader approach, where pharmacological treatment is complemented with other psychotherapeutic and psychosocial interventions, which must be efficiently coordinated and applied to help them recover from acute episodes and from the functional deficit during the episodes and between them. Caring for people with SMI requires the integration of different levels of care and different types of intervention that form an inseparable whole and that are integrated into new objectives: CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 21
Page 1: Clinical Practice Guidelines for Ps
Page 4 and 5: This CPG is an aid for decision mak
Page 7 and 8: Table of Contents Presentation 7 Au
Page 9 and 10: Presentation Healthcare practice is
Page 11 and 12: Authorship and collaborators CPG de
Page 13: José Manuel Lalana Cuenca. Special
Page 16 and 17: c) SERVICE LEVEL INTERVENTIONS •
Page 18 and 19: A B A A B B B C Psychosocial inter
Page 20 and 21: B B B C A C C 5.3. SERVICE LEV
Page 24 and 25: independence, quality of life, pers
Page 26 and 27: This guideline is aimed at mental h
Page 28 and 29: Figure 1. Search Strategy Search fo
Page 30 and 31: The highest evidence level found wa
Page 33 and 34: 4. Characteristics of the CPG 4.1.
Page 35 and 36: The main focus of rehabilitation is
Page 37 and 38: 5. Psychosocial type rehabilitation
Page 39 and 40: From another point of view, social
Page 41 and 42: defined as “standard care” or
Page 43 and 44: General global state In the short r
Page 45 and 46: Specific symptoms: when CBT was com
Page 47 and 48: In the systematic review by Kurtz a
Page 49 and 50: Summary of evidence 1- 1- 1- 1- 1-
Page 51 and 52: People with SMI and a diagnosis of
Page 53 and 54: 5.1.3. Interpersonal therapy The li
Page 55 and 56: weekly or fortnightly sessions. The
Page 57 and 58: 5.1.5. Family interventions There a
Page 59 and 60: In the RCT carried out by Hogarty e
Page 61 and 62: A family intervention of more than
Page 63 and 64: After two years’ treatment, and b
Page 65 and 66: Family intervention vs. other psych
Page 67 and 68: 1- 1- 1- 1- 1- 1- 1- 1- 1+ No diffe
Page 69 and 70: Question to be answered • Are pys
Page 71 and 72: Summary of evidence Pyschoeducation
Page 73 and 74:
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 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 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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