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

5.2.1. Daily living skills programmes
The daily living skills training programmes referred to in this section are instrumental skills that
can include aspects such as self-care, handling money, organising the house, domestic chores,
and even interpersonal skills. The aim of acquiring these skills is to facilitate rehabilitation, maintenance
and adaptation of the people with SMI to their normal environment, and, within each
person’s possibilities, for them to be able to lead a more independent life.
Tungpunkom & Nicol141 conducted an SR including 4 RCTs (n = 318) which assesses the
effectiveness of daily skills training programmes, comparing them with standard programmes or
other programmes, in people with severe mental illness. Different articles by Robert Libermann
142-145
have also been reviewed. This author has several publications in this field, and they have
been rejected as they refer to social skills training and not to instrumental skills, which is the focus
of this question.
SR (1-)
The results found do not indicate differences between people who
have been trained in the daily living skills programme, compared with
people who have received standard intervention, regarding the following
aspects 141
Domestic activities (n = 10; RR = 0.24; 95% CI: between 0.001 and
4.72).
Self-care (n = 10; RR = 1.00; 95% CI: between 0.28 and 3.54)
Positive symptoms of the PANSS (n = 38; WMD = -0.80; 95% CI
between -4.38 and 2.78).
Negative symptoms of the PANSS (n = 38; WMD = 1.90; 95% CI
between -1.75 and 5.55).
General psychopathology of the PANSS (n = 38; WMD = 0.00; 95%
CI -3.12 to 3.12).
Quality of life (n =32; WMD = -0.02; 95% CI: -0.01 to 0.03).
5.2.2. Residential programmes in the community
These programmes consist of alternative housing where people with SMI live either temporarily
or permanently and whose aim is to train them in those skills required for them to independently
adapt to daily life, insofar as possible. In these structured spaces they are provided with a resource
where their personal and social deficiencies are compensated, in order to improve their physical
health, self-care, responsibility with the treatment, cognitive functioning, social functioning and
participation in community activities, avoiding relapses, readmissions and use of health services.
Literature distinguishes two types of approaches: supported housing, where the independent
housing in the community is accompanied by support and monitoring by community mental
health services, and residential continuum where it is the actual service or agency that provides
the clinical care, the person is progressively located at levels of differing support and supervision
intensities 146,147 . The most common residential programmes in Spain are independent flats, supervised
flats, mini-homes and supervised places in hostels and housing in alternative families 148 . All
of this falls within a coordinated socio-health functional model.
78 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS