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

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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
Supervised fl ats are a community housing and social support resource located in flats or houses where several people, with sufficient level of independence and with Severe Mental Illness, live together, and who do not have sufficient family support to live independently. They offer, on a temporary or indefinite basis and depending on the needs of each case, housing, personal and social support, support to integration, and flexible and continued supervision. Mini-homes are small community residential centres with around 20 places, destined for people with severe mental illness and with their personal and social autonomy impaired. Their main objective is to temporarily or indefinitely provide housing, maintenance, care, personal and social support, support to community integration, to people who do not have family and social support or who, due to their degree of psychosocial impairment, require the services of this type of residential centre. Supervised places in hostels are hostels where, in order to avoid marginalisation processes, housing as well as the coverage of basic needs are offered to people with severe mental illness with a good level of autonomy and a very independent lifestyle, but with no family support or economic resources. There is a systematic review conducted by Chilvers s et al 149 with respect to which, despite obtaining 139 quotes, after selecting the studies and assessing their quality, none were found that satisfied the inclusion criteria established in the review, so no conclusions could be drawn. Although no data have been found in systematic reviews or controlled clinical trials that provide any proof, there is information to indicate that different residential programmes are able to maintain a considerable number of people with SMI in the community, as occurs with the work carried out by Fakhoury et al 150 . These authors conduct a review of 30 studies (mainly descriptive) where the efficacy of the community residential programmes for SMI patients is assessed. In this study, positive results are found with respect to the improvement of functioning and social integration, and greater satisfaction of the patients, compared with patients from mid and long stay units. Furthermore, in the cross-sectional and descriptive study by López et al 151-155, the community residential programme for people with SMI in Andalusia is analysed. Practically all the devices and residents attached to this programme were assessed in this study (16 homes, 67 flats and 399 residents). The results of this work, among others, indicate that there is an improvement in the user’s satisfaction with supervised housing (n = 327; p = 0.035) and the pharmacological treatment adherence increases (n = 372; p
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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
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
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Page 63 and 64: After two years’ treatment, and b
Page 65 and 66: Family intervention vs. other psych
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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: Hypnosis vs. relaxation No improvem
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
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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
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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
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Social protection systems Pursuant
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Specifi c regulation • (SPANISH)
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Service Management: The first anti-
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on Mental Health and the future Eur
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Spanish Society of Legal Psychiatry
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Appendix 5. Abbreviations ACT Asser
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Appendix 6. Glossary Therapy adhere
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Appendix 7. Declaration of interest
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15 Rossler W. Psychiatric rehabilit
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53 Graeber DA, Moyers TB, Griffi th
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86 Schooler NR, Keith SJ, Severe JB
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117 Sohlberg MM, Mateer CA. Effecti
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154 López M, García-Cubillana P,
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190 Bond GR, Drake RE. Predictors o
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225 Hurley AD. Individual psychothe
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