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

The different formulations orientated to labour insertion can be grouped into three types of
instrumental programmes: supported employment, social enterprises and vocational rehabilitation
162 . These programmes are not antagonist conceptions as they can be complementary and respond
to different degrees of difficulty both individual (stability, employment prior to the illness,
labour and social skill, etc.), and availability of human resources, as well as to situations derived
from the labour market.
Vocational rehabilitation (or labour rehabilitation) starts up social skills training and professional
preparation programmes for the subsequent incorporation into a job. They adapt both to
the special difficulties of the candidate and to their counselling, support and monitoring needs in
the job, and they can incorporate occupational learning workshops with occupational activities.
They risk losing their efficiency and just providing training and repetitive learning if there is no
perspective of immediate incorporation into employment, either sheltered or ordinary.
The concept of social enterprise is a concept that encompasses (although with certain risks)
different business figures whose objective is to create employment for people with difficulties
for the competitive market. The regulation that governs them forces individual capacity-building
and adjustment programmes and compensates individual and structural difficulties with supportive
measures which can be economic (grants, rebates), contract of employment (times and
conditions), as well as in supportive human resources: Social Firms (UK and Germany), and
Cooperatives (Italy).
In Spain, the predominant figure has been the Special Employment Centre (Spanish acronym
CEE) (with which the expression “sheltered employment” is identified), created for the group of
disabled people through the Law on Social Integration for the Disabled 163 . The CEE is understood
in law as transition employment to the ordinary market, but in many cases, due to either structural
difficulties, the rigidity of the labour market, and the lack of supportive programmes to the ordinary
market, they remain as definite sheltered employment and sometimes marginal employment.
Supported employment is directed at immediate placement in the competitive market, accompanied
by training and individual monitoring measures at work, as well as support to the
employer, with no definite time interval to guarantee maintenance of the job. This approach places
emphasis on quick access and attention to personal preferences and motivations; on considering
that there is not need for long processes of evaluation and re-training, which, in some cases, are
a factor of demotivation; and that the personal stability process is accelerated if care and labour
aspects are integrated at the same time, enabling them to overcome difficulties.
Of all the employment support models, the one that has been investigated into the most is
individual placement and support (IPS) 164 .
In this way it can be considered that the interventions to be addressed by this CPG will
include not only sheltered employment, labour rehabilitation interventions including sheltered
workshops, special employment centres, etc., but also include employment support.
Question to be answered
• Which employment-related intervention format improves labour market insertion of people
with SMI?
The NICE Schizophrenia CPG 8 includes the SR by Crowther et al 165 and also 2 other
RCTs 166,167 . The inclusion criteria used in the NICE CPG 8 refer to people with a diagnosis of
82 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS