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

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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
SMI (schizophrenia, affective schizophrenia and bipolar disorders). Studies, whose population consisted of people with low intellectual level/mentally retardation, or abuse of substances as first and only diagnosis, were excluded. The studies included vary with respect to the follow-up period (from 5 months to 4 years), losses, diagnosis and age (19-46 years). The systematic review elaborated by Crowther et al 165 , which includes 18 RCTs 168-185 , is designed to assess the efficiency on employment of pre-vocational training (PVT) and sheltered employment (SE), compared with each other and with standard treatment (ST). With respect to people with SMI and a diagnosis of bipolar disorder, data have been found in the NICE Bipolar Disorder CPG 7 that include data from the NICE Schizophrenia CPG 8 and add another 3 RCTs that are useful due to the specific nature of the studies, but lack applicability to the subgroup of SMI with a diagnosis of bipolar disorder, as they include SMI with little representation of this diagnosis in the samples (5%-43%). Bond et al 186 perform an SR, which includes 11 RCTs on sheltered employment studies which are very faithful to the Individual Placement and Support, (IPS) on patients with SMI, in order to assess their efficacy in achieving competitive employment. Mueser et al 187 performed a RCT where the relationships between preferences, satisfaction and maintenance of employment are examined in a sample of 204 patients with SMI. The patients were randomised between IPS, a psychiatric rehabilitation programme and standard treatment. The patients assigned to the IPS programme, those who obtained employment that coincided with their prior preferences with respect to the type of work desired, obtained higher levels of satisfaction and longer duration of the employment. This relationship was not observed in the other two programmes. In the RCT (n = 40) developed by McGurk et al. 188 in people with SMI and with a prior history of labour failure, they were assigned randomly either to a sheltered employment programme or to another employment programme fostered with cognitive training. The labour results were measured after 2 to 3 years. The results obtained indicate that patients in the sheltered employment programme with cognitive training obtained greater access to employment (69% vs. 14%), maintained more jobs, worked more weeks, more hours and with better salaries than patients who were only offered sheltered employment (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
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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: 3 Programmes directed to leisure an
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)
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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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