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

All these studies include patients who satisfy similar SMI criteria to those used in our setting.
However, the studies originate mainly from the United Status, where the peri-environmental
factors (legislation, economic and social protection situation, unemployment rate, social and
health structures, etc.) are considered important and are very different to the Spanish context. The
interventions can be similar to those carried out in Spain, although faithfulness to the IPS model
is difficult in the few places where there are labour insertion programmes or services; it is more
similar with respect to standard treatment and pre-vocational training.
The authors of the studies point out the difficulty of working with community samples that
are heterogeneous and that include people who do not want to work, and the difference that exists
with patients in employment programmes, that may represent a self-selected sample. Furthermore,
the employment rates obtained are low, even with the more effective programmes (except for the
EP-IPS programmes with high fidelity to the model, with which the majority of the participants,
>50% obtain employment), and employment is not a personal or valid objective for all people
with SMI.
There are authors who point out that a general unemployment rate of over 10% in the society
has a clear and negative effect on the acquisition and maintenance of employment in the population
with SMI, and in our context this case arises 190. However, although the incorporation into an
employment programme is a personal decision, after the information and appropriate consent, the
acquisition and maintenance of the role of worker favours a normalising process in the person and
improves independence, so the implementation of employment orientated programmes appears to
be important and necessary.
Pre-vocation training (PVT) vs. standard treatment (ST)
RCT (1-)
RCT (1-)
RCT (1-)
RCT (1-)
RCT (1-)
SR (1+)
There is no evidence in favour of PVT when maintaining competitive employment
after 8 months, compared with standard hospital treatment in a
small study (n = 50; RR = 0.79; 95% CI between 0.63 and 1.00) 168 .
No differences are observed in obtaining competitive employment after
18 months between PVT and community treatment (n = 28; RR = 1.18,
95% CI: between 0.87 and 1.61) 169 and 24 months (n = 215; RR = 0.95;
95% CI: between 0.77 and 1.17) 170 .
The PVT favours obtaining some type of employment when compared
with standard hospital treatment (n = 59; RR = 0.42; 95% CI between 0.26
and 0.68) 168 .
No differences were observed in hours worked per month between
PVT and standard hospital treatment (n = 28; hours = 36.8 and 31.6 average
hours respectively; p = 0.92) 171 .
There is certain evidence that PVT users earn significantly more money
a month than those that receive standard hospital treatment ($176 and
$97.3 on average, respectively; p