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

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There are no differences between music therapy and ST with respect to patient satisfaction
in the medium term 194 or the improvement of the quality of life 196 .
Art therapy may produce an improvement in the mental state of people with schizophrenia.
However, there are no differences with respect to social functioning or improvement
of quality of life 198 .
Recommendations
C
Music therapy and art therapy could be offered to people with SMI and schizophrenia and
related disorders as a therapeutic complement to other types of interventions.
5.3. Service level interventions
The different community care models are based on the need to help people with SMI have access
to health resources and to coordinate the different interventions. After a global deinstitutionalisation
process, a series of community services have been developed (Community Mental Health
Centres- CMHC, day centres, etc.) 8 , which will be reviewed in this section. In Spain, this process
came hand in hand with the General Law on Health 200 and represented the emergence of a new
care culture, characterised by a shift of the care centre from the psychiatric hospital/mental hospital
to the community 11 .
The multi-disciplinary and inter-disciplinary teams (community mental health teams,
CMHT), characterised by the involvement of all the mental health care professional categories
(nursing, psychology, psychiatry, occupational therapy and social work), have become the most
prevalent way of organising work in Europe and United States. The most elementary form of the
CMHT provides a whole range of interventions including contributions from psychiatry, psychology,
nursing, social work and occupational therapy, for a geographic area of reference, giving
priority to adults with SMI 201 . The concerns about the functioning of the CMHT have arisen about
the following aspects 8 .
• Impact on the community, violence, etc. of people with SMI.
• Quality of life of patients with SMI and their caregivers.
• Lack of clear evidence about the benefits of the organisation in CMHC.
• Scarce knowledge of the component that would make the functioning more effective.
The development of additional services in the community has resulted in an increase in the
complexity that people with SMI encounter when they try to access services that were previously
available in hospitals, and precisely some of the problems of this population is the limited initiative,
the difficulty to request help and the problems they encounter to be linked up with community
services. The recognition of the need to coordinate these different services is what has given
rise to the Case Management (CM), and consequently, a new health profession: the case manager
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. Thus, over the last 20 years other types of services have been generated that can be classified
into 2 categories 8 .
• Services with highly defined objectives: intervention in crisis, home care, labour rehabilitation
or early intervention.
• Services aimed at covering a wide range of patient’s needs, such as Assertive Community
Treatment (CAT) or Case Management.
92 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS