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

• The satisfaction data originating from the study by Merson et al 202 are only taken into account
in the SR by Malone et al 204 , as in the NICE Schizophrenia CPG it considers that
the tool used to extract them was not valid, so these data are excluded.
This CPG development group has chosen to taken into account the data provided by the
NICE schizophrenia CPG and the SR by Malone et al indicating their methodological divergences
as in the majority of their findings, there is agreement.
Assertive Community Treatment (ACT), Intensive Case Management (ICM) non-acute Day
Hospitals and Case Management (CM)
With respect to ACT, ICM, non-acute Day Hospitals and CM, the discrepancy that exists in literature
referring to whether there is a reduction or not of hospitalisation is already classical.
To respond to the section on ACT and non-acute Day Hospitals, the data obtained from the
NICE schizophrenia CPG 8 are provided.
There have been studies that have followed the NICE schizophrenia CPG 8 including the
review by Burns et al 207 (it includes 29 RCT) where the efficacy of ICM was assessed when preventing
hospitalisation compared with standard treatment or CM with low intensity. The review
by Marshall et al 205 also exists, which analysed the effectiveness of CM compared with standard
care in people with SMI (11 RCTs, n > 1300).
The different ways of providing psychiatric and social care in different countries limits the
generalisation of the findings of this type of research. Local and international contexts affect the
extrapolation of the findings to different settings 208. With respect to the applicability in our context
of the evidence found, there are several problems:
• The different health frameworks of the United States and United Kingdom (countries
where the majority of the studies have been conducted), which determine differences on
establishing what is the standard treatment with which the majority of the experimental
interventions are compared.
• The different supportive systems and social welfare, which determine differences with
respect to the needs and the areas for which an intervention has to be designed.
• The different names of interventions (Assertive Outreach, in the United Kingdom);
Assertive Community Treatment in the United States) and the different versions of
the same intervention adapted to each context (Case Management, Intensive Case
Management).
These limitations in the applicability are translated into practical aspects. For example,
Malone et al 204 recall, when talking about the generalisation of result of the CMHC studies, that
care must be taken, as community care in mental health has spread substantially and it is very likely
that traditional therapy is quite close to what is considered as treatment with CMHC teams. Thus,
additional studies can be associated with smaller differences between these two forms of care.
The majority of the service level configurations and interventions referred to in this chapter
are, to a greater or lesser extent, implemented in our context, so the impact must be focused on
the implementation of Assertive Community Treatment teams. Indeed, care, in the majority of the
Spanish NHS territory is focused on the CMHC, the availability of psychosocial rehabilitation
centres, rehabilitation hospital units, etc. varies from one area to another, but it can be considered
as generalised for the entire territory.
CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 95