Life skills programmes for chronic mental illnesses

Life skills programmes for chronic mental illnesses

BACKGROUND

Most people with schizophrenia have a cyclical pattern of illness characterised by remission and relapses. The illness can reduce the ability of self-care and functioning and can lead to the illness becoming disabling. Life skills programmes, emphasising the needs associated with independent functioning, are often a part of the rehabilitation process. These programmes have been developed to enhance independent living and quality of life for people with schizophrenia.

OBJECTIVES

To review the effects of life skills programmes compared with standard care or other comparable therapies for people with chronic mental health problems.

SEARCH METHODS

We searched the Cochrane Schizophrenia Group Trials Register (June 2010). We supplemented this process with handsearching and scrutiny of references. We inspected references of all included studies for further trials.

SELECTION CRITERIA

We included all relevant randomised or quasi-randomised controlled trials for life skills programmes versus other comparable therapies or standard care involving people with serious mental illnesses.

DATA COLLECTION AND ANALYSIS

We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a random-effects model. For continuous data, we calculated mean differences (MD), again based on a random-effects model.

MAIN RESULTS

We included seven randomised controlled trials with a total of 483 participants. These evaluated life skills programmes versus standard care, or support group. We found no significant difference in life skills performance between people given life skills training and standard care (1 RCT, n = 32, MD -1.10; 95% CI -7.82 to 5.62). Life skills training did not improve or worsen study retention (5 RCTs, n = 345, RR 1.16; 95% CI 0.40 to 3.36). We found no significant difference in PANSS positive, negative or total scores between life skills intervention and standard care. We found quality of life scores to be equivocal between participants given life skills training (1 RCT, n = 32, MD -0.02; 95% CI -0.07 to 0.03) and standard care. Life skills compared with support groups also did not reveal any significant differences in PANSS scores, quality of life, or social performance skills (1 RCT, n = 158, MD -0.90; 95% CI -3.39 to 1.59).

AUTHORS' CONCLUSIONS

Currently there is no good evidence to suggest life skills programmes are effective for people with chronic mental illnesses. More robust data are needed from studies that are adequately powered to determine whether life skills training is beneficial for people with chronic mental health problems.

The effect of salutogenic treatment principles on coping with mental health problems A randomised controlled trial

OBJECTIVE

Although the theory of salutogenesis provides generic understanding of how coping may be created, this theoretical perspective has not been explored sufficiently within research among people suffering from mental health problems. The aim of this study is to investigate the effect of talk-therapy groups based on salutogenic treatment principles on coping with mental health problems.

METHOD

In an experimental design, the participants (residents in the community) were randomly allocated to a coping-enhancing experimental group (n=59) and a control group (n=47) receiving standard care. Coping was measured using the sense of coherence (SOC) questionnaire.

RESULTS

Coping improved significantly in the experiment group (+6 points) compared with the control group (-2 points). The manageability component contributed most to this improvement.

CONCLUSION

Talk-therapy groups based on salutogenic treatment principles improve coping among people with mental health problems.

PRACTICE IMPLICATIONS

Talk-therapy groups based on salutogenic treatment principles may be helpful in increasing coping in the recovery process among people with mental health problems and seem to be applicable to people with various mental health problems.

[Sociotherapy in German social law. Indication, contents, and aspects of public health]

In German mental health services, the ill-defined term "sociotherapy" has been used to designate nonmedical, social, and work-related components of the care process. Recently, a new component of outpatient/community mental health care called "sociotherapy" (according to Paragraph 37a of the Fifth German Social Code) which is funded by the public health insurance system has been introduced and is now in the process of being implemented. The paper describes (a) patients eligible for the service and (b) the aims and scope of this case management module. The key objectives are to motivate patients with schizophrenia to utilise mental health services and antipsychotic medication and to liaise with psychosocial services. Therefore, sociotherapy is distinct from (a) multidisciplinary inpatient care for people with severe mental illness, (b) assertive community treatment, (c) community care provided by social workers or community psychiatric nurses, and (d) family interventions. So far there has been little evaluation of sociotherapy.