Severe Mental Illness Program, impact and response of structured interentions in a group of patients in Bogota, Colombia.
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Abstracto
Introduction: Disability in people with severe mental disorders it is not limited to health interventions. Cognitive alterations, lack of autonomy, social isolation, labor insertion and family issues are among the common problems this populations have. Psychosocial interventions are focused not only the symptoms, but the different vulnerabilities according to people needs. Objective: To implement a psychosocial rehabilitation program within a specific population to minimize the impact of severe mental disorders on quality of life, global functioning, lowering the impact and burden of disease. Methods: A program was created directed to people with severe mental disorders including diagnosis of schizophrenia, bipolar disorder, recurrent depression, among others. Splitting the population in three groups according to disease staging, nor diagnosis. Several key performance indicators (involving functionality, treatment adherence, health resources utilization, support network, and quality of life) were measured. As soon as patients entered the group a comprehensive diagnosis was performed, including clinic, occupational, psycho-social, and nutritional status. Patients entered to a structured program of 52 weeks long according to groupclassification. Here we will show the results of the program according to the impact by each diagnostic category.
Introduction: Severe Mental Illness is a theoretical concept that refers to a series of clinical chronic conditions, with high prevalence and impact on patients, their environment and health systems. The National Institute of Mental Health (NIMH) defines Severe Mental Illness as a mental, behavioral, or emotional disorder that results in a serious impairment that interferes and limits one or more activities of daily living. Based on this definition, the Severe Mental Illness program has designed a series of interventions developed within a determined time frame, as well at group as at individual level, taking into account the main affectations of the population with severe mental disorder (diagnosis confirmed by structured interview M.I.N.I.) Methods: Interventions were aimed at reducing the impact this condition has on the quality of life, overall functioning and burden of disease on patients and their support network. Fulfillment of these objectives is evaluated on the basis of analysis of data obtained in periodic evaluations carried out on a cohort of patients, which include the application of PSP scale, GAF scale, RUQ questionnaire (modified), MOCA test, the Quality of Life Scale GENCAT, and the Basic Evaluation of Living Skills BELS. All this instruments are meant to identify clinical, functional, cognitive characteristics and use of health resources throughout the program. Results: Charts 1, 2 and 3 show the evolution and improvement of the cohort of patients in the five domains evaluated for functionality. Four measurements are shown over time where the achievement of the objectives is evidenced. According to periodic evaluations the efficacy of structured interventions was noted not only in fulfillment of objectives, but also, in benefits at multiple levels: functioning, reduction of hospital bed days and benefits in cognitive performance.Discussion: Individual treatment plans based on patient’s characteristics and their support network, along with periodic monitoring of goal’s achievements were part of pillar tools for success. The patients reached greater independence in daily life, remission of symptoms, adherence to treatment, cognitive strengthening, development of occupational activities and participation in social areas, as observed in the evaluations presented.
