Guideline No 30: Psychosocial Interventions in the Management of Schizophrenia

Psychosocial Interventions in the Management of Schizophrenia
Section 4: Implementation of the guideline

4.1 Management and training

Psychosocial interventions may be delivered by suitably trained health or social work professionals from a variety of backgrounds. The common elements of the interventions represent good practice and should be familiar to all mental health nurses and should therefore be a component of preregistration nurse education.

In most research studies family sessions have been supervised by experienced clinical psychologists. It is anticipated that appropriate health or social work professionals will be trained to carry out this work in everyday practice. There is evidence that community psychiatric nurses can be trained successfully^{36,
37} but this requires further clarification. Inexperienced professionals attempting to carry out this work may do more harm than good. Evidence level Ib

Intervention programmes should be carried out by a trained health professional.

An approach to management involving psychosocial interventions is an essential component of the work of community psychiatric nurses (CPN) working with patients with schizophrenia. Training in psychosocial intervention for qualified mental health nurses could be achieved as follows:

incorporated into courses leading to the Specialist Practitioner Qualification (SPQ) as a CPN
incorporated into other SPQ courses for mental health nurses, e.g. Rehabilitation and Resettlement in Mental Health Nursing, or Forensic Mental Health Nursing
offered to currently qualified CPNs and other relevant mental health nurses on a continuing education basis.

Clinical psychologists have received the intensive training required for the provision of Cognitive Behaviour Therapy. Other healthcare professionals may be trained to employ a cognitive approach with appropriate supervision, e.g. managing symptoms.

4.2 Continuing education

All healthcare staff involved in the care of patients with schizophrenia should be familiar with the appropriate aspects of treatment including psychosocial interventions. Continuing education is required to ensure that new advances are assimilated and incorporated into local management guidelines.

4.3 Organisation of services

At present, the interventions outlined in this guideline are not used consistently in clinical practice. Available evidence suggests that successful implementation of psychosocial interventions requires a team approach where the interventions are part of an integrated care plan. If they are the sole responsibility of one team member, they are less likely to be successful.^{37,
38}

Provision of comprehensive services encompassing the approaches outlined may have resource implications which will require to be addressed by Health Boards and Primary Care Trusts.