Life skills programmes for chronic mental illnesses -
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Having a mental health problem can cause difficulties and obstacles in all areas of life, even those as simple as washing, shopping, talking openly with other people, brushing teeth, cleaning the house, managing money, making friends, shaving and being independent. Having a mental health problem, combined with the sleep-like haze of many antipsychotic medications, limits people’s ability to look after themselves, socialise with other people, take part in education or career development and find work.
Life skills programmes attempt to remedy some of these difficulties by encouraging independent living, so enhancing quality of life. Life skills often have several components: communication and talking; financial awareness and money management; domestic tasks (such as cooking, washing- up dishes, hoovering, doing the laundry and running a home); and personal self-care (such as washing, bathing, cleaning teeth, shaving, combing hair and getting dressed). Other life skills include training on coping with stress, shopping for and eating healthy food, knowing the time, taking medication, improving social skills, using transport and forward planning.
Rehabilitation or getting better is slow, complex and difficult. There are many ways of engaging with people during this process, including: creative therapies (art, drama, music, poetry, education, dancing, singing); life skills (as described above); work-based therapy to enhance employment; and recreational activities (such as group walks, swimming, sport, reading, writing a diary, watching television, going to parties, events and day trips).
This review looks at different types of rehabilitation therapy for people with mental health problems. It compares life skills training with occupational therapy and peer support (where a group of people with mental health problems were encouraged to help each other). Comparison was also made with standard or usual care. Life skills, occupational therapy and peer support all aim to promote health by enabling people to perform meaningful and purposeful activities.
In the main, the authors of the review conclude that there is no great difference between those that receive life skills, occupational therapy, peer support and standard care. It is questionable if people should be put under pressure to attend life skills and not known whether life skills are a benefit or perhaps even harmful. Professionals and service users invest much time in life skills and this may cost both time and money. However, the quality of scientific evidence is low and uncertain. The authors note that life skills are still a simple and easy way that has the potential to make great benefits for people who are almost disabled by mental health problems.
This plain language summary has been prepared by Ben Gray of Rethink Mental Illness: Benjamin Gray, Service User and Service User Expert, Rethink Mental Illness. Email: ben.gray@rethink.org
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 strategy:
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.
This record should be cited as:
Tungpunkom P, Maayan N, Soares-Weiser K. Life skills programmes for chronic mental illnesses. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD000381. DOI: 10.1002/14651858.CD000381.pub3
Assessed as up to date:
June 20, 2010
