Life skills programmes for chronic mental illnesses.
BACKGROUND
Most people with schizophrenia have a pattern of illness characterised by remission and relapses. The illness can become chronic and disabling. The social disability can require a variety of psychological, nursing and occupational therapies. Life skills programmes, addressing the needs associated with independent functioning, are often a part of the rehabilitation process.


OBJECTIVE
To compare the effectiveness of life skills programmes with standard care for people with chronic mental health problems.


METHODS
CINAHL (1982-1997), The Cochrane Library (Issue 2, 1997), The Cochrane Schizophrenia Group's Register of Trials (April 1998), EMBASE (1980-1997), MEDLINE (1966-1997) and PsycLIT (1974-1997) were methodically searched. Hand searches and scrutiny of references supplemented this process.


METHODS
All relevant randomised or quasi-randomised controlled trials for life skills programmes versus standard care involving those with serious mental illnesses.


METHODS
Searches were inspected by two reviewers (LR, MN) with a third (JC) acting as arbitrator. Data were extracted in the same way. Where possible an intention-to-treat analysis was undertaken on dichotomous data and normally distributed continuous data.


RESULTS
Two randomised controlled trials were included with a total of 38 participants. Data were sparse and no clear effects were demonstrated.


CONCLUSIONS
If life skills training is to continue as part of rehabilitation programmes a large, well designed, conducted and reported pragmatic randomised trial is an urgent necessity. There may even be an argument for stating that maintenance of current practice, outside of a randomised trial, is unethical.
Nicol
M M
MM
State Hospital, Carstairs, Lanark, Scotland, UK, ML11 8RP. m.nicol@leith.qmced.ac.uk
Robertson
L
L
Connaughton
J A
JA
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D002908:Chronic Disease; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation*; D012648:Self Care; D012917:Social Adjustment