1. Illness Management and Recovery: An Introduction
Kim T. Mueser

2. Outline of Presentation
Definition of Illness Management & Recovery
Empirical foundations of IMR
The role of recovery in illness self-management
Logistics of implementing IMR
IMR modules and their contents
Teaching strategies used in IMR

3. Outline (cont.) Developing home assignments
Involving significant others
Tracking progress and evaluation
Supervision
Organizational structure for providing IMR
Resources

4. Summary of Illness Management and Recovery
IMR is a program that helps people set meaningful goals for themselves, acquire information and skills to develop more sense of mastery over their psychiatric illness, and make progress towards their own personal recovery.

5. Illness Management Research*
Reviewed 40 randomized controlled studies of illness management programs
Identified five effective components of successful programs
* See: Mueser, K. T. et al. (2002). Illness management and recovery for severe mental illness: A review of the research. Psychiatric Services, 53,

6. Effective Components of Illness Management Programs
Psychoeducation
Behavioral tailoring for medication adherence
Relapse prevention training
Coping skills training
Social skills training

7. Psychoeducation
Improves consumers’ knowledge about mental illness and its treatment
Equips them with information to make informed decisions about their treatment

8. Behavioral Tailoring for Medication
Improves consumers taking medication as prescribed

9. Relapse Prevention Training
Reduces relapses
Reduces rehospitalizations

10. Coping Skills Training
Reduces severity of persistent symptoms
Reduces distress experienced from persistent symptoms

11. Social Skills Training
Improves social functioning, including quality and # of relationships
Improves skills that are related to achieving recovery goals

12. What is Recovery?
Outcome?
Process?
Both?

13. One definition of Recovery
“Recovery is a process, a way of life, an attitude, and a way of approaching the day’s challenges. It is not a perfectly linear process. At times our course is erratic and we falter, slide back, regroup, and start again. . .

14. …The need is to reestablish a new and valued sense of integrity and purpose within and beyond the limits of the disability; the inspiration is to live, work, and love in a community in which one makes a significant contribution.” Patricia Deegan, 1988

15. Essential Themes of Recovery
Hope
Expectations
Respect
Optimism
Well-being
Confidence

16. How does Illness Management relate to Recovery?
Improved ability to manage one’s illness is a common recovery goal
Avoiding relapses and hospitalizations gives people greater control over their lives
Less time dealing with mental illness allows more time for pursuing personal goals
Less distress from symptoms leads to better quality of life

17. Recovery Goals Individualized Personally meaningful
Range from the modest to the ambitious
Exploration of personally meaningful goals often needed to engage consumer before introducing IMR program

18. Core Ingredients of Illness Management and Recovery
5 to 10 months of weekly or twice weekly sessions
9 educational handouts (one more “optional”)
Practitioners use motivational, educational, and cognitive behavioral techniques
Consumers set and pursue personal recovery goals
Consumers practice skills in IMR sessions
Home assignments are developed together
Significant others are involved (with permission)

19. IMR Resource Materials
Educational handout for consumer for each module
Practitioners’ guidelines for clinician for each module
Group leader’s session-by-session guide for each module
Introductory videotape (15 min.)
Practice demonstration videotape (3 hrs)

20. IMR Modules

21. 1. Recovery Strategies Build hope for reaching goals
Help identify recovery goals
Help develop plans to achieve goals

22. 2. Practical Facts about Mental Illness
Provide optimism about the future
Help identify symptoms
Reduce blame and stigma regarding mental illness

23. 3. Stress-Vulnerability Model
Role of stress and biological vulnerability in causing symptoms and impairments
Convey optimism that treatment and coping strategies work
Provide information about treatment options

24. 4. Building Social Support
Benefits of social support
Meeting new people
Getting closer to people you already know

25. 5. Using Medication Effectively
Accurate information about medications
Weighing pros and cons of taking medications
Developing a partnership with medical staff
Developing strategies for taking meds

26. 6. Reducing Relapses Identifying triggers of past relapses
Recognizing early warning signs
What helps when a relapse is starting to happen?
Developing a relapse prevention plan

27. 7. Coping with Stress
Identifying stressors and strategies for preventing stress
Identifying and practicing strategies for coping with stress that can’t be avoided
Encouraging involvement of significant others

28. 8. Coping with Problems and Persistent Symptoms
Using a step-by-step method for solving problems and achieving goals
Identifying problem areas, especially persistent symptoms
Selecting & practicing strategies for coping with problems and persistent symptoms

29. 9. Getting Your Needs Met in the Mental Health System
Identifying current services received and those that person would like to pursue
Developing and practicing skills for advocating for oneself in the system

30. Drug and Alcohol Use (Optional)
Effects of substance abuse on biological vulnerability
Helping consumer weigh the pros and cons of using drugs and alcohol
If consumer wants to change his or her use, helpiing to develop an action plan

31. Structure of IMR Sessions
1. Informal socializing
2. Review previous session
3. Review home assignments
4. Follow up on goals (for group, follow up on goals of 2-3 consumers on rotating basis)
5. Set agenda for current session

32. Structure of IMR Sessions, cont’d
6. Teach new material from handout (usually a few pages); use educational, motivational, CBT and social skills training strategies as needed
7. Develop a home assignment in collaboration with consumer(s)
8. Summarize session and progress made

33. IMR Practitioners Use 3 Different Teaching Strategies
Motivational Strategies
Educational Strategies
Cognitive-Behavioral Strategies

34. Motivational Strategies
People are motivated to learn things if they are relevant to personal goals
Connect IMR materials to goals
Explore how illness has interfered with goals
Convey hope and confidence in person
Help person explore costs and benefits of change

35. Educational Strategies
Goal: help consumers learn about their illness & how to manage it
Use handouts in interactive ways (e.g., take turns reading)
Ask questions to check on understanding; ask for “own words”
Break down information into small bites
Adopt consumer’s language
Don’t push consumer to accept diagnosis

36. Cognitive-Behavioral Strategies
Shaping task focused behavior, homework completion
Modeling, role playing, positive feedback
Behavioral tailoring
Relapse prevention training
Relaxation training
Coping skills enhancement

37. Home Assignments
Help consumers transfer information and skills into their daily lives
The “real” therapy is what happens outside of session
Use alternative term if necessary
Always develop home assignments collaboratively at end of each session
Be as specific as possible (when, where, how, etc.)

38. Involving Significant Others
Support progress towards recovery goals & help practice skills learned in IMR
Significant others are defined by the consumer
Explore who the consumer spends time with
Approach significant others with “good news”
Send handouts & conduct follow-up phone calls
Aim for monthly contact with significant others
If needed, professionals can be significant others

39. Tracking Progress Use goal tracking sheet to monitor progress
Follow up on goals every session (individual) or every 2-3 sessions (group)
Break down goals into smaller steps if lack of progress, or modify
Bring goal tracking sheets to supervision

40. Measuring Outcome using the IMR Scales
15 item questionnaire covering IMR domains
Behaviorally anchored
User-friendly language
Clinician version and consumer version
Completed at baseline and every three months
Use to evaluate success of IMR
Can be integrated into treatment planning for IMR

41. Supervision Weekly group supervision, not more than 6-8 clinicians
Review cases
Discuss goals, share treatment formulations, troubleshoot problems
Role play challenging situations
Selected teaching of core skills

42. Organizational Structure for Implementing IMR

43. Members of IMR Team IMR Clinicians (5-8) ? IMR Consumer Providers
IMR Coordinator/Program Leader
Agency Director

44. IMR Clinicians
Have protected time to provide IMR, prepare for sessions, attend supervision
Receive weekly group supervision on IMR
Have accountability for providing IMR
Become IMR experts and educate others in agency about IMR and recovery

45. IMR Coordinator/Team Leader
Coordinating IMR is part of job
Specific proportion of time designated and protected for supervising and coordinating IMR
Receives IMR training and works with some consumers using IMR
Provides weekly IMR supervision

46. IMR Coordinator/Team Leader (cont.)
Establishes and monitors IMR referral process
Assures that referred consumers receive IMR
Monitors the quality and quantity of IMR services delivered at the agency
Reports to the agency director and meets regularly with him or her

47. Agency Director Shows Interest and Support by:
Attending training
Attending some supervision sessions
Meeting regularly with IMR Coordinator/Team Leader
Troubleshooting obstacles to IMR

48. Toolkit Components Manual
Information brochures for different stakeholders (client, family, clinician, etc.)
Introductory video
Training video
Fidelity scale
Outcome measures
Can be downloaded at:

49. Other Resources
Bellack, A. S., Mueser, K. T., Gingerich, S., & Agresta, J. (2004). Social Skills Training for Schizophrenia: A Step-by-Step Guide. (Second ed.). New York: Guilford Press.
Gingerich, S., & Mueser, K. T. (2005). Illness management and recovery. In R. E. Drake, M. R. Merrens, & D. W. Lynde (Eds.), Evidence-Based Mental Health Practice: A Textbook (pp ). New York: Norton.
Miller, W. R., & Rollnick, S. (Eds.). (2002). Motivational Interviewing: Preparing People for Change (Second ed.). New York: Guilford Press.
Mueser, K. T., & Gingerich, S. (in press). The Complete Family Guide to Schizophrenia: Helping Your Loved One Get the Most out of Life. New York: Guilford Press.

50. Summary
IMR is a program that helps consumers pursue recovery goals and learn how to better manage their illness
Practitioners use motivational, educational, and cognitive-behavioral strategies to help people learn skills that are helpful in their recovery
All participants identify personally meaningful recovery goals which are pursued and followed up in the program
Illness management strategies are based on specific evidence-based practices including education, relapse prevention training, behavioral tailoring for medication, coping skills training, and social skills training