ILLNESS MANAGEMENT AND RECOVERY

1. ILLNESS MANAGEMENT AND RECOVERY EVIDENCE-BASED PRACTICE An Introduction

2. What is Illness Management and Recovery? • Illness Management and Recovery is a program that helps people set meaningful goals for themselves, acquire information and skills to develop more mastery over their psychiatric illness, and make progress towards their own personal recovery.

3. What is provided in the IMR program? • People participate in 3 to 6 months of weekly sessions conducted by trained practitioners. • Participants develop personal strategies for managing their symptoms and moving forward in their lives. • Educational handouts are provided to all participants. • Training and essential written materials (workbooks, guidelines, forms,brochures, etc) are provided to the practitioners

4. The Importance of Recovery “Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” (Anthony, 1993)

5. Characteristics of Recovery • Is defined and accomplished by the person • Can be viewed as a process or outcome • Distinguished from rehabilitation • Involves personal and social success • Is a universal human experience • Includes the themes of hope, self-confidence, enjoyment, well-being, & optimism

6. Relationship of Illness Management to Recovery • Improved ability to manage one’s illness is a common recovery goal • Avoiding relapses and re-hospitalizations gives people greater control over their lives • Less time spent dealing with mental illness allows more time to be spent on personal recovery • Less distress due to symptoms and impairment leads to better quality of life

7. Evidenced-Based Components of Illness Management • Education about mental illness and its treatment • Behavioral tailoring for medication (for people who choose to take medications) • Relapse prevention training • Coping skills training See, Mueser, et al, “Illness Management and Recovery: A Review of the Research” in press, Psychiatric Services.

8. Evidence for Illness Management Components All the evidence cited in this presentation is the result of randomized, controlled studies.

9. Evidence Supporting Providing Education • 3/4 studies show improved knowledge of mental illness and its treatment • Little effect of education alone on other areas of functioning, including using medication effectively, relapses, rehospitalizations, symptoms, or quality of life.

10. Evidence Supporting Behavioral Tailoring for Medication (for People Who Choose to Take Medication) • 4/4 studies of fitting medication into daily routines showed improvements in taking medication as prescribed • 1/1 study showed that simplifying the medication regimen improved taking medication as prescribed. • 1/1 study showed motivational interviewing improved taking medication as prescribed. • 0/1 study showed skills training improved taking medication as prescribed.

11. Evidence Supporting Training in Relapse Prevention • 5/5 studies showed relapse prevention training reduced relapses and rehospitalizations

12. Evidence Supporting Coping Skills Training • 4/4 studies showed coping skills training decreased the severity of symptoms

13. Overarching Goals of IMR • Inspire people to become hopeful about their recovery • Prepare people to be informed decision-makers about their own treatment • Help people gain more sense of mastery over their mental illness • Free people up to spend less time dealing with their psychiatric disorder and more time enjoying life

14. Specific Goals of IMR • Help people set and make progress towards personal recovery goals • Teach people about psychiatric illness and its treatment • Teach people how to use medication effectively • Help people develop relapse prevention plans • Teach people strategies for coping with persistent symptoms and other problems

15. Logistics • Individual or group format • Weekly sessions • Session length: 45-60 minutes, depending on the participants’ attention capacity • Program duration: 3-6 months for most participants • Curriculum developed for schizophrenia-spectrum and major affective disorders; can also be adapted for other disorders

16. Logistics (continued) • Location of sessions: clinic, peer support center, community, or hospital • Program is structured and step-by-step • Educational handouts with ample worksheets and checklists are provided to participants • Practitioners’ Guide provides guidelines for each topic in the educational handouts • Short video introduces the program to participants • Practice demonstration video illustrates the teaching strategies for practitioners

17. Involvement of Family & Other Supportive People • Participants are encouraged to involve family members and other supportive people in the IMR program • With the participant’s permission, family members and other supportive people can help in a variety of ways: attending some sessions, reading handouts, assisting with homework, helping to develop a relapse prevention plan, taking a role in the participant’s plan for achieving a goal, etc.

18. Curriculum: Topic Areas 1. Recovery Strategies 2. Practical Facts about Mental Illness [schizophrenia, bipolar disorder, major depression] 3. The Stress-Vulnerability Model and Treatment Strategies 4. Building Social Support 5. Using Medication Effectively 6. Reducing Relapses 7. Coping with Stress 8. Coping with Problems and Symptoms 9. Getting Your Needs Met in the Mental Health System

19. How is the IMR program tailored to the individual? • People learn information and strategies at their own pace and focus on the content most relevant to their own needs. • People apply what they are learning towards their own personal goals. • In the sessions, people select and practice strategies and skills that they think will be most beneficial.

20. How is the IMR program tailored?, cont’d • People develop homework which reflects their own interests and needs. • People practice skills in their own environment. • People develop individualized plans for relapse prevention, coping with symptoms, achieving personal goals, etc. .

21. Structure of IMR Sessions • Informal socializing and identification of any major problems (1-3 minutes) • Review previous session (1-3 minutes) • Review homework (3-5 minutes) • Follow-up on goals (1-3 minutes) • Agree on an agenda for current session (1-2 minutes)

22. Structure of Sessions(continued) • Teach new material or review previously taught material (30-40 minutes) • Agree on a homework assignment (3-5 minutes) • Summarize progress made in current session (3-5 minutes)

23. Outcomes of IMR The following outcomes may be expected to improve following full participation in Illness Management and Recovery: • Relapses and re-hospitalizations • Symptom severity • Knowledge of mental illness • Taking medications as prescribed (for people who choose to take medications)

24. Outcomes, cont’d Improvement in: • Coping self-efficacy • Hopefulness and optimism • Perceived social support • Positive treatment alliance with mental health professionals

25. Summary • IMR is a program designed to help people pursue recovery goals and learn how to better manage their illness. • Practitioners use a combination of 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 (for people who choose go take medications), and coping skills training.

26. Closing Thoughts “Having strategies for coping with mental illness is extremely important. It is hard to enjoy your life if you are constantly sick with mental illness. . .

27. A Consumer’s Perspective . . . However, believing in yourself, having hope that things will continue to get better, and looking forward to your future are also vital in overcoming mental illness. Our hopes and dreams are not delusions. Our hopes and dreams are what makes us human.” David Kime, artist, writer, floral designer, person in recovery from bipolar disorder.