Illness management and recovery: Implementation and Effects

Illness Management and Recovery (IMR) is a structured psychosocial program to teach self-management strategies to people with schizophrenia or other serious mental illnesses. IMR combines psychoeducation, behavioral tailoring for medication adherence, relapse-prevention training, and cognitive-behavioral training in social and coping skills. The working mechanisms underlying IMR have been suggested in a conceptual framework, indicating that improving illness management would improve clinical recovery. Then, improvement of clinical recovery would improve functional and personal recovery. Although its components were considered evidenced, research on the overall IMR program was indicated because of inconsistent findings on IMR efficacy.
This study aimed to comprehensively investigate the effectiveness of IMR, including the impact of completion and fidelity. In this randomized controlled trial, 187 outpatients received either IMR plus care as usual (CAU) or only CAU. Multilevel modeling was used to investigate group differences over an 18-month period, comprising 12-month of treatment and six months of follow-up. As compared with the control group, the IMR group showed a statistically significant improvement in the primary outcome measure: self-scored overall illness self-management. Compared with the control group, the IMR group also showed a statistically significant improvement in self-esteem (a component of personal recovery). There were no effects on illness self-management measured via the clinician version of the IMR scale, neither on illness management components, nor on clinical, functional, and personal recovery.
Regarding the quality of IMR implementation, not only the fidelity of the model (especially regarding the use of cognitive behavioral techniques), but also the degree of participant exposure to IMR (completion) was found to be relevant to IMR effectiveness. Results of this study only partially supported the workings of IMR as suggested in the conceptual framework.
Given the results of this study and those elsewhere in the world, IMR may be worthwhile considering as a structural part of health care provisions. However, the quality of IMR implementation requires sustained attention of practitioners, staff, and managers.