Self-management of mental illness? It’s possible

Patients with chronic illness, such as diabetes, are expected, and taught how, to participate in managing their disease. On the other hand, patients with serious mental illness historically have been thought of as passive recipients of care. Attitudes of care providers, patients, and family members are changing, how­ever, and, in the last decade, the Illness Management and Recovery (IMR) program has been developed for treating patients with serious mental illness, such as schizo­phrenia, using principles of chronic disease management.¹ Consider using this evi­dence-based psychosocial treatment modal­ity for your patients with schizophrenia.

Basic philosophy
A core assumption of IMR is realistic opti­mism that recovery is possible. Recovery, in this context, means that a patient can have a meaningful life despite having a serious illness. In IMR, patients engage in developing and tracking their prog­ress toward personally meaningful goals; that progress is broken down into small steps and worked on over the course of the program.

Critical components
IMR addresses practical matters of living with schizophrenia, including coping with symptoms and collaborating with provid­ers. The program combines elements from 6 areas:
   • psychoeducation
   • cognitive-behavioral approaches to medication management and other treatment targets
   • motivational interviewing
   • relapse prevention planning
   • social skills training
   • coping skills to manage persistent symptoms.

The original curriculum, which is avail­able free of charge, comprises 10 topics (Table).² Of note, the newest version, IMR-3, includes an additional module focused on healthy lifestyles.³

Implementation
Although typically delivered as a struc­tured weekly group intervention for 9 to 12 months, IMR can be taught individually. Involving a supportive person such as a family member, case manager, or residen­tial staff member can be useful. Physicians can select modules tailored to the patient’s needs. Any physician who wants to bring IMR to her (his) patient can download the SAMHSA Illness Management and Recovery Evidence-Based Practices KIT (Knowledge Informing Transformation).² This free down­load provides the full curriculum with hand­outs, and tips and training tools related to implementation and evaluation of IMR in a typical mental health care setting.

IMR is well-accepted by most participants; studies report a median 63% of patients com­plete IMR.⁴ Attendance for the intervention appears to be better in a group, rather than an individual, format. A number of patient characteristics, including older age, lower hostility, fewer psychotic symptoms, and more education, have been identified as pre­dictors of better attendance to manualized psychosocial treatments, such as IMR.⁵

Disclosure
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

Patients with chronic illness, such as diabetes, are expected, and taught how, to participate in managing their disease. On the other hand, patients with serious mental illness historically have been thought of as passive recipients of care. Attitudes of care providers, patients, and family members are changing, how­ever, and, in the last decade, the Illness Management and Recovery (IMR) program has been developed for treating patients with serious mental illness, such as schizo­phrenia, using principles of chronic disease management.¹ Consider using this evi­dence-based psychosocial treatment modal­ity for your patients with schizophrenia.

Basic philosophy
A core assumption of IMR is realistic opti­mism that recovery is possible. Recovery, in this context, means that a patient can have a meaningful life despite having a serious illness. In IMR, patients engage in developing and tracking their prog­ress toward personally meaningful goals; that progress is broken down into small steps and worked on over the course of the program.

Critical components
IMR addresses practical matters of living with schizophrenia, including coping with symptoms and collaborating with provid­ers. The program combines elements from 6 areas:
   • psychoeducation
   • cognitive-behavioral approaches to medication management and other treatment targets
   • motivational interviewing
   • relapse prevention planning
   • social skills training
   • coping skills to manage persistent symptoms.

The original curriculum, which is avail­able free of charge, comprises 10 topics (Table).² Of note, the newest version, IMR-3, includes an additional module focused on healthy lifestyles.³

Implementation
Although typically delivered as a struc­tured weekly group intervention for 9 to 12 months, IMR can be taught individually. Involving a supportive person such as a family member, case manager, or residen­tial staff member can be useful. Physicians can select modules tailored to the patient’s needs. Any physician who wants to bring IMR to her (his) patient can download the SAMHSA Illness Management and Recovery Evidence-Based Practices KIT (Knowledge Informing Transformation).² This free down­load provides the full curriculum with hand­outs, and tips and training tools related to implementation and evaluation of IMR in a typical mental health care setting.

IMR is well-accepted by most participants; studies report a median 63% of patients com­plete IMR.⁴ Attendance for the intervention appears to be better in a group, rather than an individual, format. A number of patient characteristics, including older age, lower hostility, fewer psychotic symptoms, and more education, have been identified as pre­dictors of better attendance to manualized psychosocial treatments, such as IMR.⁵

Disclosure
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

Patients with chronic illness, such as diabetes, are expected, and taught how, to participate in managing their disease. On the other hand, patients with serious mental illness historically have been thought of as passive recipients of care. Attitudes of care providers, patients, and family members are changing, how­ever, and, in the last decade, the Illness Management and Recovery (IMR) program has been developed for treating patients with serious mental illness, such as schizo­phrenia, using principles of chronic disease management.¹ Consider using this evi­dence-based psychosocial treatment modal­ity for your patients with schizophrenia.

Basic philosophy
A core assumption of IMR is realistic opti­mism that recovery is possible. Recovery, in this context, means that a patient can have a meaningful life despite having a serious illness. In IMR, patients engage in developing and tracking their prog­ress toward personally meaningful goals; that progress is broken down into small steps and worked on over the course of the program.

Critical components
IMR addresses practical matters of living with schizophrenia, including coping with symptoms and collaborating with provid­ers. The program combines elements from 6 areas:
   • psychoeducation
   • cognitive-behavioral approaches to medication management and other treatment targets
   • motivational interviewing
   • relapse prevention planning
   • social skills training
   • coping skills to manage persistent symptoms.

The original curriculum, which is avail­able free of charge, comprises 10 topics (Table).² Of note, the newest version, IMR-3, includes an additional module focused on healthy lifestyles.³

Implementation
Although typically delivered as a struc­tured weekly group intervention for 9 to 12 months, IMR can be taught individually. Involving a supportive person such as a family member, case manager, or residen­tial staff member can be useful. Physicians can select modules tailored to the patient’s needs. Any physician who wants to bring IMR to her (his) patient can download the SAMHSA Illness Management and Recovery Evidence-Based Practices KIT (Knowledge Informing Transformation).² This free down­load provides the full curriculum with hand­outs, and tips and training tools related to implementation and evaluation of IMR in a typical mental health care setting.

IMR is well-accepted by most participants; studies report a median 63% of patients com­plete IMR.⁴ Attendance for the intervention appears to be better in a group, rather than an individual, format. A number of patient characteristics, including older age, lower hostility, fewer psychotic symptoms, and more education, have been identified as pre­dictors of better attendance to manualized psychosocial treatments, such as IMR.⁵

Disclosure
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.