BACKGROUND 
Illness management is a broad set of strategies designed to help individuals with serious mental illness collaborate with professionals, reduce their susceptibility to the illness, and cope effectively with their symptoms. Recovery occurs when people with mental illness discover, or rediscover, their strengths and abilities for pursuing personal goals and develop a sense of identity that allows them to grow beyond their mental illness.

The practice in medicine of professionals teaching persons with medical diseases and their families about the diseases in order to improve adherence to recommended treatments and to manage or relieve persistent symptoms and treatment side effects has a long history. In the behavioral health field, didactic methods for educating people have been referred to as psychoeducation. Other methods, especially cognitive-behavioral strategies, have also been used to help people learn how to manage their mental illnesses more effectively.

People with psychiatric disorders can be given information and taught skills by either professionals or peers to help them learn ways to manage their illness better. Although the goals of professional-based and peer-based teaching are similar, they have differences. Professional-based intervention is conducted in the context of a therapeutic relationship in which the teacher-or the organization to which the teacher belongs, such as a community behavioral health center-is responsible for the overall treatment of the individual’s psychiatric disorder. In contrast, peer-based intervention is conducted in the context of a relationship in which the teacher-or the organization to which the teacher belongs, such as a peer support center-usually does not have formal responsibility for the overall treatment of the individual’s disorder. Given this distinction, the relationship between a professional and the person with a mental illness may be perceived as hierarchical, because the professional assumes responsibility for the person’s treatment, whereas the relationship between a peer and the person with a mental illness is less likely to be perceived as hierarchical, because the peer does not assume such responsibility. This distinction is crucial among individuals with psychiatric disorders who have advocated for self-help and peer-based services as alternatives to, or in addition to, traditional professional-based services.

Professional and peer-based services are also different in that most professionals do not have serious psychiatric disorders-in contrast, by definition, to peers. Thus when teaching others how to manage their mental illness, peers are able to convey the lessons they have learned from personal experience, whereas professionals cannot. This places peers in a unique position of being able to teach “self” management skills to other persons with a mental illness.

To recognize these differences, a distinction may be made between professional-based services and peer-based services aimed at helping people deal with their psychiatric disorders. Illness management can be defined as professional-based interventions designed to help people collaborate with professionals in the treatment of their mental illness, reduce their susceptibility to relapses, and cope more effectively with their symptoms. Illness self-management, on the other hand, may be used to refer to peer-facilitated services aimed at helping people cope more effectively with their mental illness and facilitating people’s ability to take care of themselves.

WHO BENEFITS FROM IMR?
This program (as described in the toolkit) is designed for people who have experienced the symptoms of severe mental illness, including:

• Schizophrenia
• Bipolar disorder
• Major depression

ESSENTIAL ELEMENTS
As discussed in the Illness Management and Recovery toolkit, and as reflected in the suggested fidelity scale, research shows that the following elements lead to positive outcomes:

• A comprehensive curriculum, including the following topics:
  • Recovery strategies
  • Practical facts about mental illness
  • The stress-vulnerability model and treatment strategies
  • Building social support
  • Reducing relapses
  • Using medication effectively
  • Coping with stress
  • Coping with problems and symptoms
  • Getting your needs met in the mental health system
• Goal setting and goal follow-up
• Motivation-based strategies
• Educational techniques
• Cognitive-behavioral techniques
• Coping skills training
• Relapse prevention training
• Behavioral tailoring for medication

OUTCOMES
The results of controlled research indicate that when illness management is conceptualized as a group of specific interventions, it is an evidence-based practice. The specific interventions and their outcomes are as follows:

• psychoeducation improves people’s knowledge of mental illness
• behavioral tailoring helps people take medication as prescribed
• relapse prevention programs reduce symptom relapses and re-hospitalizations
• coping skills training using cognitive-behavioral techniques reduces the severity and distress of persistent symptoms

The following measures may help determine the success of the components above:

• Percent of medical records including a illness self-management and relapse prevention plan
• Rates of relapse
• Severity of symptoms measures
• Hospitalization events and lengths of stay
• Number or percentage of emergency visits
• Pre- and post-tests measuring skill and knowledge acquisition

HOW ARE IMR PROGRAMS STRUCTURED?
This program is a series of weekly sessions in which a specially trained mental health practitioner helps people who have experienced psychiatric symptoms develop their own personal strategies for coping with the illness and moving forward with their lives.

• can be provided in an individual or group format
• generally lasts between three and six months

Goals of the Illness Management and Recovery Program

• Learning about mental illness and strategies for treatment
• Decreasing symptoms
• Reducing relapses and re-hospitalizations
• Making progress towards goals and recovery

Materials Provided to Consumers

• Educational handouts
• Planning sheets
• Checklists

Also, a practitioner helps the consumer apply the contents of the handouts to develop his or her own strategies for managing mental illness and setting and achieving goals.

SUBJECTS COVERED IN ILLNESS MANAGEMENT AND RECOVERY PROGRAMS
The following subjects are covered in educational handouts

• Recovery strategies
• Practical facts about mental illness
• The stress-vulnerability model and treatment strategies
• Building social support
• Reducing relapses
• Using medication effectively
• Coping with stress
• Coping with problems and symptoms
• Getting your needs met in the behavioral health system