Illness management and recovery

Domain II · Behavioural & cognitive · Mueser, Gingerich · 2000

What it is

Illness Management and Recovery (IMR) is a curriculum-based programme for adults with serious mental illness, mainly schizophrenia-spectrum, bipolar and major depressive disorders. It teaches people to manage their illness so they can pursue goals they themselves define. Mueser and Gingerich built…

Format

• Phase A: Referral, engagement and orientation (usually 1–3 sessions).
• Run the Knowledge and Skills Inventory as a strengths-focused, conversational assessment, not an interview. One or two further sessions may be used to get to know the person.

Who practises it, and how they are trained or regulated

• Format. Sessions are weekly, or biweekly where agreed, for roughly 3 to 10 months. Individual sessions run about 45–60 minutes. Groups run 45–90 minutes, and the fidelity scale caps them at 8 participants. For people with limited attention, the KIT suggests shorter sessions (20–30 minutes) held two or three times a week. Each client keeps an IMR binder of handouts, with the goal chart at the front, and brings it to…
• Move on when the person agrees to take part and has a first sense of how IMR could serve something they want.
• Tailoring the order. Follow the order unless there is reason not to. For example, teach persistent-symptom coping early if a symptom is very distressing. For individuals, use only the diagnosis-specific Topic 2 handouts that fit them. The I-IMR adaptation keeps Recovery and Stress-Vulnerability first in all cases.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Hope that sounds scripted. Tie it to specifics.
• Generic praise. Be specific about the behaviour.
• Long demonstrations. Keep them short and concrete.
• Content written for the US system needs localising.
• Members with no goal update for weeks. Keep a rotation log.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.