copyright west institute evidence-based practices illness management and recovery...

Evidence-Based Practices Copyright West Institute

ILLNESS MANAGEMENT AND RECOVERY

ILLNESS MANAGEMENT AND RECOVERY

EVIDENCE-BASED EVIDENCE-BASED

PRACTICEPRACTICE

An IntroductionAn Introduction


What is Illness Management and Recovery?

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


What is provided in the IMR program?

People participate in 3 to 6 months of weekly People participate in 3 to 6 months of weekly sessions conducted by trained practitioners.sessions conducted by trained practitioners.

Participants develop personal strategies for managing Participants develop personal strategies for managing their symptoms and moving forward in their lives.their symptoms and moving forward in their lives.

Educational handouts are provided to all participants.Educational handouts are provided to all participants. Training and essential written materials (workbooks, Training and essential written materials (workbooks,

guidelines, forms,brochures, etc) are provided to the guidelines, forms,brochures, etc) are provided to the practitioners practitioners


The Importance of Recovery

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


Characteristics of Recovery

Is defined and accomplished by the personIs defined and accomplished by the person Can be viewed as a process or outcomeCan be viewed as a process or outcome Distinguished from rehabilitationDistinguished from rehabilitation Involves personal and social successInvolves personal and social success Is a universal human experienceIs a universal human experience Includes the themes of hope, self-confidence, Includes the themes of hope, self-confidence,

enjoyment, well-being, & optimismenjoyment, well-being, & optimism


Relationship of Illness Management to Recovery

Improved ability to manage one’s illness is a Improved ability to manage one’s illness is a common recovery goalcommon recovery goal

Avoiding relapses and re-hospitalizations Avoiding relapses and re-hospitalizations gives people greater control over their livesgives people greater control over their lives

Less time spent dealing with mental illness Less time spent dealing with mental illness allows more time to be spent on personal allows more time to be spent on personal recoveryrecovery

Less distress due to symptoms and impairment Less distress due to symptoms and impairment leads to better quality of lifeleads to better quality of life


Evidenced-Based Components of Illness

Management Education about mental illness and its treatmentEducation about mental illness and its treatment Behavioral tailoring for medication (for people who Behavioral tailoring for medication (for people who

choose to take medications)choose to take medications) Relapse prevention trainingRelapse prevention training Coping skills training Coping skills training See, Mueser, et al, “Illness Management and Recovery: See, Mueser, et al, “Illness Management and Recovery:

A Review of the Research” in press, Psychiatric A Review of the Research” in press, Psychiatric Services.Services.


Evidence for Illness Management Components

All the evidence cited in this presentation is the All the evidence cited in this presentation is the result of randomized, controlled studies. result of randomized, controlled studies.


Evidence Supporting Providing EducationEvidence Supporting Providing Education

3/4 studies show improved knowledge of 3/4 studies show improved knowledge of mental illness and its treatmentmental illness and its treatment

Little effect of education alone on other areas Little effect of education alone on other areas of functioning, including using medication of functioning, including using medication effectively, relapses, rehospitalizations, effectively, relapses, rehospitalizations, symptoms, or quality of life.symptoms, or quality of life.


Evidence Supporting Behavioral Tailoring for Evidence Supporting Behavioral Tailoring for Medication (for People Who Choose to Take Medication (for People Who Choose to Take Medication) Medication)

4/4 studies of fitting medication into daily routines 4/4 studies of fitting medication into daily routines showed improvements in taking medication as prescribedshowed improvements in taking medication as prescribed

1/1 study showed that simplifying the medication 1/1 study showed that simplifying the medication regimen improved taking medication as prescribed.regimen improved taking medication as prescribed.

1/1 study showed motivational interviewing improved 1/1 study showed motivational interviewing improved taking medication as prescribed.taking medication as prescribed.

0/1 study showed skills training improved taking 0/1 study showed skills training improved taking medication as prescribed.medication as prescribed.


Evidence Supporting Training in Relapse Evidence Supporting Training in Relapse PreventionPrevention

5/5 studies showed relapse prevention training 5/5 studies showed relapse prevention training reduced relapses and rehospitalizationsreduced relapses and rehospitalizations


Evidence Supporting Coping Skills TrainingEvidence Supporting Coping Skills Training

4/4 studies showed coping skills training 4/4 studies showed coping skills training decreased the severity of symptomsdecreased the severity of symptoms


Overarching Goals of IMR Inspire people to become hopeful about their Inspire people to become hopeful about their

recoveryrecovery Prepare people to be informed decision-Prepare people to be informed decision-

makers about their own treatmentmakers about their own treatment Help people gain more sense of mastery over Help people gain more sense of mastery over

their mental illnesstheir mental illness Free people up to spend less time dealing with Free people up to spend less time dealing with

their psychiatric disorder and more time their psychiatric disorder and more time enjoying lifeenjoying life


Specific Goals of IMR Help people set and make progress towards Help people set and make progress towards

personal recovery goalspersonal recovery goals Teach people about psychiatric illness and its Teach people about psychiatric illness and its

treatmenttreatment Teach people how to use medication effectivelyTeach people how to use medication effectively Help people develop relapse prevention plansHelp people develop relapse prevention plans Teach people strategies for coping with Teach people strategies for coping with

persistent symptoms and other problemspersistent symptoms and other problems


Logistics Individual or group formatIndividual or group format Weekly sessionsWeekly sessions Session length: 45-60 minutes, depending on Session length: 45-60 minutes, depending on

the participants’ attention capacitythe participants’ attention capacity Program duration: 3-6 months for most Program duration: 3-6 months for most

participantsparticipants Curriculum developed for schizophrenia-Curriculum developed for schizophrenia-

spectrum and major affective disorders; can spectrum and major affective disorders; can also be adapted for other disordersalso be adapted for other disorders


Logistics (continued) Location of sessions: clinic, peer support center, Location of sessions: clinic, peer support center,

community, or hospitalcommunity, or hospital Program is structured and step-by-stepProgram is structured and step-by-step Educational handouts with ample worksheets and Educational handouts with ample worksheets and

checklists are provided to participantschecklists are provided to participants Practitioners’ Guide provides guidelines for each Practitioners’ Guide provides guidelines for each

topic in the educational handoutstopic in the educational handouts Short video introduces the program to participantsShort video introduces the program to participants Practice demonstration video illustrates the teaching Practice demonstration video illustrates the teaching

strategies for practitionersstrategies for practitioners


Involvement of Family & Other Supportive People

Participants are encouraged to involve family Participants are encouraged to involve family members and other supportive people in the IMR members and other supportive people in the IMR programprogram

With the participant’s permission, family members With the participant’s permission, family members and other supportive people can help in a variety of and other supportive people can help in a variety of ways: attending some sessions, reading handouts, ways: attending some sessions, reading handouts, assisting with homework, helping to develop a assisting with homework, helping to develop a relapse prevention plan, taking a role in the relapse prevention plan, taking a role in the participant’s plan for achieving a goal, etc. participant’s plan for achieving a goal, etc.


Curriculum: Topic Areas1. Recovery Strategies1. Recovery Strategies

2. Practical Facts about Mental Illness [schizophrenia, bipolar 2. Practical Facts about Mental Illness [schizophrenia, bipolar disorder, major depression]disorder, major depression]

3. The Stress-Vulnerability Model and Treatment Strategies3. The Stress-Vulnerability Model and Treatment Strategies

4. Building Social Support4. Building Social Support

5. Using Medication Effectively5. Using Medication Effectively

6. Reducing Relapses6. Reducing Relapses

7. Coping with Stress7. Coping with Stress

8. Coping with Problems and Symptoms8. Coping with Problems and Symptoms

9. Getting Your Needs Met in the Mental Health System9. Getting Your Needs Met in the Mental Health System


How is the IMR program tailored to the individual?

People learn information and strategies at their People learn information and strategies at their own pace and focus on the content most own pace and focus on the content most relevant to their own needs.relevant to their own needs.

People apply what they are learning towards People apply what they are learning towards their own personal goals.their own personal goals.

In the sessions, people select and practice In the sessions, people select and practice strategies and skills that they think will be strategies and skills that they think will be most beneficial.most beneficial.


How is the IMR program tailored?, cont’d

People develop homework which reflects their People develop homework which reflects their own interests and needs.own interests and needs.

People practice skills in their own People practice skills in their own environment.environment.

People develop individualized plans for People develop individualized plans for relapse prevention, coping with symptoms, relapse prevention, coping with symptoms, achieving personal goals, etc.achieving personal goals, etc.

..


Structure of IMR Sessions Informal socializing and identification of any Informal socializing and identification of any

major problems (1-3 minutes)major problems (1-3 minutes)

Review previous session (1-3 minutes)Review previous session (1-3 minutes)

Review homework (3-5 minutes)Review homework (3-5 minutes)

Follow-up on goals (1-3 minutes)Follow-up on goals (1-3 minutes)

Agree on an agenda for current session (1-2 Agree on an agenda for current session (1-2 minutes)minutes)


Structure of Sessions (continued)

Teach new material or review previously Teach new material or review previously taught material (30-40 minutes)taught material (30-40 minutes)

Agree on a homework assignment (3-5 Agree on a homework assignment (3-5 minutes)minutes)

Summarize progress made in current session Summarize progress made in current session (3-5 minutes)(3-5 minutes)


Outcomes of IMRThe following outcomes may be expected to improve The following outcomes may be expected to improve following full participation in Illness Management and following full participation in Illness Management and Recovery:Recovery:

• Relapses and re-hospitalizationsRelapses and re-hospitalizations• Symptom severitySymptom severity• Knowledge of mental illnessKnowledge of mental illness• Taking medications as prescribed (for people who choose Taking medications as prescribed (for people who choose

to take medications)to take medications)


Outcomes, cont’d

Improvement in: Coping self-efficacy Hopefulness and optimism Perceived social support Positive treatment alliance with mental health

professionals


Summary IMR is a program designed to help people pursue recovery IMR is a program designed to help people pursue recovery

goals and learn how to better manage their illness.goals and learn how to better manage their illness. Practitioners use a combination of motivational, Practitioners use a combination of motivational,

educational and cognitive-behavioral strategies to help educational and cognitive-behavioral strategies to help people learn skills that are helpful in their recovery.people learn skills that are helpful in their recovery.

All participants identify personally meaningful recovery All participants identify personally meaningful recovery goals which are pursued and followed up in the program.goals which are pursued and followed up in the program.

Illness management strategies are based on specific Illness management strategies are based on specific evidence-based practices including education, relapse evidence-based practices including education, relapse prevention training, behavioral tailoring for medication prevention training, behavioral tailoring for medication (for people who choose go take medications), and coping (for people who choose go take medications), and coping skills training.skills training.


Closing Thoughts

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


A Consumer’s Perspective

. . . However, believing in yourself, having . . . However, believing in yourself, having hope that things will continue to get better, and hope that things will continue to get better, and looking forward to your future are also vital in looking forward to your future are also vital in overcoming mental illness. Our hopes and overcoming mental illness. Our hopes and dreams are not delusions. Our hopes and dreams are not delusions. Our hopes and dreams are what makes us human.”dreams are what makes us human.”

David Kime, artist, writer, floral designer, David Kime, artist, writer, floral designer, person in recovery from bipolar disorder.person in recovery from bipolar disorder.

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Documents

personal recovery

ones illness

psychiatric illness

recovery improved ability

personal strategies

optimism slide

introduction slide

people greater control