An investigation of the Illness Management and Recovery (IMR) program's effect on clients' recovery - Exploring the participants' lived experience with the IMR-program

The illness Management and Recovery program (IMR) is a curriculum- and goal-based recovery-oriented rehabilitation program designed for patients diagnosed with severe mental illness (SMI). The theory behind the IMR program is to help people diagnosed with SMI set and pursue personal goals and to teach them illness self-management skills to help them achieve clinical and personal recovery on long term. The IMR intervention consists of a curriculum with a manual, handouts, information brochures, training videos, a fidelity scale and outcome measures. The theoretical foundation for achieving goals in the IMR-program is the stressvulnerability model and the transtheoretical model. The IMR-program consists of 11 modules, and each session is standardized, manualized and designed to last between 1 and 1½ hours. The IMR-program is provided by specially trained mental health professionals on a weekly basis over a period of 6-9 months. In the IMR-program, personal goals are the driving force behind the motivation to learn about illness self-management. Setting, pursuing and achieving goals are seen as important elements of recovery that it is integrated into all aspects of the program.
The overall aim was to investigate the IMR-program’s impact on the participants’ recovery and included three sub-studies and used both quantitative and qualitative data collection and analysis. The one-year follow-up on the Danish randomized clinical trial (RCT) was an assessor-blinded, multi-center trial investigating the IMR-program compared to treatment as usual. The primary outcome was level of functioning assessed with Global Assessment of Functioning at postintervention. All outcomes at one-year follow-up were secondary or explorative outcomes including illness management, severity of symptoms, personal recovery, hope, use of alcohol/drugs and hospitalization. A qualitative study with a descriptive phenomenological design was selected because the aim of the study was a) to explore whether they experienced changes and to examine how these changes related to their recovery during or after their
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participation in IMR and b) to explore participants’ lived experience of personal goal setting as part of the IMR-program and how this is related to their recovery process.
The one-year follow-up on the Danish RCT on IMR showed that IMR had no significant effect on functioning; mean difference +0.8 (95 % confidence interval: -4.7 points to 3.0 points, p=0.67) between the IMR group and the control group regarding Global Assessment of
Functioning (GAF-F) one year after the intervention indicates that the hypothesized difference of 6 points favoring IMR is unlikely. Neither the patient outcomes related to illness management, symptom severity, personal recovery, use of alcohol/drugs or hospitalization differed significantly between the two groups. From the qualitative study exploring the IMR-program’s impact on the participants’ recovery process, three main themes emerged: First (Th1), the participants’ experience with participating in IMR was “Social connection with other IMR group members”. The second main theme (Th2) of the impact of IMR on the participants’ personal recovery process was, “In IMR, we talked about our everyday lives with mental illness”. The participants described how they talked about and discussed their everyday lives with mental illness in the IMR group. The third main theme (Th3) concerning changes related to the participants’ recovery during or after IMR was, “In IMR we learned about recovery as a personal experience”. In this theme, the participants described developing an understanding of recovery as a phenomenon. The qualitative study also aimed to describe participants’ lived experience with personal goal setting in IMR and its possible impact on illness-self-management and three main themes (Th) derived from the qualitative analysis: (Th1) “We were guided to set clearer and specific goals in IMR”, (Th2) “We were encouraged to pursue our personal goals in IMR” and (Th3) “We were encouraged and supported to resume work on our goals when we stopped making progress”, illustrating the participants’ lived experience of pursuing personal goals. The present study showed no significant effect of IMR on clinical and personal recovery at oneyear follow-up. Along with previous RCTs with a long-term follow-up, the findings raise questions about the effect of IMR’s effect on symptom severity. Altogether, the results of existing RCTs that have investigated IMR raise questions regarding the impact of IMR on functioning and do not suggest any effects on personal recovery. However, qualitative studies on
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the IMR-program findings indicate that the participants learn about illness management skills and personal goal setting. Hopefully, ongoing research on the IMR-program will give us a more solid answer on this matter. However, the results suggest the need to consider the development of interventions based on other conceptual frameworks to help people with SMI gain a better level of functioning and to achieve personal recovery.