Chapter 1 18 FIGURE 1 Conceptual Framework for the Illness Management and Recovery program (56). IMR may be considered a complex and extended intervention. Consequently, providing IMR requires mastery of a variety of advanced clinical skills (98) (see Chapter 6). IMR is currently implemented in various countries, including the United States, the Netherlands, Denmark, Norway, Sweden, Spain, Japan, and Singapore (65). Variants of IMR This study used a translation of the American IMR curriculum, which was slightly adapted to the Dutch situation. The IMR program provides a program structure with room for individual interpretations. In some modules, for example, experts such as a psychiatrist in the medication module are invited, or a particular game or exercise that is not part of the formal IMR curriculum is performed. In the present study, on average, one module requires four meetings. However, the number of sessions per module may vary per group depending on the interests and needs of the participants. Over time, some variants of the IMR have emerged in the Netherlands. For some time, in the day treatment of former Bavo-Europoort, IMR was supplemented with several regular components of group treatment, so called “IMRplus”. Sometimes in the in-patient treatment facilities, only a few IMR modules are given, such as portions of "Practical Facts about Mental Illness", because the length of stay in the hospital is usually limited. Another variant of outpatient care is ‘’Strength’’ or FACT-plus (99). IMR program Goal setting Education about illness Using medications effectively Coping skills training Social skills training Relapse prevention training Alcohol and Drugs Use Coping Skills Meaningful Activities Social Support Program Proximal Outcomes Distal Outcomes Medications Stress Biological Vulnerability - Symptom control -Relapse Subjective recovery: - Perceived recovery - Sense of purpose - Personal agency - - - - - + + - Objective recovery: - Role funcioning - Social functioning
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