A naturalistic pilot study 35 Background Introduction The aim of Illness Management and Recovery (IMR) is to provide a structured psychosocial program that helps individuals to manage the disabling effects of severe and persistent mental illnesses such as schizophrenia and bipolar disorders. It is curriculum based. To improve different aspects of illness management, it includes interventions such as goal-setting, psycho-education, and coping and social skills training. The overall aim is to improve illness outcomes and to support subjective and objective recovery (1). IMR is based on a review of controlled research on professionally based programs for helping people to manage their mental illness (2). It was developed in the United States (3, 4) and is currently used in several countries. While its individual components are not new in Dutch Mental Health Care, what is new of this program is to offer these services together as an integrated package. A review conducted in 2011 showed that three randomized controlled trials (RCTs), three quasi-controlled trials and three pre-post trials had been conducted on the overall IMR program (5). To date (March 2016), four RCTs have been published on this program (6-9). The results were mixed. The three RCTs that had been published before the start of our pilot (6-8) differed from each other with regard to setting, the number of participants and diagnoses, the length and format of IMR, the trainers’ training and their qualifications, the frequency of supervision of the trainers, the number and timing of measurements and the fidelity of implementation of IMR (10). The same three RCTs compared IMR with care as usual (CAU) (6-8). On the overall score of the client version of the Illness Management and Recovery Scale (IMRS) (11-13), two of them showed significantly positive results for clients assigned to IMR relative to those in the control groups; the respective effect sizes were .36 (7) and .29 (8). The other study found a significant improvement only if the analyses were limited to sites with high IMR fidelity (6). On the overall score of the clinician version of the IMRS (11-13), all three of these studies showed significantly positive results for clients assigned to IMR relative to those in the control groups, with respective effect sizes of .28 (6), .39 (7) and .34 (5, 8). Additional significantly positive results for IMR were found on client-reported knowledge in one study (6), on clientreported coping in another study (8), on clinician-reported quality of life in the third study (7), and on observer-rated psychiatric symptoms in two of these studies (7, 8). These results were either not found in the other RCTs, or the domains in question were not measured. No significant outcomes were found on objective outcomes
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