Study protocol 65 Background Introduction Due to the disabling effects of their illness, it is hard for people with severe and persistent mental illnesses (SMI) such as schizophrenia or a bipolar disorder to participate fully in society. Though they have the same aspirations as other people, these wishes are harder to realize, due not only to their illness, but also to barriers within society (such as stigma) (1). Mental-health care should therefore include interventions that support individual recovery and contribute to self-determination and wellbeing, and also to skills for illness self-management and for fulfilling valued roles in domains such as work, social connections and housing (2, 3). In recent years, various psychosocial interventions have been developed to support recovery, such as the Cognitive Adaptation Training (CAT) (4), the Wellness Recovery Action Plan (WRAP) (5) and the Boston Psychiatric Rehabilitation (PR) Approach (6). Over the last decade, a promising new programme for people with SMI has been developed: Illness Management and Recovery (IMR) (2), a programme that combines psychosocial interventions such as psychoeducation with aspects of cognitive behavioural therapy, skills training, peer support and rehabilitation. These interventions aim to help participants gain greater control of their problems through illness management, and also to support their recovery. The IMR programme was based on an empirical review of the research literature on teaching illness self-management strategies to people with SMI (7). It was also part of the National Implementing Evidence-Based Practices Project in the U.S. (8, 9). In themselves, the different parts of the IMR programme were not new; the newness lay in offering them as an integrated package. The theoretical foundation of IMR rests on two models. The first, the transtheoretical model, holds that people are more motivated to acquire new behaviour if the types of intervention are adjusted to the stage of change they are in. This makes it is easier for people to become aware of their problems, to take decisions, and to implement and sustain change (10, 11). The second model is the stress-vulnerability model (2), which holds not only that mental health problems originate from the interaction between biological vulnerability and sources of stress in the environment, but also that people differ in their coping ability (12, 13). In line with the stress-vulnerability model, IMR -trainers need to teach participants the basics of illness (self-) management—enabling them,
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