The Illness Management and Recovery program: rationale, development, and preliminary findings

Evaluation of the Illness Management and Recovery Scale in schizophrenia and schizoaffective disorder

The aim of the present study was to evaluate the psychometric properties of the parallel client and clinician versions of the Illness Management and Recovery Scale (IMRS) developed to monitor the clients' progress in the Illness Management and Recovery (IMR) program in schizophrenia. A total of 107 study participants completed assessments of the IMRS, interview-based ratings of psychiatric symptoms, self-ratings of psychiatric symptoms, perception of recovery, and quality of life. Case managers completed the clinician version of the IMRS. Both versions of the scale demonstrated satisfactory internal reliability and strong test-retest reliability. The results also indicated convergent validity with interview-based ratings of psychiatric symptoms, self-rated symptoms, perception of recovery, and quality of life for both versions of the IMRS. These findings support the utility of the IMRS as a measure of illness self-management and recovery in clients with schizophrenia.

Illness management and recovery (IMR) in Danish community mental health centres

Background

Schizophrenia and bipolar disorder are severe mental illnesses that can have a significant disabling impact on the lives of people. Psychosocial interventions that stress hope and recovery as a part of a multi-dimensional approach are possibly indicated to support people with severe mental illness in facilitating recovery. Illness Management and Recovery (IMR) is a curriculum-based psychosocial intervention designed as structured program with a recovery-oriented approach. The aim of IMR is to rehabilitate people with severe mental illnesses by helping them acquire knowledge and skills in managing their illness and achieve personal recovery goals. Previous randomised clinical trials indicate that IMR can be implemented with a good effect and a high fidelity though further trials are crucial to demonstrate the potential effectiveness of IMR.

Methods/Design

The trial design is a randomised, assessor-blinded, multi-centre, clinical trial of the IMR program compared with treatment as usual for 200 participants diagnosed with schizophrenia or bipolar disorder under the care of two community mental health centres in the Capital Region of Denmark. The primary outcome is level of functioning at the end of treatment. The secondary outcomes are disease symptoms; use of alcohol/drugs; individual meaning of recovery; hope; hospital admissions and out-patient psychiatric treatment at the end of treatment and the abovementioned and level of functioning at follow-up 21 months after baseline.

Discussion

If the results of this trial show IMR to be effective these positive results will strengthen the evidence of IMR as an effective comprehensive psychosocial intervention with a recovery-oriented approach for people with severe mental illness. This will have significant implications for the treatment and recovery of people with severe mental illness.

Trial registration

Registration number NCT01361698.

Effectiveness of a psychosocial intervention model for persons with chronic psychiatric disorders in long-term hospitalization

The article describes a psychosocial model of intervention with psychiatric patients in long-term hospitalization in a psychiatric ward in Israel and reports the findings of the evaluation conducted of its effectiveness. The model was aimed at maintaining or improving the patients' functioning in four main areas: personal hygiene, environmental maintenance, occupational competency, and social and recreational activities. For each patient, an individualized intervention program was designed and implemented by a personal case manager appointed from the ward's clinical staff. The programs involved family and ward staff as well as the patients themselves. The evaluation, based on comparison of monthly data for 4 months before and 12 months during the intervention, showed significant improvement in all but two areas of functioning: social functioning and psychiatric status. The findings, although in need of confirmation in larger, representative samples of patients in Israel and elsewhere, hold promise for effective intervention with patients whose treatment today consists largely of medication.

Impact of illness management and recovery programs on hospital and emergency room use by Medicaid enrollees

OBJECTIVE

Illness management and recovery is a structured program that helps consumers with severe mental illness learn effective ways to manage illness and pursue recovery goals. This study examined the impact of the program on health service utilization.

METHODS

This was a retrospective cohort study of five assertive community treatment (ACT) teams in Indiana that implemented illness management and recovery. With Medicaid claims data from July 1, 2003, to June 30, 2008, panel data were created with person-months as the level of analysis, resulting in 14,261 observations for a total of 498 unique individuals. Zero-inflated negative binomial regression models were used to predict hospitalization days and emergency room visits, including covariates of demographic characteristics, employment status, psychiatric diagnosis, and concurrent substance use disorder. The main predictor variables of interest were receipt of illness management and recovery services, dropout from the program, and program graduation status.

RESULTS

Consumers who received some illness management and recovery services had fewer hospitalization days than those receiving only ACT. Graduates had fewer emergency room visits than did ACT-only consumers.

CONCLUSIONS

This is the first study to examine the impact of illness management and recovery on service utilization. Controlling for a number of background variables, the study showed that illness management and recovery programs were associated with reduced inpatient hospitalization and emergency room use over and above ACT.

Quantitative relationship between recovery and benefit-finding among persons with chronic mental illness in Japan

This study quantitatively examined the association between recovery and benefit-finding among persons with a chronic mental illness in Japan. A cross-sectional questionnaire survey was conducted, with responses from 237 (74%) of 319 individuals (≥ 20 years old) with a chronic mental illness in community and inpatient ward settings. The data of 120 questionnaires were analyzed (men, 64%; average age, 41 years). The questionnaire included the Recovery Assessment Scale (RAS) and Self-identified Stage of Recovery Parts A and B (SISR-A and SISR-B) for assessing recovery and the Perceived Positive Change Scale (PPCS) for assessing benefit-finding. The total RAS and SISR-B scores strongly and positively correlated with the PPCS score. The PPCS score significantly differed among the recovery stages, as classified by the SISR-A, with higher scores at higher stages; the association was almost linear. The study confirmed the theoretically expected relationship between recovery and benefit-finding among these individuals. Benefit-finding might be associated not only with a higher stage of recovery but also with each step from one stage to another.

Service user perspectives on the impact of a mental illness diagnosis

Aim – to provide a conceptual and practical analysis of the impacts of mental health diagnoses on consumers and to consider how service users might contribute to the new psychiatric classifications currently being drawn up. Methods – A search was carried out revealing a very sparse literature on this topic. Consultations with service users were conducted and the views of experts sought. Results – Diagnosis is important as it marks the formal status of psychiatric patient being conferred. Consumers react differently, and often, negatively to this. Stigma can follow from a diagnosis. The process of giving a diagnosis can range from one of negotiation and taking the person's strengths into account to the blunt allocation of an unwanted label. Consumers can be reduced to their diagnosis so it becomes their whole personhood and this can have an effect on their sense of self. However, consumers are not passive victims and have their own strategies for dealing with these issues. Conclusion – Consumers can use these experiences to make contributions to the new diagnostic classification systems and to future research.

Do therapeutic homework assignments address areas of need for individuals with severe mental illness?

The current study explores the types of homework assignments used in a recovery orientated case management approach. It also examines the relationship between the types of homework used and the clients' area of need as rated on the CANSAS. There were 129 client and mental health case manager dyads that participated in the study. Written copies of all homework assignments administered during the 12-month research period were collected (N = 1,054). The homework assignments were categorised according to the 'type' and the 'need domain addressed by the task'. The majority of these tasks were behavioural in nature. On a group level homework tended to broadly address areas of need for clients in the study. Only 2 of the 1,054 homework assignments administered directly addressed areas of Intimate Relationships or Sexual Expression. The importance of addressing Intimate Relationship and Sexual Expression within mental health case management is discussed.

Promoting wellness and recovery for persons with serious mental illness: a program evaluation

This retrospective descriptive correlational study evaluated treatment satisfaction and the quality of life (QOL) of consumers with serious mental illness participating in a community mental health program that combined illness management and recovery strategies with a group appointment model. The Wellness Enhancement and Recovery Program (WERP) was evaluated to determine satisfaction with services and QOL of consumers over 3 years. Findings from the data analyses indicated that consumers in WERP were satisfied with treatment services and had a fair to good QOL. Satisfaction and QOL were moderately correlated.

Use of 'chronic disease self-management strategies' in mental healthcare

PURPOSE OF REVIEW

Medical care for chronic conditions imposes a substantial burden on healthcare systems designed originally for acute illness or injury. The notion of chronic disease self-management (CDSM) has been developed as a means of encouraging individuals with chronic conditions to self-manage their own health. It is known that successful chronic disease management reduces hospital admission rates and improves patients' quality of life. Although recognized widely by other medical disciplines, it is beginning to have an impact on psychiatric practice; therefore, a review of how the CDSM approach is implemented in psychiatry is timely.

RECENT FINDINGS

The move toward self-management in general medicine can be seen by and large as a holistic approach that encourages the person to work in partnership with health professionals to improve outcomes and assist patients to better manage their healthcare needs. One of the defining features of CDSM approaches is the active collaboration between the patient and the healthcare professional. Five mechanisms that demonstrate such active collaboration are self-directed care, illness management and recovery, shared decision-making, joint crisis planning and wellness planning. Their use in psychiatry is discussed.

SUMMARY

The key feature of CDSM approaches is an active collaboration between healthcare professionals and healthcare consumers. It is a fundamental shift away from traditional active expert/passive patient treatment modes. Each of the five approaches discussed exemplifies the active participation in treatment planning by both consumers and mental health professionals.

A cross-sectional study of recovery training and staff attitudes in four community mental health centers

OBJECTIVE

Recovery has become a concept often incorporated in mental health staff trainings. However, little research has investigated the influence of training on recovery attitudes. The current study examined whether recovery-related trainings in community mental health centers is associated with differences in staff attitudes and reported organizational practices.

METHODS

A total of 318 staff members at four community mental health centers completed questionnaires about their recovery attitudes and trainings they had received in the past year.

RESULTS

Compared to staff who had no recovery-related training in the past year, staff who had at least one recovery-related training reported significantly higher consumer optimism and a greater agency recovery orientation towards consumers' life goals. The number of recovery-related trainings was significantly correlated with scores on personal optimism, consumer optimism, and agency recovery orientation towards consumers' life goals.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The findings suggest recovery training is positively related to staff recovery attitudes and agency practices. Community mental health centers may benefit from a systematic approach to recovery training. Further research is needed to determine directionality of these relationships and to parse the mechanisms of action.

Trajectories of Depression Symptoms among Older Youths Exiting Foster Care

The purpose of this study was to determine the trajectories of depressive symptoms as older youths from the foster care system mature while also examining the correlates of these trajectories. Data came from a longitudinal study of 404 youths from the foster care system in Missouri, who were interviewed nine times between their 17th and 19th birthdays. Depression was assessed with the Depression Outcomes Module and the Diagnostic Interview Schedule for DSM-IV. Data best fit a model of three trajectory classes, describing young people (1) maintaining low levels of depressive symptoms (never depressed class, 78%), (2) with increasing symptoms (increasing class, 6%), and (3) with decreasing symptoms (decreasing class, 15%). The increasing depression group was mostly male youths who were working or in school; the decreasing class was mostly highly maltreated female youths exiting the foster care system from residential care, with low levels of employment, and in school. Implications for social work practice are discussed.

Recovery-oriented training and staff attitudes over time in two state hospitals

Recovery attitudes and concepts are often promoted to community mental health staff through educational and in-service trainings, but no study found has examined this in state hospitals. The current observational study aimed to examine the types of recovery-oriented trainings that occurred at two state hospitals over 1 year and subsequent changes in staff recovery attitudes. A total of 184 state hospital staff completed questionnaires assessing their personal optimism, consumer optimism, and agency recovery orientation at baseline and 1 year later. The types of recovery-oriented trainings staff received were categorized as general/inspirational or specific/practical training. Results found that the majority of staff at the two state hospitals received some recovery-oriented training, mostly general/inspirational training. Staff who received specific/practical training had a greater increase in agency recovery attitudes than staff who received only general/inspirational training or no training. However, the more trainings staff had, the higher their consumer optimism. These results suggest state hospitals are incorporating recovery-oriented staff trainings, but more specific trainings may be needed and all staff involved in different levels of care need to be included.

Psychiatric rehabilitation interventions: a review

Psychiatric rehabilitation has become accepted by the mental health field as a legitimate field of study and practice. Over the last several decades various psychiatric rehabilitation programme models and procedures have been developed, evaluated and disseminated. At the same time the process of psychiatric rehabilitation has been specified and its underlying values and practitioner technology articulated. This review describes the psychiatric rehabilitation process and in so doing differentiates psychosocial interventions that can be classified as psychiatric rehabilitation interventions from other psychosocial interventions. Furthermore, the major psychiatric rehabilitation interventions are examined within a framework of the psychiatric rehabilitation process with a review of their evidence. The review concludes that psychiatric rehabilitation interventions are currently a mixture of evidence-based practices, promising practices and emerging methods that can be effectively tied together using the psychiatric rehabilitation process framework of helping individuals with serious mental illnesses choose, get and keep valued roles, and together with complementary treatment orientated psychosocial interventions, provide a broad strategy for facilitating recovery.

Integrating assertive community treatment and illness management and recovery for consumers with severe mental illness

This study examined the integration of two evidence-based practices for adults with severe mental illness: Assertive community treatment (ACT) and illness management and recovery (IMR) with peer specialists as IMR practitioners. Two of four ACT teams were randomly assigned to implement IMR. Over 2 years, the ACT-IMR teams achieved moderate fidelity to the IMR model, but low penetration rates: 47 (25.7%) consumers participated in any IMR sessions and 7 (3.8%) completed the program during the study period. Overall, there were no differences in consumer outcomes at the ACT team level; however, consumers exposed to IMR showed reduced hospital use over time.

A clinical trial of peer-based culturally responsive person-centered care for psychosis for African Americans and Latinos

BACKGROUND

Providing culturally competent and person-centered care is at the forefront of changing practices in behavioral health. Significant health disparities remain between people of color and whites in terms of care received in the mental health system. Peer services, or support provided by others who have experience in the behavioral health system, is a promising new avenue for helping those with behavioral health concerns move forward in their lives.

PURPOSE

We describe a model of peer-based culturally competent person-centered care and treatment planning, informed by longstanding research on recovery from serious mental illness used in a randomized clinical trial conducted at two community mental health centers.

METHODS

Participants all were Latino or African American with a current or past diagnosis within the psychotic disorders spectrum as this population is often underserved with limited access to culturally responsive, person-centered services. Study interventions were carried out in both an English-speaking and a Spanish-speaking outpatient program at each study center. Interventions included connecting individuals to their communities of choice and providing assistance in preparing for treatment planning meetings, all delivered by peer-service providers. Three points of evaluation, at baseline, 6 and 18 months, explored the impact of the interventions on areas such as community engagement, satisfaction with treatment, symptom distress, ethnic identity, personal empowerment, and quality of life.

CONCLUSIONS

Lessons learned from implementation include making cultural modifications, the need for a longer engagement period with participants, and the tension between maintaining strict interventions while addressing the individual needs of participants in line with person-centered principles. The study is one of the first to rigorously test peer-supported interventions in implementing person-centered care within the context of public mental health systems.

Awareness of early warning signs and help-seeking behaviours among patients with schizophrenia who utilize social rehabilitation facilities in Japan

The purpose of this study was to examine the relationship between early warning signs (EWS) and early help-seeking behaviours (HSB) and to identify the characteristics of patients with schizophrenia who sought early help. A cross-sectional study was carried out in 2004 using a self-reported questionnaire. Participants were recruited from social rehabilitation facilities for the mentally ill; 224 subjects participated, 170 of whom had schizophrenia. The survey included questions about demographic characteristics, self-care behaviours (HSB, recognition of EWS and others) and current service utilization and satisfaction. Fisher's exact test and Student's t-test were used to compare the characteristics of study participants. Logistic regression analyses were used to examine the association between recognition of EWS and early HSB.We found that 96 (56.5%) of 170 patients with schizophrenia reported at least one occasion of early HSB during their deterioration. Early HSB were related to the following factors: recognition of EWS, consultation with non-professional and professional support persons during deterioration, consulting with public mental health workers and living with family. Care and support should be offered to patients with schizophrenia to enable them to recognize their own mental deterioration.

A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems

BACKGROUND

A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components.

METHODS

We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery.

RESULTS

We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation).

CONCLUSION

Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.

Implementation of the Strengths Model at an area mental health service

OBJECTIVE

The objectives of this paper are to provide an overview of recovery-focused models of care and discuss the implementation of the Strengths Model at St. Vincent's Mental Health Melbourne (SVMH), Victoria, Australia.

CONCLUSIONS

The implementation of the Strengths Model at SVMH is discussed with particular emphasis on the process of implementation, service implications, practical challenges and dilemmas that have arisen, and proposed evaluation. Recovery-focused care is feasible and can enhance current practice of mental health services.

Self-efficacy and self-care: missing ingredients in health and healthcare among adults with serious mental illnesses

To help inform the design of a self-management intervention for improving the physical health of adults with serious mental illnesses, we conducted focus groups about their perceived medical care and physical health needs. Adults with serious mental illnesses participated in four semi-structured focus groups conducted at a transitional living facility, a social club, and a Hispanic outpatient mental health clinic. Questions included their recent experiences of seeking medical care, the effect of having a mental illnesses diagnosis, strategies for active self-care, and perceived barriers to better physical health. In addition to various systemic barriers to better medical care, participants articulated limited knowledge and self-efficacy regarding active self-management of their physical health. Despite their interest in learning more about health promotion, most participants expressed a sense of personal futility and powerlessness in improving their health. These data suggest that any effort to improve the wellbeing of these adults will need to address self-efficacy in the hope of improving self-care for their physical health needs.

Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia

BACKGROUND

We evaluated the cross-sectional and longitudinal association of measures of both insight and attitudes toward medication to outcomes that included psychopathology and community functioning.

METHODS

Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) was a large 18-month follow-up study pharmacotherapy of people with schizophrenia. Insight was measured using the Insight and Treatment Attitudes Questionnaire and attitudes toward medication by the Drug Attitude Inventory. Widely known scales were used to assess symptoms of schizophrenia and depression and community functioning. Medication adherence was globally assessed by the treating psychiatrist using several sources of information. Bivariate correlations and mixed model regression analyses were used to test the relationship of insight and medication attitudes to outcomes at baseline and during the follow-up period. Regression models were used to evaluate the relationship between change in insight and medication attitudes and changes outcomes.

RESULTS

There was a significant relationship at baseline between insight and drug attitudes and symptoms of schizophrenia and depression, as well as with community functioning. Higher levels of insight at baseline were significantly associated with lower levels of schizophrenia symptoms at follow-up while more positive medication attitudes were significantly associated with both lower symptom levels and better community functioning. Change in insight scores over time was associated with declining schizophrenia symptoms but increasing levels of depression. Change toward more positive medication attitudes was associated, independently of changes in insight, with significant decreases in psychopathology, improvement in community functioning, and greater medication compliance.

CONCLUSION

Greater patient understanding of their illness and more positive attitudes toward medication may improve outcomes. Educational interventions that affect these attitudes may be an important part of psychosocial rehabilitation and/or recovery-oriented services.

[Psychiatric advance directives and the role of autonomy]

Although psychiatric advance directives (PADs) are grounded in the ethics of autonomy, the relationship between the two is unclear. PADs are legal documents that allow individuals with mental illness to record their treatment preferences should they become incompetent in the future. The relationship between autonomy and PADs has been discussed in ethical, legal, and philosophical terms, but has not been clearly operationalized for clinical purposes. Autonomy is a fundamental ethical value that includes having the independence from outside controlling influences and the mental capacity to direct one's personal actions. Individuals with mental illness sometimes require assistance to understand their ethical and legal rights with respect to autonomous choice, and professional stakeholders need education regarding the importance of autonomy for clinical practice. Competency to consent to treatment is the mental prerequisite that ensures individuals with mental illness are able to complete PADs with insight, whereas autonomy is the value that empowers individuals to work towards their recovery.

Call it a monster for lack of anything else: narrative insight in psychosis

Individuals diagnosed with schizophrenia often appear to be unaware of having an illness or actively reject their diagnostic label. It is unclear, however, how this lack of awareness relates to important outcomes. Broadening the definition of awareness to include "narrative insight" may clarify this issue. The objective of this study was to identify profiles of narrative insight and test how these relate to standardized measure of insight. Sixty-five individuals with schizophrenia spectrum disorders participated in an assessment that included the Scale of Unawareness of Mental Disorder (SUMD) and an in-depth semi-structured interview. Qualitative analysis revealed 5 central themes related to insight on the basis of which each interview was then rated. Cluster analysis of these ratings resulted in 4 profiles of narrative insight: (1) accepts illness/rejects label, (2) rejects illness/searches for a name (3) passive insight of illness and label, and (4) integrative insight. The SUMD differentiated between individuals assigned to profile 2 who showed low insight to their illness and those assigned to the other profiles of narrative insight, but could not differentiate between them. Results support the claim that illness narratives are multifaceted and that traditional measures of insight may not be sensitive to different ways in which people understand their illness.

The graduated recovery intervention program for first episode psychosis: treatment development and preliminary data

The Graduated Recovery Intervention Program (GRIP) is a novel cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. In this paper, the treatment development process of GRIP is described and data from an open feasibility trial are presented. Findings suggest clinical and psychosocial benefits associated with GRIP, and the treatment was well-received by clients and therapists. The retention rate of 67%, however, suggests the need for protocol modifications to improve engagement. Initial data on the efficacy of GRIP are encouraging, although the study design precludes more robust conclusions at this time.

Relationship between functional capacity and community responsibility in patients with schizophrenia: differences between independent and assisted living settings

We examined factors potentially associated with level of community responsibility among middle-aged and older patients with schizophrenia. Participants in residential care facilities engaged in significantly fewer community responsibilities than those residing in the community. However, demographic and clinical characteristics did not explain these differences. Further, greater functional capacity was associated with greater community responsibility among participants residing in the community, but not those in residential care facilities. These results suggest that, despite capacity, patients residing in residential care facilities are not engaging in community responsibilities. Further, among participants residing in the community, functional capacity may predict level of responsibility.

The psychometric properties of the Illness Management and Recovery scale: client and clinician versions

The present study examined the psychometric properties of the clinician and client versions of the Illness Management and Recovery (IMR) scale. Using a 5-point behaviorally anchored response format, these scales were designed to tap the critical illness management and recovery domains targeted by the IMR program. This program is a curriculum-based approach to helping persons with a serious mental illness (SMI) acquire the knowledge and skills they need to manage their illness effectively and to achieve personal recovery goals. Two hundred and ten persons with a diagnosis of a SMI and their 13 clinicians filled-out the client and clinician versions of the IMR questionnaire. The clients also responded to measures of coping efficacy and social support. While indicating limitations of the IMR scales and pointing to how they could be improved, this study provided some support for the construct and concurrent validity of the client and clinician versions of the IMR questionnaire. Moderate reliabilities were uncovered for these parallel versions of the questionnaire. Client responses to the client IMR scale and clinician responses to the clinician IMR scale were shown to be characterized by similar major components of the IMR intervention.

Conceptualising Recovery in Mental Health Rehabilitation

Recovery as a concept has gained increased attention in the field of mental health. There is an expectation that service providers use a recovery framework in their work. This raises the question of what recovery means, and how it is conceptualised and operationalised. It is proposed that service providers approach the application of recovery principles by considering systematically individual recovery goals in multiple domains, encompassing clinical recovery, personal recovery, social recovery and functional recovery.

This approach enables practitioners to focus on service users' personal recovery goals while considering parallel goals in the clinical, social, and role-functioning domains. Practitioners can reconceptualise recovery as involving more than symptom remission, and interventions can be tailored to aspects of recovery of importance to service users.

In order to accomplish this shift, practitioners will require effective assessments, access to optimal treatment and care, and the capacity to conduct recovery planning in collaboration with service users and their families and carers. Mental health managers can help by fostering an organisational culture of service provision that supports a broader focus than that on clinical recovery alone, extending to client-centred recovery planning in multiple recovery domains.

Clinical trial of wellness training: health promotion for severely mentally ill adults

This randomized controlled trial examined benefits of adding active health promotion to basic primary care (BPC) services for SMI adults. It compared BPC with BPC plus wellness training (WT), a 12 months intervention promoting individual skills in self-management. Three hundred nine participants enrolled during short-term residential treatment completed baseline assessments and were assigned to treatment groups, before discharge. Outcomes of perceived health status (SF-36), global assessment of function, and ratings of self-efficacy were assessed at follow-up interviews at 6, 12, and 18 months. The intent-to-treat analysis employed multilevel regression to examine differences by group on outcomes across time, controlling for health related covariates. The WT group showed significantly better outcomes on the SF-36 physical functioning and general health scales. Findings affirm ability of SMI adults to benefit from active health promotion.

Measuring illness management outcomes: a psychometric study of clinician and consumer rating scales for illness self management and recovery

Psychometric properties of the Illness Management and Recovery (IMR) Scales (consumer and clinician versions), new 15-item instruments measuring illness self-management and pursuit of recovery goals, were evaluated in consumers with severe mental illness. Both versions had moderate internal consistency and high 2-week test-retest reliability. In addition, the consumer version was correlated with self-ratings of recovery and symptoms, and the clinician version was correlated with clinician ratings of community functioning, indicating convergent validity. The results suggest the IMR Scales have adequate psychometric properties and may be useful in treatment planning and assessing recovery in individuals with severe mental illness.