Serious Mental Illness (SMI)

SMI exacts a high toll on society, both in terms of direct and indirect costs of health care, lost productivity, and the suffering of afflicted individuals and their families. Mental health provider organizations are charged with transforming the services they provide to improve the outcomes of people with SMI. To address these needs, policy makers are increasingly focused on improving the quality of treatment for SMI. Much of this emphasis has been stimulated by the development of higher standards for care within the research community (Lehman, et al, 1998), coupled with the fact that such evidence-based practices are rarely available to most consumers (Lehman & Steinwachs, 1998a).

Disparities between the latest research advances and actual clinical practice have been further highlighted in the Bridging Science and Service Report (NIMH, 1999), the Surgeon General's Report (Surgeon General, 2000), and most recently, the President's New Freedom Commission Report (2003). Indeed, the Commission has called for a transformation of the mental health system and argues for a system focused on consumers and their families as partners, with shared decision-making and access to high quality treatment based on the best evidence-based practices. There is also agreement that the mental health care system should focus on concepts such as recovery and resilience, not just managing symptoms. Prospectively, healthcare organizations need to help consumers "live, work, learn, and participate fully in their communities" (President's New Freedom Commission Report, 2003).

Illness Management and Recovery (IMR)

IMR is a standardized intervention designed to help people with severe mental illness set personally meaningful goals based on their own concept of “recovery,” and then to learn strategies for managing their illness more effectively in the process of pursuing those goals.

The IMR program incorporates four empirically supported strategies for teaching people how to manage a severe mental illness, including psychoeducation about the disorder and its treatment, cognitive-behavioral methods to include taking medication as part of the individual’s daily routine, developing a relapse prevention plan, and teaching coping skills for persistent symptoms.

The program is organized into Ten Modules that can be taught in an individual or group format, and usually requires 9-10 months of weekly sessions to complete. Research supports the feasibility of implementing the IMR program in routine mental health treatment settings, and suggests it is effective at improving illness self-management and functioning.

IMR Conceptual Framework

Substance Abuse and Mental Health Services Administration (SAMHSA)

IMR is the first comprehensive, evidence-based, self-management training program supported and selected by SAMHSA (Substance Abuse & Mental Health Services Administration) for national dissemination. SAMHSA is a division of the US Department of Health and Human Services. In 2006, SAMHSA released a revised version of the IMR Toolkit.

Cost and Workflow Inefficiencies of Paper-Based IMR on Mental Health Service Systems

The paper-based IMR program (e.g. workbooks and manuals) has been applied in many demonstration and evaluation projects. However, reliance on paper-based implementation has proven relatively labor intensive and costly for many public health programs. In addition, the accessibility of the paper-based IMR program is limited by the number of trained clinicians who can efficiently provide the intervention.

Public health systems, which provide most of the care for those with SMI, are commonly over-burdened. And, although per-capita reimbursements are substantial, budgets are still too small to provide all consumers with the treatments they need. Accordingly, large caseloads decrease the quality of care provided, resulting in poor access and lack of assistance available to aid consumers in navigating through the medical, entitlement, and insurance systems (Lehman, 1999). Finally, front-line providers charged with delivering care to the SMI population often do not possess the required competencies, meaning the knowledge, attitudes, and skills necessary to deliver care that is consistent with successful illness management and recovery (Young et al., 2000).

Web-Based Illness Management and Recovery (IMR-Web)

NeuroComp Systems is now developing a computerized, web-based version of the IMR program. This effort is supported by the National Institute of Mental Health (NIMH), in partnership with IMR developers. IMR-Web has the potential to revolutionize care for people with SMI.

• Electronic data capture at the point-of-care with consumers/patients.
• Centralized IMR program management, database and reporting services.
• A high degree of standardization of services delivery.
• Increased consumer involvement.
• Reduced clinical resource requirements for provider organizations.
• Tracking short- and long-term client progress through:
• Integrated assessments
• Intrinsic compliance and wellness indicators
• Automated support services
• Integration of the IMR-Web database with electronic medical record systems.
• Active promotion of medication adherence through computerized utilities.

Overall, IMR-Web enables broad implementation and utilization of IMR in managed care and state administered mental health care institutions. Importantly, IMR-Web does not replace clinicians, but will substantially reduce the demands for clinician time.

IMR-Web: An Enterprise Level Solution for Implementing Recovery Services

The IMR-Web infrastructure is ideal for large scale, distributed services delivery.

IMR-Web Service Delivery Modalities

IMR-Web services can be delivered in various modalities including: individually online, face-to-face, 1-to-1 individual televideo, and 1-to-many group televideo.

In the individual account access mode, an individual user can access various system resources, including their progress reports, charts on goal and homework tracking, and educational video materials. The user can log in from anywhere to review their goals, homework, or program resources.

The clinician will be present at all times during the face-to-face IMR-Web session mode.

Televideo services enabling IMR clinical practitioners to remotely conduct IMR sessions individually and in groups through a wideband web connection.

IMR-Web Implementation

IMR-Web will be implemented by an enterprise-scale IT infrastructure designed to meet the needs of consumers and providers.

IMR-Web Development Sponsorship and Collaborators

IMR-Web is supported by the National Institute of Mental Health (NIMH) in partnership with IMR developers.