Illness Management and Recovery

Omschrijving

This introductory chapter reviews various aspects and themes related to the main subject of this dissertation. The focus is on the origins of Illness Management and Recovery (IMR). Particularly in the United States, after the deinstitutionalization of large state hospitals, many outpatient care innovations emerged for people with s vere and persistent mental illness (SMI) under the heading of community care. An increasing number of these innovative outpatient services were based on two principles: the use of recovery orientation and demonstrated evidence for effectiveness.

Long-term care, illness management, rehabilitation, and recovery

Epidemiology
People are regarded as having SMI if they have a long-term psychiatric disorder that involves serious impairments in social and/or community functioning requiring multidisciplinary professional care to achieve a treatment plan. These impairments are both cause and effect (1). SMI is not diagnosis specific. 

Most people with SMI (60%) are diagnosed with schizophrenia or other psychotic disorders, 10% have a primary diagnosis of substance addiction, and 30% have another primary diagnosis (1). SMI also includes diagnoses such as bipolar disorder and major depression, and comorbid disorders are often present such as addiction, personality disorder, or pervasive developmental disorder (1). Comorbidity with physical diseases also occurs, including cardiovascular diseases, diabetes, cancer, and obesity (2). These physical diseases may substantially reduce life expectancy (3). In 2017, the prevalence of SMI in the Netherlands was estimated to be 1.7% of the population (~281,000 people). Of these individuals, approximately 210,700 are under care (4).

New perspectives for people with SMI
People with schizophrenia and other SMIs face major challenges in achieving their personal goals and fully participating in society. Although they have the same aspirations as others, their wishes are more difficult to realize because of recurring symptoms, cognitive impairment, loss of social support, and societal barriers such as stigma (5, 6). For a long time, people with SMI were thought to have little chance for improvement. Many relied on long-term stays in psychiatric hospitals. However, by the 1970s and 1980s, the mental health paradigm changed to deinstitutionalization and community care.