Illness Management and Recovery (IMR) Scale

Abstract

The Illness Management and Recovery (IMR) Scale is a specialized assessment tool developed to measure outcomes associated with participation in the Illness Management and Recovery program, an evidence-based practice designed for individuals living with serious mental illnesses. The scale provides a dual perspective, featuring both a client self-rating version and a corresponding clinician rating version. It systematically assesses the individual’s progress across core domains critical to personal recovery, including goal attainment, knowledge of their illness and treatment, social functioning, and effective coping strategies.

Keywords

Illness Management and Recovery, IMR, mental health, psychological assessment, self-management, recovery scale, symptom distress, functioning impairment, relapse prevention, psychiatric hospitalization.

Authors

Mueser, K.T., Gingerich, S., Salyers, M.P., McGuire, A.B., Reyes, R.U., and Cunningham, H.

Purpose

The primary purpose of the IMR Scale is to longitudinally track the progress and effectiveness of the Illness Management and Recovery intervention program. By collecting data from both the client’s perspective (self-rating) and the provider’s perspective (clinician rating), the scale offers a robust measure of changes in key recovery indicators. This instrument helps service providers monitor whether clients are successfully integrating self-management principles, improving their functional status, and reducing the impact of symptoms and substance use on their daily lives. It serves as an essential tool for program evaluation and clinical monitoring in community mental health settings.

Construct

The IMR Scale measures several interrelated components central to the Illness Management and Recovery (IMR) model. These components collectively form the construct of active self-management and functional recovery from severe mental illness. The scale dimensions include:

• Goal Attainment: Measuring active progress toward achieving personal recovery goals.
• Illness Knowledge: Assessing understanding of symptoms, treatment, and medication.
• Functional Status: Evaluating the degree of symptom distress and impairment of functioning in daily life.
• Relapse Prevention: Gauging the client’s knowledge and implementation of a formal Relapse Prevention plan.
• Social and Structured Involvement: Quantifying contact with people outside the immediate family and time spent in meaningful, structured roles (e.g., work, volunteering).
• Substance Use Impact: Measuring the degree to which alcohol or drug use interferes with overall functioning.
• Medication Adherence and Coping: Assessing effective use of prescribed medication and overall coping ability.

Validity

Research, such as the study conducted by Hasson-Ohayon, Roe, and Kravetz (2007), has investigated the psychometric properties of the IMR Scale. These studies generally support the scale’s validity, demonstrating that it measures the intended constructs—specifically, the core elements of illness management and recovery. Both the client and clinician versions are designed to capture concurrent changes in areas like functioning and goal progress, which are expected outcomes of IMR interventions.

The scale’s content validity is supported by its direct alignment with the five core components of the IMR program model: psychoeducation, relapse prevention, social support strategies, coping skills training, and health goals. The items are structured to assess behaviors and self-perceptions directly related to these intervention targets.

Reliability

Psychometric evaluations have generally indicated adequate to good reliability for the IMR Scales. The internal consistency of the subscales and the overall measure is typically examined using metrics like Cronbach’s alpha, confirming that the items within the scale consistently measure the same underlying construct. Furthermore, the two versions of the scale (Client and Clinician) allow for the assessment of inter-rater reliability, which is crucial for determining consistency between the client’s subjective experience and the clinician’s objective observation of progress.

Factor Analysis

While specific factor analytic results are not provided in the source content, studies examining the psychometric structure of the IMR Scale, such as Hasson-Ohayon et al. (2007), typically employ factor analysis to confirm the dimensionality of the instrument. The goal is to determine if the 15 items cluster into theoretically sound factors (e.g., self-efficacy, symptom management, social integration) that correspond to the domains of mental health treatment and recovery. Establishing a clear factor structure ensures that the scale provides meaningful, distinct scores for different aspects of recovery.

Instrument

Test Type: Outcome and Process Measure (Self-Report and Observer Rating)

Format: 15 items, typically administered using a 5-point Likert-type scale, measuring behaviors and perceptions over the past 3 months or the past year.

Language Available: English (Original version); translations may exist based on international use of the IMR program.

Population Group: Individuals with serious mental illnesses (SMI), such as schizophrenia, bipolar disorder, or major depressive disorder.

Age Group: Adults.

Population Details: Clients actively participating in or having recently completed structured psychiatric rehabilitation or recovery programs.

Test Methodology: The scale consists of two parallel forms: a Client Self-Rating form completed by the individual and a Clinician Rating form completed by the treating mental health professional. The instrument assesses both subjective experiences (e.g., symptom distress, coping effectiveness) and objective outcomes (e.g., recent Psychiatric Hospitalizations, time spent in structured roles).

Keywords

Psychiatric rehabilitation, SMI, objective outcomes, self-efficacy, adherence, substance abuse, social support, structured roles, quality of life, assessment tool.

Authors

Author ORCID Identifier: Not provided in source.

Affiliation Email addresses: [email protected]

Correspondence Address: New Hampshire-Dartmouth Psychiatric Research Center (as per the 2004 reference).

Permissions & Fee and Test Year

The scale was initially published in 2004 by Mueser et al. Permissions for use are typically managed through the New Hampshire-Dartmouth Psychiatric Research Center, where the scale originated. Users should consult the original authors or affiliated institution for the most current information regarding usage fees and formal permission requirements for clinical or research implementation.

Reference’s

• Bullock, W.A., O’Rourke, M., Farrer, E., Breedlove, A., Smith M.K., & Claggett, A. (2005, August). Evaluation of the Illness Management and Recovery (IMR) Program. Presented at the 113th annual meeting of the American Psychological Association Meeting, Washington, D.C.
• Hasson-Ohayon I, Roe D, Kravetz S. (2007). The psychometric properties of the illness management and recovery scale: Client and clinician versions. Psychiatry Research; 160:228-235.
• Mueser, K.T., Gingerich, S., Salyers, M.P., McGuire, A.B., Reyes, R.U., and Cunningham, H. (2004). The Illness Management and Recovery (IMR) Scales (Client and Clinician Versions). Concord, NH: New Hampshire- Dartmouth Psychiatric Research Center.

The original PDF can be downloaded here: https://www.power2u.org/downloads/pn-55.pdf

Items of the Illness Management and Recovery (IMR) Scale

Client Self-Rating

1. Progress towards personal goals: In the past 3 months, I have come up with…

1. No personal goals
2. A personal goal, but have not done anything to finish my goal.
3. A personal goal and made it a little way toward finishing it.
4. A personal goal and have gotten pretty far in finishing my goal.
5. A personal goal and have finished it.

2. Knowledge: How much do you feel like you know about symptoms, treatment, coping strategies (coping methods), and medication?

1. Not very much
2. A little
3. Some
4. Quite a bit
5. A great deal

3. Involvement of family and friends in my mental health treatment: How much are family members, friends, boyfriend/girlfriend, and other people who are important to you (outside your mental health agency) involved in your mental health treatment?

1. Not at all
2. Only when there is a serious problem
3. Sometimes, like when things are starting to go badly
4. Much of the time
5. A lot of the time and they really help me with my mental health

4. Contact with people outside of my family: In a normal week, how many times do you talk to someone outside of your family (like a friend, co-worker, classmate, roommate, etc.)

1. 0 times/ week
2. 1-2 times/ week
3. 3-4 times/ week
4. 6-7 times/ week
5. 8 or more times/ week

5. Time in Structured Roles: How much time do you spend working, volunteering, being a student, being a parent, taking care of someone else or someone else’s house or apartment? That is, how much time do you spend in doing activities for or with another person that are expected of you? (This would not include self care or personal home maintenance.)

1. 2 hours or less/ week
2. 3-5 hours/ week
3. 6 to 15 hours/ week
4. 16-30 hours/ week
5. More than 30 hours/ week

6. Symptom distress: How much do your symptoms bother you?

1. My symptoms really bother me a lot.
2. My symptoms bother me quite a bit.
3. My symptoms bother me somewhat.
4. My symptoms bother me very little.
5. My symptoms don’t bother me at all.

7. Impairment of functioning: How much do your symptoms get in the way of you doing things that you would like to or need to do?

1. My symptoms really get in my way a lot.
2. My symptoms get in my way quite a bit.
3. My symptoms get in my way somewhat.
4. My symptoms get in my way very little.
5. My symptoms don’t get in my way at all.

8. Relapse Prevention Planning: Which of the following would best describe what you know and what you have done in order not to have a relapse?

1. I don’t know how to prevent relapses.
2. I know a little, but I haven’t made a relapse prevention plan.
3. I know 1 or 2 things I can do, but I don’t have a written plan
4. I have several things that I can do, but I don’t have a written plan
5. I have a written plan that I have shared with others.

9. Relapse of Symptoms: When is the last time you had a relapse of symptoms (that is, when your symptoms have gotten much worse)?

1. Within the last month
2. In the past 2 to 3 months
3. In the past 4 to 6 months
4. In the past 7 to 12 months
5. I haven’t had a relapse in the past year

10. Psychiatric Hospitalizations: When is the last time you have been hospitalized for mental health or substance abuse reasons?

1. Within the last month
2. In the past 2 to 3 months
3. In the past 4 to 6 months
4. In the past 7 to 12 months
5. I haven’t been hospitalized in the past year

11. Coping: How well do feel like you are coping with your mental or emotional illness from day to day?

1. Not well at all
2. Not very well
3. Alright
4. Well
5. Very well

12. Involvement with self-help activities: How involved are you in consumer run services, peer support groups, Alcoholics Anonymous, dr‎op-in centers, WRAP (Wellness Recovery Action Plan), or other similar self-help programs?

1. I don’t know about any self-help activities
2. I know about some self-help activities, but I’m not interested
3. I’m interested in self-help activities, but I have not participated in the past year
4. I participate in self-help activities occasionally.
5. I participate in self-help activities regularly.

13. Using Medication Effectively: (Don’t answer this question if your doctor has not prescribed medication for you). How often do you take your medication as prescribed?

1. Never
2. Occasionally
3. About half the time
4. Most of the time
5. Every day

14. Functioning affected by alcohol use. Drinking can interfere with functioning when it contributes to conflict in relationships, or to money, housing and legal concerns, to difficulty showing up at appointments or paying attention during them, or to increased symptoms. Over the past 3 months, how much did drinking get in the way of your functioning?

1. Alcohol use really gets in my way a lot
2. Alcohol use gets in my way quite a bit
3. Alcohol use gets in my way somewhat
4. Alcohol use gets in my way very little
5. Alcohol use is not a factor in my functioning

15. Functioning affected by drug use. Using street drugs, and misusing prescription or over-the-counter medication can interfere with functioning when it contributes to conflict in relationships, or to money, housing and legal concerns, to difficulty showing up at appointments or paying attention during them, or to increased symptoms. Over the past 3 months, how much did drug use get in the way of your functioning?

1. Drug use really gets in my way a lot
2. Drug use gets in my way quite a bit
3. Drug use gets in my way somewhat
4. Drug use gets in my way very little
5. Drug use is not a factor in my functioning

***********************************************

Clinician Rating

1. Progress toward goals: In the past 3 months, s/he has come up with…

1. No personal goals
2. A personal goal, but has not done anything to finish the goal
3. A personal goal and made it a little way toward finishing it
4. A personal goal and has gotten pretty far in finishing the goal
5. A personal goal and has finished it

2. Knowledge: How much do you feel your client knows about symptoms, treatment, coping strategies (coping methods), and medication?

1. Not very much
2. A little
3. Some
4. Quite a bit
5. A great deal

3. Involvement of family and friends in his/her mental health treatment: How much are people like family, friends, boyfriends/girlfriends, and other people who are important to your client (outside the mental health agency) involved in his/her treatment?

1. Not at all
2. Only when there is a serious problem
3. Sometimes, like when things are starting to go badly
4. Much of the time
5. A lot of the time and they really help with his/her mental health

4. Contact with people outside of the family: In a normal week, how many times does s/he talk to someone outside of her/his family (like a friend, co-worker, classmate, roommate, etc.)?

1. 0 times/ week
2. 1-2 times/ week
3. 3-4 times/ week
4. 6-7 times/ week
5. 8 or more times/ week

5. Time in Structured Roles: How much time does s/he spend working, volunteering, being a student, being a parent, taking care of someone else or someone else’s house or apartment? That is, how much time does s/he spend in doing activities for or with another person that are expected of him/her? (This would not include self-care or personal home maintenance.)

1. 2 hours or less/ week
2. 3-5 hours/ week
3. 6 to 15 hours/ week
4. 16-30 hours/ week
5. More than 30 hours/ week

6. Symptom distress: How much do symptoms bother him/her?

1. Symptoms really bother him/her a lot
2. Symptoms bother him/her quite a bit
3. Symptoms bother him/her somewhat
4. Symptoms bother him/her very little
5. Symptoms don’t bother him/her at all

7. Impairment of functioning: How much do symptoms get in the way of him/her doing things that s/he would like to do or needs to do?

1. Symptoms really get in her/his way a lot
2. Symptoms get in his/her way quite a bit
3. Symptoms get in his/her way somewhat
4. Symptoms get in his/her way very little
5. Symptoms don’t get in his/her way at all

8. Relapse Prevention Planning: Which of the following would best describe what s/he knows and has done in order not to have a relapse?

1. Doesn’t know how to prevent relapses
2. Knows a little, but hasn’t made a relapse prevention plan
3. Knows 1 or 2 things to do, but doesn’t have a written plan
4. Knows several things to do, but doesn’t have a written plan
5. Has a written plan and has shared it with others

9. Relapse of Symptoms: When is the last time s/he had a relapse of symptoms (that is, when his/her symptoms have gotten much worse)?

1. Within the last month
2. In the past 2 to 3 months
3. In the past 4 to 6 months
4. In the past 7 to 12 months
5. Hasn’t had a relapse in the past year

10. Psychiatric Hospitalizations: When is the last time s/he has been hospitalized for mental health or substance abuse reasons?

1. Within the last month
2. In the past 2 to 3 months
3. In the past 4 to 6 months
4. In the past 7 to 12 months
5. No hospitalization in the past year

11. Coping: How well do feel your client is coping with her/his mental or emotional illness from day to day?

1. Not well at all
2. Not very well
3. Alright
4. Well
5. Very well

12. Involvement with self-help activities: How involved is s/he in consumer run services, peer support groups, Alcoholics Anonymous, dr‎op-in centers, WRAP (Wellness Recovery Action Plan), or other similar self-help programs?

1. Doesn’t know about any self help activities
2. Knows about some self-help activities, but isn’t interested
3. Is interested in self-help activities, but hasn’t participated in the past year
4. Participates in self-help activities occasionally
5. Participates in self-help activities regularly

13. Using Medication Effectively: (Don’t answer this question if her/his doctor has not prescribed medication). How often does s/he take his/her medication as prescribed?

1. Never
2. Occasionally
3. About half the time
4. Most of the time
5. Every day
6. _____ Check here if the client is not prescribed psychiatric medications.

14. Impairment of functioning through alcohol use: Drinking can interfere with functioning when it contributes to conflict in relationships, or to financial, housing and legal concerns, to difficulty attending appointments or focusing during them, or to increases of symptoms. Over the past 3 months, did alcohol use get in the way of his/her functioning?

1. Alcohol use really gets in h er/his way a lot
2. Alcohol use gets in his/her way quite a bit
3. Alcohol use gets in his/her way somewhat
4. Alcohol use gets in his/her way very little
5. Alcohol use is not a factor in his/her functioning

15. Impairment of functioning through drug use: Using street drugs, and misusing prescription or over-the-counter medication can interfere with functioning when it contributes to conflict in relationships, or to financial, housing and legal concerns, to difficulty attending appointments or focusing during them, or to increases of symptoms. Over the past 3 months, did drug use get in the way of his/her functioning?

1. Drug use really gets in her/his way a lot
2. Drug use gets in his/her way quite a bit
3. Drug use gets in his/her way somewhat
4. Drug use gets in his/her way very little
5. Drug use is not a factor in his/her functioning