Staying Well Relapse Prevention Advice for family and friends Mental Health Services for Older People We recognise that people can and do recover from spells of mental health and we are committed to doing all we can to help. We know that one of the concerns for people who experience mental ill health is the fear of relapse. The aim of this staying well/relapse prevention information booklet is to provide you with the necessary information about relapse and recovery. This booklet can be used in conjunction with recovery care plans, staying well plans, crisis plans and wellness recovery action plans. What is recovery? Recovery is a journey rather than an end point and involves more than just recovery from illness or the absence of symptoms. We promote recovery/relapse prevention by working in partnership with the person recovering from mental health illness and whoever they choose to involve in their care, for example family, friends and supporters. Recovery is person centred and tackles mental health challenges with hope and optimism, and recognising strengths and aspirations to enable a positive lifestyle whilst overcoming mental health problems. There are five key recovery concepts that enable the management of risk or prevent relapse. Hope Personal responsibility Self advocacy Education Support Page 1 of 7
What is relapse? This simply means the worsening of symptoms that may be experienced or a return of symptoms associated with illness. Instead of the word relapse you may prefer to use words such as episode or being unwell. Some people feel that the only way to cope is to deny their experiences and forget that it ever happened, but control can be taken by understanding and getting to know what is happening. By doing this it may be possible to prevent a relapse. Staying well/relapse prevention is only one part of the recovery journey; however, it can help give a greater sense of stability as it can help reduce the need for hospital admission and means more control. Experiencing a relapse is undoubtedly an anxious time for those who are affected, their carers and their families and we feel that it is vital that support is available to restore wellbeing. Open discussions on what relapse looks like and feels like will ensure that all those involved in care are aware of how it occurs and the ways it can be prevented. Early warning signs The early warning signs of relapse can be individual or they can be recognised as identifiable symptoms of illness. Learning to identify these early warning signs helps reduce the incidence of relapse. These signs include changes in feelings, thoughts, or behaviour. By carefully monitoring early warning signs together with a trusted friend or relative, named nurse, a member of the Community Mental Health Team or General Practitioner, can help to improve control and prevent setbacks. Changes in feelings: Feeling anxious or restless Feeling sad or low Feeling tense Feeling irritable or aggressive Feeling depressed Feeling unsafe or threatened Feeling like you are being watched or talked about Feeling like you can t trust other people You may wish to make your own list of your relative/friend s early warning changes in thoughts Page 2 of 7
Changes in thoughts: Having difficulty concentrating or remembering things Having difficulty making decisions Confused thoughts Negative thoughts Hearing voices Thinking about harming themselves Thinking that they have special powers Thinking that they may be someone else Receiving personal messages from the TV or radio You may wish to make your own list of your relative/friend s early warning changes in thoughts Changes in behaviour: Not wanting to go outside or participate in activities Not seeing people Eating more or eating less Difficulty sleeping or sleeping too much Emotional outbursts such as crying, yelling or laughing Neglecting appearance Behaving aggressively Speech comes out jumbled and filled with odd words You may wish to make your own list of your relative/friend s early warning changes in behaviour Most people in the world will have one or more of these symptoms at one time or another, but it is not the individual symptoms themselves that are important, but the pattern of these symptoms. A named nurse, key worker or a member of the Community Mental Health Team will know most of the common, and some of the rarer illness signs and behaviour, and you may find these professionals are useful to talk to when signs of relapse are being identified. Page 3 of 7
It is worth remembering that other medical problems, such as asthma or diabetes, also have early symptoms that signal that a person should seek medical advice. Causes of relapse Relapse can occur for a number of reasons, as well as for no apparent reason. However, there are certain well known causes of relapse such as stress, low mood, not taking medication, use of drugs and alcohol, lack of social support or poor physical health. There are occasions when it is difficult to identify why relapse occurs, although it is always worthwhile looking at the circumstances, lifestyle and events leading up to your relative/friend becoming ill. Here are some things that can trigger a relapse: Not taking prescribed medication Unsettling events in life Bereavement Becoming overwhelmed by feelings and emotions Family/marital problems Feelings of guilt, anger, loneliness, abandonment, shame Fear and/or reaction to change Use of illicit drugs, for example cannabis, cocaine Excessive alcohol consumption Lack of routine and structure, for example; work, poor diet, lack of sleep Lack of exercise/relaxation What your relative/friend experienced before their last relapse? What should you do? It is very important to recognise signs of relapse before they worsen, as these signs are good indicators that there is a need to take proactive steps to prevent relapse. It is good to contact someone you trust and who understands the illness well and tell them your concerns. This could be a key worker, General Practitioner, a relative or friend, or even a neighbour. It is helpful if you have discussed the possibility of relapse with your relative or friend. Page 4 of 7
You may wish to write down the name of the person you would like to contact about your concerns How to help prevent a relapse? This really depends on individual circumstances and the severity of the illness. There are various ways to help prevent a relapse, for example: Proper medication Lifestyle habits Recognition of signs and symptoms Proper medication: Because everyone s experience is different, treatments will vary from person to person and it is not uncommon to have difficulty in finding a suitable medication. Sometimes more than one medication will have to be tried before finding one that will lead to long-term improvement in the condition. If the medication works, encourage your relative/friend to stay on it. It is important to remember that even if someone feels well and symptoms are under control, medication should not be stopped without consulting a General Practitioner or Consultant. Staying well is not the same as being cured. Medication needs to be taken to stay well. It is important to understand what medication is supposed to do, along with any side effects of medication. A pharmacist, General Practitioner or Consultant can explain these. Lifestyle habits: Lifestyle habits are an essential part of maintaining good mental health and should be encouraged. Minimise alcohol intake drink responsibly Take caffeine in moderation Take a well balanced diet Adequate rest or sleep, without excess, is also a necessary component of daily lifestyle Reduce stress levels by minimising stressful activities Keep in good physical health Establish a daily structure/routine Recognition of signs and symptoms: It is important to recognise individual signs and symptoms of relapse before mental health deteriorates. The signs are good indicators that are needed to take proactive steps to prevent a full relapse. It is good to talk to someone you trust and who will understand the illness well. They will assist you to get further help when necessary. Page 5 of 7
Try to keep records of previous episodes and this will help you identify events or situations that trigger relapse. It is important that, along with the named nurse, key worker or a member of the Community Mental Health Team, make an agreed plan of action for such an event. This may include using coping strategies which have worked in the past. Some suggestions of strategies that may be considered are: Relaxation techniques/exercise. Going for a walk/run/ swim. Write thoughts/feelings down. Challenge these and ask what evidence is there to support them. Are there any other explanations/ways of viewing the thoughts/ feelings? When coping with problems/stressors, help your family member/friend write the problem down then help them write all the possible strategies and help them select the best solution. Talking to someone involved in your relative/ friend s care, for example a help line, community worker. When you feel that your relative/friend is becoming unwell, it can be difficult to remember what coping strategies help. It may be helpful to write down a list of the things, which have helped in the past. Things that have helped your relative/friend in the past The important thing is that the plan is agreed upon by a relative/family member and is workable, although there are going to be times when the plan might need to be amended to reflect experiences encountered. Being well Preventing a relapse means continuing to stay well. What does being well mean? It means: The ability to trust thoughts The ability to function independently in day-to-day life To feel alert and alive To feel hopeful about the future The ability to have an active social life The ability to stay out of hospital It is important to remember that the person is not their illness. It is one aspect of who they are. Mental illness can be unpleasant, but a satisfying life can be lived in spite of it. Page 6 of 7
Leaflet developed by the Community Mental Health Team for Older People, NSH Tayside Reviewed: 11/2017 Review: 11/2019 LN0151 Page 7 of 7