Purpose

To lay out the basic principles and practice of a Relapse Prevention intervention

What is Relapse Prevention?

Relapse prevention refers to the work that should go into setting up plans to maintain good mental health once an acute crisis has been brought under control.

Unfortunately it is a fact that many mental health conditions recur, although this is not inevitable. May factors contribute to determining whether or not a mental health condition recurs - some are not easily 'treated' (for instance a strong genetic predisposition), where as others can be addressed. In particular, some of the the commonest TRIGGERS can be learned, and avoided (commonly these are things like high stress, sleep deprivation, drug or alcohol use, and high Expressed Emotion in families.)

First

Check that the present is seen as preferable to the recent past (Reviewing change):

Introducing Relapse Prevention

"You have done really well in the way you (and your family) have responded to such a difficult time - and I am really glad you say you are feeling things are a bit better. Now, here is the headline... GETTING WELL is very important, and it seems to us that you are doing very well at that... but now we need to think about something that is at least as important, and that is the tricky business of STAYING WELL - because we know from working with lots of young people with similar problems to your own that these problems can have an annoying habit of coming back again if we don't spend some time fixing up a plan to prevent that... Do you think you are up for doing some simple stuff about helping yourself to stay well?

Relapse prevention consists of 2 key steps, and then there is always useful FamilyWork to support this:

1. RELAPSE SIGNATURE

Agreeing on and define the likely RELAPSE SIGNATURE is a key piece of work.

An individual's relapses tend to unfold in similar ways across time (though they are by no means always the same.) Work with the young person and network to uncover:

"What did the last deterioration into symptoms [be they psychosis, substance misuse, etc...] look like?"

Gather information from the client's perspective and then question others to get family/friends' persectives.

Using the Sort Cards (see below) the young person and therapist can invite trusted family members to comment on whether there were other signs/symptoms that may have been more noticeable to outside observers than the young person themself at that time.

1. Use Sort Cards with multiple symptoms/difficulties printed on them - see Sort Cards for how to do this.
2. Divide the resultant timeline into Early signs ("Amber"), and Late signs ("Red"), as well as Crisis signs ("Blue light") if required.

2. Crisis Contingency Plans

How to draw these up is outlined in Crisis Contingency Planning. Plans should be agreed for the future, relating to each of these phases of a "typical" relapse, so that a ladder of responses is agreed, appropriate to each step of a deterioration.

(a) Print small laminated crisis cards:
Put the colour-coded signs/symptoms on one side of a small laminated card, and the Crisis Contingency Planning on the other side.

(b) Consider circulation list for these cards:

1. Client ("I don't expect you to carry it around in your wallet (though you could!) but you could maybe put it in that drawer in your bedroom where you tend to put important bits and pieces - you know the kind of place? - somewhere where you would know where to find it if you did need it again."
2. G.P.
3. Family members
4. Friend?

3. Family work

Helping the family to Mentalize a young person who has had mental health problems more accurately and reliably is important - not least because evidence strongly suggests that reducing Expressed Emotion in families is a powerful intervention to reduce relapse.

This work will consist of FamilyWork, but usually with a special emphasis on PsychoEducation.