Preventing relapse and promoting wellness in mental health
When you feel well, the last thing you want to think about is a relapse of a mental health difficulty. But you can do a lot to lower the risk of relapse if you plan ahead. Try thinking of it this way: if you have a physical injury, you would likely do things to enhance and aid recovery and prevent the injury from happening again. Preventing a relapse of a mental difficulty isn’t much different. You can learn a systematic way to monitor your well-being and take action when you need it.
What is a mental health relapse?
A “relapse” is when troubling symptoms come back or get worse. Fortunately, you can take a lot of steps to help prevent a relapse or worsening symptoms. No one can guarantee that you’ll never feel unwell again. But you can look for early warning signs, create a plan to help with difficult situations, and take steps to care for yourself. These steps may help you take action before symptoms become a major problem and help lessen the effect of symptoms on your day-to-day life. This is based on the principles of “self-management,” which means you taking charge of your health. It may sound daunting, but self-management is really about building small, practical steps into your day.
When it comes to preventing relapse, there are 3 parts to self-management;
- Identifying your warning signs,
- taking action,
- and seeking outside help when it’s needed.
The best time to do this is when you are well.
If you take medication it’s important to follow your doctor’s recommendations, even when you feel well. You may need to continue the medication for several months or longer, depending on your risk factors. Stopping medication too early or not taking as prescribed is a major reason for relapse. Think of a time you’ve had to take antibiotics for an infection. You probably felt better after a couple of days, but you still had to take the antibiotics for one or two weeks to help stop the infection returning. It’s the same thing for mental health medications. It’s very important to talk with your doctor if you want to make any changes to your medication plan, such as reducing your dose or stopping your medication.
Identifying early warning signs
An early warning sign is a sign that shows your health may be starting to get worse. These signs are the first signs to appear, before major symptoms begin to affect your life in a big way. The purpose of identifying your unique warning signs is to help you take action early. The act of identifying early warning signs can make some people nervous. After all, no one wants to remember difficult or unpleasant situations. It may be helpful to think of this exercise as an opportunity to take control of your health. When you identify your early warning signs, you give yourself the power to change and challenge the outcome.
To start identifying your early warning signs, you’ll need to think back on times when your symptoms were extremely difficult. How did it start? How did it progress? What did you experience? What kind of thoughts did you have? Did your behaviour change? Did anything happen in a particular order? It may also be helpful to ask loved ones for their feedback- people close to us often notice changes before we see changes in ourselves.
Now that you’ve thought about what your warning signs look like, think about what was happening in your life when you started to notice these changes. This will help you see when and where your warning signs start to happen. For example, do warning signs seem to come after working extra long hours or during conflict with others? These situations are called “triggers”. While everyone will have their own triggers, there are some common ones, for example:
- Poor sleep or not getting enough sleep
- Loss or grief
- Conflict amongst Loved ones
- An unpleasant event such as perceived failure, disappointment or criticism
- Other stressful events
- Over use of Alcohol and other drugs
- Not following through on your treatment plan (such as not taking prescribed medications)
- Other health problems or concerns
Now that you have your early warning signs and your triggers, it’s time to put everything together. Think back to your last episode. Can you tie your warning signs to a particular trigger or triggers? If you can, try to map out a timeline that shows your triggers and warning signs in order.
- Building healthy coping skills
- Identifying stressful situations
- Managing stressful situations
Building healthy coping skills
A big part of coping skills is a healthy lifestyle; healthy activities like eating well, exercising regularly, getting enough sleep and practicing relaxation exercises can have a significant impact on your mood and your ability to tackle challenges. Likewise, unhealthy activities can make mood problems worse. The goal is to make healthy sustainable changes –and commit to keeping up even during times of stress.
- Eating well—Food gives you energy, eating a well balanced diet help both your physical/mental health.
- Exercising regularly—Exercise has many positive benefits for mental health. Find an activity you enjoy. The goal is to exercise for at least short period of time on a regular basis. Remember, start with manageable, realistic goals and gradually increase your goals as you gain confidence.
- Getting enough sleep—Sleep plays a big part in mental health, watch sleep patterns, particularly when travelling, taking holidays or working long hours. Try to go to bed at the same time each night.
- Knowledge—Become an expert on your illness. Ask your team about the illness and its treatment. Many resources are available from our Information Centre here in St Patrick’s University hospital. Tel: Support & Info line 01 249 3333 or in our Learning & Resource Hub
- Relaxation skills—Activities such as walking, art, music or writing can be calming and relaxing. Find an activity that you enjoy doing and set aside time to have that space in your life.
- Healthy thinking skills—mental health issues can really affect the way you think about yourself, others and the world around you. Part of healthy coping is identifying and challenging thinking problems.
Managing stress is a big part of wellness. You can control some things that cause stress --- but it’s unlikely you can eliminate all stress from your life. Therefore establishing your stress and taking action to solve it reduces the effects on your wellbeing much quicker.
Managing stressful situations:
When you have identified your signs of stress and situations that may cause problems, it’s time to plan how to manage them. Healthy coping skills, including your toolbox of supports, are a good place to start.
Start slowly—If possible, add in new stress gradually, rather than all at once. For example if you want to go back to full time education, it may be possible to start with part-time courses.
Time for self-care—Remember, self-care is even more important when you are dealing with a stressful situation.
Cut back on ongoing responsibilities—Check in with yourself what ESSENTIAL responsibility is, it’s OK to let people know that you need to spend time on other things.
Make sure your own expectations are realistic—If you take on something new, it’s OK to cut back on something else.
Problem Solving Skills are useful when you’re facing a challenging situation. There are six basic steps.
- Define the Problem - Figure out what is causing the problem and how it’s causing problems.
- Set Goals - Decide what you want your solution to address, it’s important your goals are realistic.
- Think of Solutions - the more the merrier! Enlist supports of friends/family/ treatment services.
- Look at Pro’s and Con’s - Pick a few possible solutions and consider the positive and negatives of your choices.
- Pick ONE solution - Remember, it should describe who does what and what you want to achieve.
- Evaluate the results - After you put your plan into action, see if it worked or SOME of it worked, it may need to be changed slightly or you may need to try another approach.
Seeking outside help when needed
At times, you may need extra outside help. Warning signs may come up very quickly or your self management strategy isn’t enough. Seeking outside help doesn’t mean you’ve done anything wrong and it isn’t a sign of weakness. In fact, asking for help when you need it is a sign that you understand how your mental health affects you and how you want to take action.
Talking to and making contact with your health care team is a good first step, you can contact our Support & Information line here in St. Pats at 01 249 3333 or firstname.lastname@example.org. We are here to advise you of your best options and to give that assurance you need. Enlisting family/concerned others in your relapse plan can also help you make decisions and therefore allow them to make contact with us if needs be.
Planning for relapse
You can plan ahead for times you need extra help. Planning ahead may help ease worries of what might happen if you experience a relapse because you know there is a plan if you need it. Whatever way you choose your plan it should outline what needs to happen if you or members of your support network notice warning signs and what each person should do. It might include:
- Signs that show you aren’t feeling well
- At what point you want outside help
- Where to go for help or who to contact in an emergency situation
- What treatment you’d prefer
- A list of your current medications and any known allergies
- Contact information for the hospital, admission number, contact numbers for Family/Concerned Others you want notified.
Your action plan may also include practical steps for others to do such as informing your place of work, pay bills, and attend to pets if you need to spend some time in hospital.