How to prevent mental health relapses: the role of ongoing support and early identification

There is no health without mental health. With this powerful statement, the World Health Organization emphasised the need to integrate mental health with physical health and well-being; constantly focusing on ways in which the primary causes for mental ill health can be addressed, and existing support services can be improved.

Neglecting our mental health prevents us from leading fuller lives. Yet, overcoming this barrier remains a challenge to this day. According to WHO, the mental health disease burden in India is 2443 Disability-Adjusted Life Years (DALY) per 10000 population (DALYs for a health condition are the sum of the years of life lost to due to premature mortality and the years lived with a disability due to prevalent cases of the disease in a population).

This alarming statistic makes a pressing case to prevent a relapse among those who have struggled/ struggle with a mental disorder.

A combination of long term pharmacological and psycho-social management approaches is necessary and the only way if we are to lower the chances of relapse and pave the way for a better, more fulfilled life for those of us in this position.

The problem of relapse in mental ill health

Relapses in mental ill health can be extremely anxiety provoking not only for the patient but also for the family. A relapse happens when individuals who have successfully managed their mental health issues experience a resurgence or worsening of their condition. These setbacks can be precipitated by a variety of events, such as stress, trauma, major life changes, or even external factors beyond one's control. A relapse can be both emotionally traumatic and socially/financially draining, like a huge step back after moving forward in their mental health journey.

The undisputed value of prevention and continuous support

Relapse prevention is a strategy to reduce the probability and severity of relapse following full-fledged treatment of mental disorders and reduction in problematic behavior. Identifying triggers and potential risk factors are crucial to disease/disorder prevention and relapse deterrence in recovery.

A multi-dimensional approach to relapse prevention:

1.  Sticking to the treatment plan: Most mental disorders treatment plans include long term medication, regular follow-ups with the psychiatrist, scheduled counselling sessions for learning ways to cope effectively with stress, participation in cognitive behavior therapy sessions and psycho education for both self and family. The most effective way to prevent a relapse is to stay the course and stick to the long-term treatment and recovery plan.

2.  Professional mental health support: Therapists, counsellors, and psychiatrists play pivotal roles in treatment and recovery. Their expertise and guidance are instrumental in helping individuals on their path to mental well-being.

3.  The power of family participation and inter-dependence: Having a strong support network is crucial to preventing mental health disorder relapses. Friends and family can provide invaluable assistance in navigating life's challenges. Emotional support can serve as a constant reminder that one is not alone in this Journey.

4.  Support groups: One of the most important aspects in preventing relapses in mental disorder recovery is being a part of a peer or therapist-led support group. Shared lived experiences, common concerns and peer to peer encouragement goes a long way in aiding recovery and staying there.

5. Psycho education: Awareness is empowering. Armed with the right knowledge, one can better understand triggers, early symptoms/warning signs which might help them take proactive steps to avoid a relapse. Recovery relies heavily on self-awareness.

6.    Crisis plan: Working with a mental health professional to create a crisis plan can be a proactive, effective way to prevent a relapse. A crisis or emergency safety plan is a guide with steps to be taken in situations of heightened discomfort or when relapse warning signs start to develop. This plan may include listing out emergency contacts, coping mechanisms, and a list of reliable people who can provide immediate help.

Early detection of warning signs

Understanding triggers: Every person's journey to mental wellness is different. It's critical to recognise and act on any individual red flags of a potential relapse. Changes in sleep habits, hunger, mood fluctuations, elevated anxiety, or a withdrawal from social activities are a few examples. Early detection of these indicators enables people to respond before the situation worsens.

Communication: It's important to promote direct and honest communication with family and friends as they might offer helpful insights into the behaviour and mood of a person. By expressing concern and encouraging professional intervention, when necessary, they can aid in early identification and relapse prevention.

Journalling/tracker: Keeping a journal can help people keep tabs on their emotional and mental health. They can spot patterns and identify potential relapse risks by routinely documenting their thoughts, feelings, and experiences. Self-monitoring enables people to take proactive action.

Setting achievable objectives: Working with their counsellor to set realistic goals and working on achieving them can help people feel more confident and give them a feeling of direction. However, it's crucial to avoid overloading oneself with excessive expectations as this can result in stress and a possible relapse.

Relapse prevention is a continuing journey that calls for commitment, self-compassion, encouragement, and self-awareness. People can dramatically lower their chance of relapse by having a solid support system, identifying warning signals, and putting preventive measures into action. The key to ensuring that persons dealing with mental health issues remain on their journey to recovery is early detection and assistance. Never forget that asking for help is a show of strength, and no one should struggle with mental health issues alone.

Every step in the journey should be towards building long-term resilience and enhancing mental health thus putting people closer to their goals of preventing a relapse in mental disorder recovery.

Please find a quick reference guide to a Mental Health Maintenance Plan (Ref. Therapist Aid) that can greatly help with relapse prevention.

Mental health risk spotting

1.  Warning Signs: Symptoms like thoughts, behaviors or feelings that indicate that your mental health could be at risk. For ex. Persistent Insomnia, feeling socially isolated, increasing stress etc.

List at least three warning signs that you are observing.

2.    Trigger identification: Activities, people, places, thoughts, things that you recall as your previous triggers which should be actively avoided. This will require you actively make changes to some old habits or relationships.

List atleast three triggers.

Preventing and coping with problems

Self-Care: Make a list of the self-care activities that you practice daily, and which make you more resilient to stress. Eg. Healthy diet, maintaining a routine, good sleep habits.

List at least threeself-care activities you practise.

Returning to therapy after previous sessions termination: Knowing when some situations become unmanageable, when the stress lasts too long and the times you feel over-whelmed can help you decide that it’s time to schedule an appointment with your psychotherapist ASAP.

List three situations which you anticipate being problematic, leading to resume therapy

Coping strategies: List the skills you learnt in therapy that help you cope with stressful situations. For eg. Mindfulness, meditation, journaling, grounding techniques.

List three coping strategies you can use.

(Rohini Kesavan Rajeev is a senior psychotherapist and Founder & Clinical Head, The Able Mind.)