Pathways of recovery: preventing further episodes of mental illness (monograph)

Awareness of potential risk and protective factors for relapse

Page last updated: 2006

The most well researched and widely accepted risk factor for relapse is not taking medication as prescribed. An emphasis on the importance of medication was evident in the consultations, particularly from representatives of clinical services.

Maintenance medication is routine practice. It is essential that people understand the importance of treatment adherence. —Clinician
Medications can be, however, a vexed issue as they often have unpleasant side effects and, when people are feeling well, they prefer not to take them.

Sometimes you are better off on no medication because of what the medication does - once my doctor even admitted that, but only once. —Consumer
Techniques that encourage people to take their medication effectively are, therefore, essential for relapse prevention. This can include psycho-education to better inform people about their mental illness and the role of medications in its management. It can also include the use of behavioural tailoring to ensure that medication is not accidentally forgotten. Primarily, though, it is essential that the concerns of consumers around their medication are taken seriously and that clinicians work with consumers to develop the most appropriate medication regime and to review this regularly to ensure that it meets current needs.

I've been searching for 13 years. I think I've finally found a reasonable mix but I take four different drugs. —Consumer
A more holistic approach that goes beyond a focus on medication and a medical treatment model is also required for effective relapse prevention. Risk and protective factors need to be explicitly identified, and deliberate attempts made to reduce the risk factors or their impact, and increase the protective factors. Despite the lack of scientific evidence, most consumers and their families become aware of their relapse triggers, as well as the positive things in their lives that help to keep them well.

All the domains of life—environmental, physical, social and emotional—are a source of both stress and support. Stress is generally a risk factor and social support is a protective factor. Environmental stressors include inappropriate housing; environmental supports are good public transport. Some of the major physical stressors are sleep disturbances, poor physical health, poor nutrition, and harmful alcohol and other drug use; physical supports are relaxation and fitness. Social stressors come from isolation and poor social relationships; social supports are good relationships of all kinds. Emotional stressors come from feelings of hopelessness, despair, and poor self-esteem, whereas emotional support can come from finding hope and meaning in life.

It is all the elements, you have to get it all in balance. You need to rebuild the physical by doing activities - walking, gym, swim, ride, just anything. You've got the mental side of things to look at. You've got the social side of things to look at. Then the emotional side of things to look at and the spiritual side of things to look at. They're all questions that come up when you experience voices or hallucinations, or mental illness or depression and the like, so you need to learn to rebuild all of those elements. —Consumer