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

Recognition of early warning signs

Page last updated: 2006

Recognition and awareness of early warning signs and of the risk and protective factors for mental health are fundamental to relapse prevention. This awareness needs to be at individual, family and service levels. There are two types of monitoring that are relevant to recognition of early warning signs: direct monitoring, where the presence or absence of symptoms is ascertained; and indirect monitoring, where situations are assessed to determine the presence or absence of risk and protective factors (van Miejel et al 2002a). Both types of monitoring are essential for a comprehensive and holistic relapse prevention approach.

People with mental illness generally report that with experience they are able to detect their early warning signs, and that they rely heavily on these indicators to know when they are at imminent risk of relapse, even though early warning signs can vary and do change over time. Symptom and reality checks are essential tools to monitor mental health status. Most consumers develop their own symptom checks, but there are standardised measures of early warning signs that can be applied (see Birchwood et al 1989).

I think people who go through a re-emergence, repeat of a cycle of an episode, are aware of that illness anyway so they can catch it so that it doesn't become a full relapse. —Consumer

For many it's very individual. I know whenever I start to change my head gets itchy inside and I know something's going on and something's changing. —Consumer

If I'm too happy, if I'm too creative, if I'm too optimistic then I have to say, "Hey this is not good". —Consumer

Many family members also are able to detect early warning signs, although some state they have trouble distinguishing these from natural variations in behaviour (van Miejel et al 2002a, van Miejel et al 2002b). For consumers who lack insight into their early warning signs, family members or significant others can be effectively trained to contribute to symptom checks. Awareness of early warning signs is fundamental to relapse prevention.

My children are my barometer; they say, "Mum you're laughing and that wasn't funny" and they sort of know my symptoms and they do a symptom check and tell me, "I notice you did this, you did that". —Consumer

To start with I was well enough to realise something was wrong, so I told my flatmate. Then two hours later I changed my mind and isolated myself in my room. I was listening to voices telling me not to leave the room and not to talk to people. So, then he had to call the CAT team. —Consumer