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

Current major approaches to relapse prevention and evidence of their effectiveness

Page last updated: 2006

Approaches to the longer-term management of mental illness can be divided into two separate processes: illness management and illness self-management. Illness management is defined as "professional-based interventions designed to help people collaborate with services in the treatment of their mental illness, reduce their susceptibility to relapses, and cope more effectively with their symptoms", whereas illness self-management has been used to refer "to peer-facilitated services aimed at helping people cope more effectively with their mental illness and facilitating people's ability to take care of themselves" (Mueser et al 2002 p1273).

In the medical and academic literatures, relapse prevention interventions have been categorised as including the following types of approaches: training in recognition of early warning signs; programs that encourage compliance with medication; coping skills training; and broad-based psycho-education programs. Both service-based and self-help programs are, therefore, clearly relevant to relapse prevention, although self-help and peer-based approaches have been researched less frequently and rigorously in terms of outcomes.

Mueser et al (2002) have reported a comprehensive review of the literature related to the effectiveness of these different types of programs. Randomised controlled trials provide the 'gold standard' of evidence to evaluate health interventions. Evidence-based practice is essential in order to provide effective and safe interventions for people with mental illness. Compelling evidence for the impact and effectiveness of mental health interventions, particularly when considered with a recovery framework, is, however, provided by a broader range of methodologies than randomised controlled trials. Anthony, Rogers and Farkas (2003) provide a list of points to consider to build the evidence base for practice within a recovery-oriented framework.

Awareness of early warning signs

Compliance with medication

Coping skills training and cognitive behavioural approaches

Broad-based psycho-education programs

Self-help programs

Risk and protective factors