The term 'relapse prevention' also prompted considerable debate and elicited a wide range of views during the consultations. Again, negative connotations and a strong perceived association with medical terminology were commonly reported.

Relapse prevention implies a medical perspective and a definition that is one of control and one-sided. —Carer
Within the medical literature, relapse prevention generally refers to illness management through compliance with medication regimes. It is widely accepted that people who have been seriously affected by mental illness are at risk of relapse if they do not take their medication as prescribed. Consequently, much of the relevant literature focuses on encouraging compliance with medication regimes through psycho-education and cognitive behavioural techniques (see Mueser et al 2002).

Relapse prevention is also generally acknowledged to involve recognising early warning signs of relapse and responding quickly and effectively. Awareness of early warning signs and planning around how to respond to these were seen as key tools for preventing relapse.

I've had eight relapses and I recognise that if I start hearing voices or hallucinations or visualisations and if that increases a couple of days in a row, and I start isolating myself and not eating properly – that's a clear sign that I'm getting unwell again. Then I'll do less work or study and activities for awhile and when I get over it I'll build them up again. If it goes on for awhile I might have to change my medication or increase it. —Consumer

I notice him start to isolate himself. He stays in his room, won't come out for meals. The best thing to do to start with is get one of his friends in touch. Getting him up and out and about can stop it progressing. —Family member

He [flatmate] knows if I'm staying in bed too long he'll knock on my door and say "Get up! Come on mate, get up, get out of bed" He'll be a bit like a parent, but you need that every now and again. —Consumer

Beyond awareness of early warning signs and complying with medication there was, however, no clear view regarding what else relapse prevention might entail. Many people in the consultations initially had a negative reaction to the term 'relapse prevention', which they thought comprised only medication compliance. However, when they began to think of what they actually did to reduce the recurrence of symptoms, they realised that they did undertake many actions that would be defined as relapse prevention, and that these were important and empowering for them.

Most people recognised that relapse prevention means putting in place supports to stay as well as possible and to reduce the likelihood and strength of future illness symptoms. This was seen as a process of "illness management" in the context of a chronic illness rather than 'relapse prevention' per se. It was understood to be a learning process that takes time and is constantly evolving. It is a process that "is a continuum" and "occurs in a context".
Top of page
Many people reported that they did not have much insight into preventing relapse after their first episode, but learned with repeat episodes what their triggers and wellness needs were. Relapse prevention is seen as part of the process of self-discovery. It involves developing "personal strategies" to cope with symptoms and stressors and to maintain wellness.

Families and carers similarly regard relapse prevention as a learning process of coming to understand "how and if to act". Relapse prevention was highlighted as "happening on an interpersonal level" and "being part of the education process".

Providers of non-clinical and non-acute services also emphasised evolving learning about the individual at risk and their environment and the importance of developing trusting relationships to facilitate this learning.

Planning was viewed as fundamental to relapse prevention. Many people who had experienced mental illness and their families and carers had, either explicitly or implicitly, a plan to attempt to reduce the likelihood of relapse when the early warning signs commenced. Many services also had relapse or recovery plans for clients.

I used to have a list of things to check that I put on my fridge with basic things like to ring someone and ask, ' How do you think I'm sounding?' or 'When was the last time you saw your psychiatrist?' and 'Have you taken your medication?', 'How many coffees have you had today?'. If you get to the end of the list maybe there are some other things you need to do because you're going to need some help. —Consumer

It's all about planning and knowing what to do and making sure you've checked everything. You have to get together and agree on it all and then have it all there in front of you ready to go through. —Carer

Lists are important in terms of what do I have to do today. Do I have to go and have a coffee with someone or do I have to go and exercise. Just like everybody else does, it's just that the consequences of what can happen if you don't maintain your mental health can be a lot more severe. —Consumer

Identifying stressors and ways to deal with them was another common element. Repeatedly, people who had experienced mental illness and their families and carers emphasised the importance of minimising stress and reducing stressful activities when early warning signs began to emerge.

Just not stressing myself out. Not do too much. —Consumer

One clear one was cutting down stress levels. —Carer

Finally, fundamental to attempts to prevent relapse was an emphasis on building relationships, communication and trust. Recognition of early warning signs and developing effective responses to them was invariably based on having trusting relationships and good communication with other people, preferably with a whole range of people involved in the ongoing support of a person with mental illness.

My case manager can tell when I'm listening to voices – she's really good. That's someone I've been with for three years. I've had three or four doctors in that time, but she's good. You need to build the trust with someone. You need to build a stable relationship with someone – it doesn't matter if it's a doctor or a mate – someone who recognises what's going on, will get you out of bed, motivate you, know you can look after yourself and they can look after you. That's a big part of stopping relapses getting extremely dramatic. —Consumer
The consultations revealed that relapse prevention is not a concept that is explicitly well understood, but it became evident after prompting that people were, in fact, implementing elements of relapse prevention. While in the research literature relapse prevention has a narrow definition and is usually applied in the context of medication compliance and recognition of early warning signs, there is clearly much more to preventing relapse that has not been explored. It is a construct that needs to be more fully understood and its role and functions, within a recovery orientation, clarified.