When you feel well, the last thing you want to think about is a relapse of a mental illness. But you can do a lot to lower the risk of relapse if you plan ahead.
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Symptoms of a mental illness may come back or worsen at times. People use terms like "relapse," "dips," and "blips" to describe this experience. While you can't guarantee that you'll never feel unwell again, you can take a lot of steps to help prevent or reduce the impact of a relapse or worsening symptoms. You can look for early warning signs, create a plan to help with difficult situations, and take care of yourself. These steps may help you take action before symptoms become a major problem and help lessen the effect of symptoms on your day-to-day life. This is based on the principles of self-management, which means you take charge of your health. It may sound daunting, but self-management is really about building small, practical strategies into your day.
When it comes to preventing relapse, there are three big parts to self-management: identifying your warning signs, taking action, and seeking outside help when it's needed. The best time to do self-management planning is when you're well.
A note on medication
If you take medication, it's important to follow your doctor's recommendations, even when you feel well. You may need to continue the medication for several months or longer, depending on your risk factors. Stopping medication too early is a major reason for relapse. It's also important to talk to your doctor if you want to make any changes to your medication plan, such as reducing your dose. For more on talking to doctors or other health care professionals, see the module Working with your Doctor When You Have a Mental Illness at www.heretohelp.bc.ca.
Part one: Identifying early warning signs
An early warning sign is something that suggests your health may be starting to get worse. These warning signs appear before major symptoms begin to affect your life in a big way. Identifying your unique warning signs can help you take action early.
Thinking about early warning signs can make some people nervous. After all, no one wants to remember difficult or unpleasant situations. But when you identify your early warning signs, you give yourself the power to take care of your mental health and respond to problems quickly, which can help prevent problems from growing or becoming harder to manage.
To start identifying your warning signs, you'll need to think back to times you felt unwell. Ask yourself:
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When did I start to feel unwell?
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What kind of thoughts did I have?
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How did my thinking change?
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Did my behaviour change?
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Did anything happen in a particular order?
It may also be helpful to ask loved ones for their feedback—people close to us often notice changes before we see changes in ourselves.
Now that you've thought about what your warning signs look like, think about what was happening in your life when these changes occurred. Do warning signs seem to come up after working a lot of overtime or after a fight with loved ones? These situations are also called triggers. While everyone will have their own triggers, common triggers include:
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Poor sleep or not getting enough sleep
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Loss or grief
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Conflict with loved ones
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An unpleasant event such as a perceived failure, disappointment or criticism
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Other stressful events
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Alcohol and other drug use
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Certain times (a change in the season or your reproductive cycle)
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Not following through on your treatment plan (such as not taking prescribed medications)
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Other health problems or concerns
Now that you have your early warning signs and your triggers, it's time to put everything together. Think back to your last episode of a mental illness. Can you tie your warning signs to a particular trigger? If you can, try to map out a timeline that shows your triggers and warning signs in order.
Here's an example of a timeline:
Work deadline approaches > thinking a lot about failure > hard to sleep > feel exhausted > stop exercising > miss work deadline > irritability increases > argument with spouse > sleep difficulties worsen > feeling that people are 'looking at you' > psychosis begins > took leave from work (too late) > hospitalization
Activity: A toolbox of support
Taking time to do things you enjoy is important for everyone, but it's easy to put off self-care and support. If you find that you often don't take time for yourself, make a list of activities that help you the most.
Some examples include:
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Setting aside time for extra sleep
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Talking with a friend or loved one
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Talking with your health care professional
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Attending a peer support group
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Spending time in nature, like going to a park
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Writing in a journal
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Spending time on a hobby
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Volunteering for your favourite organization or helping someone else
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Watching a funny movie
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Cutting back on a few non-essential responsibilities
Other healthy actions:
You can also list things that don't help you feel well or manage stressful situation well. For example:
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Staying out late
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Taking on extra projects or responsibilities
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Spending time with people who aren't supportive
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Overanalyzing why I feel bad
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Drinking more
Other unhealthy actions:
Keep this list in a place you'll see it often. Regularly pick a helpful activity from your list and set aside time to do it.
Part two: Taking action
Now that you've figured out what warning signs and triggers to watch for, it's time to decide how you'll take action when they come up.
Taking action is made up of smaller parts, but they all work together. Taking action includes:
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Building healthy coping skills
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Identifying stressful situations
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Managing stressful situations
Building healthy coping skills
A big part of coping skills is a healthy lifestyle. Healthy activities like eating well, staying active, getting enough sleep and practicing relaxation exercises can have a significant impact on your mood and your ability to tackle challenges.
Eating well—Researchers increasingly see links between mood and healthy eating habits. However, many people find it hard to stick with healthy eating due to poor appetite, low energy, poor concentration, and other reasons. And fast and affordable options that fit health goals aren't accessible or available to everyone. Talk to a dietitian to help you find solutions to the specific barriers that you might experience. BC residents can call 811 to talk to a dietitian for free—visit www.healthlinkbc.ca for more information.
Staying active—Exercise has many positive benefits for mental health. Find an activity you enjoy and commit to that activity for at least short period of time on a regular basis. Start with manageable, realistic goals and gradually increase your goals as you gain confidence. Physical activity doesn’t have to be complicated—a walk around your neighbourhood every day is a great place to start. Your local community centre can also be a great resource, and some offer financial assistance programs if costs are a barrier.
Getting enough sleep—Sleep plays a big part in mental health. Mental health problems may cause sleep problems, and sleep problems may cause or add to mental health problems. Some medications can also affect sleep. See Wellness Module 6: Getting a Good Night's Sleep at www.heretohelp.bc.ca/wellness-modules for more on healthy sleep habits. Talk to your doctor if you frequently experience sleep problems.
Relaxation skills—Relaxation skills help calm you down. You may not feel completely relaxed, but these skills can help you manage and move on from difficult thoughts or feelings that would otherwise get "stuck" and make you feel upset for a long time. You can learn specific skills like meditation, mindfulness, deep breathing exercises, progressive muscle relaxation, yoga or cognitive-behavioural therapy skills. But relaxation doesn’t have to be formal: listening to your favourite music, making art, writing, helping others, or other activities that work for you are also good options.
Healthy thinking skills—Mental illnesses can really affect the way you think about yourself, others and the world around you. Healthy thinking skills help you challenge distorted or unhelpful thinking traps and look at situations realistically. See Wellness Module 8: Healthy Thinking at www.heretohelp.bc.ca/wellness-modules for more. Healthy thinking skills are a major part of cognitive-behavioural therapy.
Identifying stressful situations
Managing stress is a big part of wellness. You can control some things that cause stress—for example, you can try to get enough sleep and use substances like alcohol and other drugs wisely. But it’s unlikely that you can eliminate all stress from your life. You can identify stress and take action by solving problems proactively so you can manage it before it affects your well-being.
The first step is learning to identify when you're experiencing stress. Your may notice stress in four general areas:
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Physical signs in your body, like tense muscles or an upset stomach
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Emotional signs, like feeling overwhelmed or feeling upset
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Cognitive or thinking signs, like thinking that everything is hopeless or thinking that you aren't appreciated
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Behavioural signs, like getting into arguments or avoiding your responsibilities
These signs of stress may look just like some of your early warning signs, and in fact, that's what they may be for you.
If you know a particular event or situation is coming up that will be stressful, you can plan ahead. Identifying situations that cause you stress and taking action before you feel overwhelmed is a big part of maintaining wellness.
Think about situations that you find stressful. Problems with your job, money or relationships may come to mind easily. However, a situation doesn't have to be bad for it to cause stress. Stressful situations or events people sometimes forget about might include:
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Starting a new job or school course or taking on new responsibilities
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A major holiday or anniversary
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A new relationship or commitment
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Pregnancy
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Moving or other changes in your home
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Other health problems
Managing stressful situations
Now that you've identified your signs of stress and situations that may cause problems, it's time to decide how you manage them. Healthy coping skills, including your toolbox of supports, are a good place to start. But you may need some extra help. There are also practical steps you can take as you approach upcoming situations or events. Here are some tips to consider:
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Start slowly. If possible, add in new stress gradually, rather than all at once. For example, if you want to go back to school, it may be possible to start taking courses part-time.
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Give yourself time for self-care. Self-care is even more important when you're dealing with a stressful situation.
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Cut back on extra responsibilities. We all take on responsibilities that aren't always essential, like hosting family dinners. But it's okay to let people know that you need to spend your time and energy on new responsibilities or ask others to help.
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Set realistic expectations for yourself. If you're starting a new job, for example, it's important to recognize that productivity in other areas of your life may decrease for some time.
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Practice self-compassion. Understand that stress can impact how you think, feel and act. Remember to treat yourself with the same understanding and compassion that you would extend to a close friend or loved one.
Problem-solving skills are also useful when you're facing a challenging situation. This is a structured approach to help you think through problems and solutions in a logical way. For more on problem-solving skills, see Wellness Module 4: Problem-Solving at www.heretohelp.bc.ca/wellness-modules.
Part three: Seeking outside help when needed
At times, you may need extra outside help. Warning signs may come up very suddenly or you may feel that your self-management strategy isn't enough. Seeking outside help doesn't mean that you've done anything wrong and it isn't a sign of weakness. In fact, asking for help when you need it is a sign that you understand how the mental illness affects you and you want to take action.
Talking with your health care professional is a good first step. You may schedule more frequent visits, and your health care professional may adjust your treatment, such as adding medication or changing medication, or adding psychotherapy techniques. Loved ones and members of your support network can also help, even if you just need to talk to someone.
Planning for relapse
You can plan ahead for times you need extra help. Planning ahead may help ease worries of what might happen if you experience a relapse because you know there is a plan if you need it. Your plan may be a formal agreement with your health care professional, or it may be an informal plan among loved ones or other members of your support network. Whatever you choose, your plan will outline what will happen if you or others notice warning signs and what each person should do. It might include:
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Signs that show you aren't feeling well
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At what point you want outside help: As soon as you notice warning signs? When you can no longer manage symptoms on your own?
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Where to go for help or who to contact in an emergency situation
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What treatments you'd prefer
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A list of your current medications and any other treatments (including alternative treatments)
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Contact information for your health professional, the nearest emergency room, and contact information for the loved ones you want notified
Your action plan may also include practical steps that your loved ones agree to take. For example, a loved one may contact your employer and keep everything in order (like rent or bill payments) if you need to spend time in the hospital.
If your plan or agreement involves the care of your children, access to your financial information or other important matters, it's best to talk with a lawyer about your options. There are a number of different legal tools to help you plan for your care, but there are important differences between these tools. A legal professional can help you make the best choice for your unique situation.
Activity: Relapse prevention plan
Write down your own relapse prevention plan using the prompts below. Be as specific as possible! It's a good idea to work with the people you identify as important contacts when you write your relapse prevention plan so everyone understands what they need to do. When you're finished, give everyone who will help a copy. Periodically review your plan and share any changes with your contacts.
Events or situations that triggered relapses in the past:
Early warning signs that I experienced in the past:
Things that help me when I experience an early warning sign:
People who help me and what I would like them to do:
People I'd like to contact in case of an emergency:
(Source: Substance Abuse and Mental Health Services Administration, Center for Mental Health Services)
Where do I go from here?
In addition to your family doctor, check out the following resources for managing mental illnesses:
BC Partners for Mental Health and Substance Use Information
Visit www.heretohelp.bc.ca for info sheets on mental illnesses and other mental health topics, self-care and recovery, such as Coping With Mental Health Crises and Emergencies, Finding Help for Mental Disorders, and Relapse Prevention. You can also find personal stories from people who are working through recovery, our Wellness Modules, and self-tests.
The BC Partners are:
Anxiety Canada: Visit www.anxietycanada.com or call 604-620-0744 for information and self-management resources for anxiety disorders.
BC Schizophrenia Society: Visit www.bcss.org or call 1-888-888-0029 (toll-free in BC) or 604-270-7841 (in Greater Vancouver). BCSS provides support to people with any serious mental illness and their families, public education, advocacy, and research.
Canadian Mental Health Association BC Division: Visit www.cmha.bc.ca or call 1-800-555-8222 (toll-free in BC) or 604-688-3234 (in Greater Vancouver). CMHA promotes the mental health of all British Columbians through education, advocacy, research and direct services.
Canadian Institute for Substance Use Research: Visit www.cisur.ca. For referrals to substance use supports and services, contact the Alcohol and Drug Referral Service at 1-800-663-1441 (toll-free in BC) or 604-660-9382 (in Greater Vancouver).
FamilySmart: Visit www.familysmart.ca. Call 1-855-887 8004 (toll-free) or 604-878-3400 (in Greater Vancouver). FamilySmart supports families of young people who experience a mental illness.
Jessie's Legacy eating disorders prevention, a Family Services of the North Shore Program: Visit jessieslegacy.com or call 604-988-5281. Jessie's Legacy provides eating disorders prevention education, resources and support for BC youth, families, educators, and professionals.
Mood Disorders Association of BC, a branch of Lookout Housing + Health Society: Visit www.mdabc.net or call 604-873-0103. MDABC provides support, education, and hope of recovery for all British Columbians living with a mood disorder or other mental illness.
WRAP: Wellness Recovery Action Plan
WRAP is a recovery and prevention tool for mental illnesses. Visit www.mentalhealthrecovery.com to learn more about the program, try practice exercises, or purchase WRAP materials. You can also talk to your care team to find WRAP courses in your area.
This is the third module in a three-part series. The other two modules are When You're Diagnosed with a Mental Illness and Working With Your Doctor When You Have a Mental Illness.
About the author
The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.
