tips for

preventing relapse
of mental illnesses
2011 www.heretohelp.bc.ca

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. Try thinking of it this way: if you injure
yourself, you would likely do things to prevent the injury from
happening again. If you hurt your ankle running, for example, you
might prevent another injury by being more mindful of where you
step. Preventing a relapse of a mental illness isn’t much different.
In this sheet, you will learn a systematic way to monitor your well-
being and take action when you need it.

A "relapse” is when troubling This is based on the principles of "self-

symptoms come back or get worse. management,” which means you taking
Fortunately, you can take a lot of steps charge of your health. It may sound
to help prevent a relapse or worsening daunting, but self-management is really
symptoms. No one can guarantee that about building small, practical steps
you'll never feel unwell again. But you into your day.
can look for early warning signs, create
a plan to help with difficult situations, When it comes to preventing relapse,
and take steps to care for yourself. there are three big parts to self-
These steps may help you take action management: identifying your warning
before symptoms become a major signs, taking action, and seeking
problem and help lessen the effect of outside help when it's needed. The best
symptoms on your day-to-day life. time to do this is when you’re well.

This the third module in a three-part series.

The other two modules are "Dealing with a
mental illness diagnosis" and "Working with
your doctor for mental illnesses."
 preventing relapse of mental illnesses

Before Part One: To start identifying your warning signs, you'll

Medication management need to think back to times you were depressed.
If you take medication, it’s important to follow How did it start? How did it progress? What did
your doctor’s recommendations, even when you experience? What kind of thoughts did you
you feel well. You may need to continue the have? Did your behaviour change? Did anything
medication for several months or longer, happen in a particular order? It may also be
depending on your risk factors. Stopping helpful to ask loved ones for their feedback—
medication too early is a major reason for people close to us often notice changes before
relapse. Think of a time you’ve had to take we see changes in ourselves.
antibiotics for an infection. You likely started
to feel better after a few days, but you still had Now that you've thought about what your
to take the antibiotics for one or two weeks to warning signs look like, think about what was
help stop the infection from returning. It’s the happening in your life when you started to
same thing for mental health medications. It’s notice these changes. This will help you see
also important to talk to your doctor is you want when and where your warning signs start to
to make any changes to your medication plan, happen. For example, do warning signs seem to
such as reducing your dose or stopping your come up after working a lot of overtime or after
medication. See our Module #2 on working with a fight with loved ones? These situations are also
your doctor on a treatment plan. called "triggers.” While everyone will have their
own triggers, there are some common triggers.
Part One: Identifying Here are some examples:
early warning signs • Poor sleep or not getting enough sleep
An early warning sign is a sign that shows • Loss or grief
your health may be starting to get worse. These • Conflict among loved ones
warning signs are the first signs to appear, • An unpleasant event such as a perceived
before major symptoms begin to affect your life failure, disappointment or criticism
in a big way. The purpose of identifying your • Other stressful events
unique warning signs is to help you take action • Alcohol and other drug use
early. • Certain times (a change in the season or, if
you’re a woman, your reproductive cycle)
The act of identifying early warning signs can • Not following through on your treatment
make some people nervous. After all, no one plan (such as not taking prescribed
wants to remember difficult or unpleasant medications)
situations. It may be helpful to think of this • Other health problems or concerns
exercise as an opportunity to take control of
your health. When you identify your early Now that you have your early warning signs
warning signs, you give yourself the power to and your triggers, it's time to put everything
challenge a mental illness. 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.

2 2011 www.heretohelp.bc.ca
 When you identify your early warning signs,
you give yourself the power to challenge a
mental illness.

Here's an example of a timeline:

Building healthy coping skills
A big part of coping skills is a healthy lifestyle.
Work deadline approaches
Healthy activities like eating well, exercising

regularly, getting enough sleep and practicing
sleep and mood difficulties begin
relaxation exercises can have a significant

impact on your mood and your ability to tackle
work deadline
challenges. Likewise, unhealthy activities can

make mood problems worse. The goal is to
irritability increases
make healthy changes you can maintain for

a long time—and commit to keeping up even
argument with spouse
during times of stress.

sleep difficulties worsen
Eating well—Food gives you energy. When

you're dealing with a mental illness, though,
feeling that people are "looking at you”
eating habits often suffer. Visit Health Canada’s

website at www.hc-sc.gc.ca for Canada’s Food
psychosis begins
Guide.

took leave from work (too late)
Exercising regularly—Exercise has many

positive benefits for mental health. Find an
hospitalization
activity you enjoy. The goal is to exercise for
at least short period of time on a regular basis.
Part Two: Taking action Remember, start with manageable, realistic goals
Now that you've figured out what warning signs and gradually increase your goals as you gain
and triggers to watch for, it's time to decide how confidence.
you'll take action when they come up.
Getting enough sleep—Sleep plays a big part
This part is made up of smaller parts, but they in mental health. Mental health problems may
all work together. Taking action includes: cause sleep problems, and sleep problems may
• Building healthy coping skills cause or add to mental health problems. Certain
• Identifying stressful situations medications for mental illnesses may also affect
• Managing stressful situations sleep for some people. It’s important to practice
good sleep habits into your daily routine.

2011 www.heretohelp.bc.ca 3
 preventing relapse of mental illnesses

Relaxation skills—Relaxation skills help • All-or-nothing: Something is only all good or

calm you down. You can learn specific skills all bad; there is no middle ground. Thinking
like meditation, mindfulness, deep breathing that you "aren’t good enough” because you
exercises, progressive muscle relaxation, yoga made a small error is an example of all-or-
or cognitive-behavioural therapy skills. Other nothing thinking.
activities like music, art or writing may also be • Catastrophizing: Seeing a small negative
helpful. event or mistake as a massive disaster, and
reacting to the small mistake like it was a
Healthy thinking skills—Mental illnesses can massive disaster.
really affect the way you think about yourself,
others and the world around you. Part of Once you’ve identified thinking traps, you can
healthy coping is identifying and challenging start to challenge them. You can ask yourself
thinking problems. what the evidence says, ask yourself if you’ve
considered all the information, and look for
Thinking problems are also called "thinking more helpful ways to look at the situation. When
traps" or "distorted thinking" because they you challenge a thinking trap, you are looking
change the way you see a situation. Here are a for the realistic thought.
few different thinking traps:
• Overgeneralization: Thinking that Thinking skills are a big part of cognitive-
everything is bad because you had one behavioural therapy. You can learn these skills
negative experience. from a practitioner. If you’d like to try them
• Filtering: Only hearing the negatives and on your own, you can find self-help resources
ignoring the positives. online or in bookstores.

For more detail on lifestyle changes

to keep you well, visit heretohelp.
bc.ca and see our info sheet "Tips
for Improving Mental Health” or our
series of eight Wellness Modules.

4 2011 www.heretohelp.bc.ca
 preventing relapse of mental illnesses
Activity: A toolbox of support
Taking time to do things you enjoy is important for everyone. But when you’re not feeling well, it’s
easy to cut back on these activities. Write down a list of things that help you when you start to feel
overwhelmed or notice warning signs.

Some examples include:

†† Setting aside time for extra sleep
†† Talking with a friend or loved one
†† Talking with your health care professional
†† Attending a peer support group
†† Spending time in nature, like going to a park
†† Writing in a journal
†† Spending time on a hobby
†† Volunteering for your favourite organization or helping someone else
†† Watching a funny movie
†† Cutting back on a few non-essential responsibilities

Other healthy actions:

††

††

††

††

††

You can also list things that don’t help and should be avoided until you feel better. For example:
†† Staying out late
†† Taking on extra projects or responsibilities
†† Spending time with people who aren’t supportive
†† Overanalyzing why I feel bad
†† Drinking more

Other unhealthy actions:

††

††

††

††

††

Keep this list in a place you’ll see it often. When you’re feeling overwhelmed or unwell,
pick a helpful activity from your list and set aside time to do it.

2011 www.heretohelp.bc.ca 5
 preventing relapse of mental illnesses

Identifying stressful situations Think about situations that you find stressful.
Managing stress is a big part of wellness. You Problems with your job, money or relationships
can control some things that cause stress—for may come to mind easily. But remember, a
example, you can try to get enough sleep and situation doesn't have to be "bad” for it to cause
use substances like alcohol wisely. But it’s stress. Stressful situations or events people
unlikely that you can eliminate all stress from sometimes forget about include:
your life. This is why stress management skills • Starting a new job or school course or taking
are important. These skills help you identify on new responsibilities

"
stress and take action by solving problems • A major holiday or anniversary
proactively. These skills can help you handle • A new relationship or commitment
stressful situations before the stress affects your • Pregnancy
well-being. • Moving or other changes in your home
• Other health problems

"
Managing stressful situations
Managing stress Now that you’ve identified your signs of
is a big part stress and situations that may cause problems,
it’s time to decide how you manage them.
of wellness Healthy coping skills, including your toolbox of
supports, are a good place to start. But you may
need some extra help.
The first step is learning to identify when you’re
experiencing stress. Your may notice stress in There are practical steps you can take as you
four general areas: approach upcoming situations or events. Here
• Physical signs in your body, like tense are some tips to consider:
muscles or an upset stomach
• Emotional signs, like feeling overwhelmed or • Start slowly. If possible, add in new stress
feeling upset gradually, rather than all at once. For
• Cognitive or thought signs, like thinking that example, if you want to go back to school, it
everything is hopeless or thinking that you may be possible to start taking courses part-
aren’t appreciated time.
• Behavioural signs, like getting into arguments • Give yourself time for self-care. Remember,
or acting aggressively self-care is even more important when you’re
dealing with a stressful situation.
Remember, these signs of stress may look just • Cut back on ongoing responsibilities. We all
like some of your early warning signs, and in take on responsibilities that aren’t always
fact, that’s what they may be for you. essential, like hosting family dinners. But
it’s okay to let people know that you need to
Next, you can plan ahead if you know a spend that time on new responsibilities or
particular event or situation is coming up. challenges.
Identifying situations that cause you stress and • Make sure your own expectations are
taking action before you feel overwhelmed is a realistic. If you’re going back to school, for
big part of maintaining wellness. example, it’s okay to cut back on housework.

6 2011 www.heretohelp.bc.ca
 preventing relapse of mental illnesses

coping with voices and delusions

coping with voices You can also find some things are unhelpful,
Hearing voices or other sounds can be very and you may wish to avoid them. Here are some
distressing. This is especially true if they are activities that may be unhelpful:
critical or threatening. It’s important to talk to
†† Passive activities (things that don’t take your
your doctor or mental health practitioner about
full attention), like watching a lot of TV
voices. Proper treatment can lessen or even
†† Arguing with voices
eliminate voices. You can also learn ways to live
well with the voices. You might have a try a few †† Using alcohol or drugs to cope
different strategies to see what works best for †† Isolating yourself from others
you. Here are some suggestions:

†† Remind yourself that you are in charge. coping with delusions

The voices can’t harm you if you don’t listen or unusual thoughts
to them. The voices know a lot about you
Delusions are false beliefs that aren’t based
because they are part of you
in reality. Delusions can be frustrating or even
†† Try to keep track of the voices. You may scary. But you can learn strategies t help cope
find that certain voices are triggered by a with delusions. Of course, it’s important to talk to
particular situation your doctor or mental health practitioner about
†† Do something you enjoy that distracts you delusions or unusual thoughts. But here are
from the voices, like listening to music some coping strategies to try:
†† Set boundaries. Tell the voices to stop or say †† Think about the evidence for and against a
that you will listen to them later belief. What does the evidence say?
†† Find a support group. Talking about your †† Write down a list of alternative explanations
experiences can help. You can also learn new for the belief
ways to cope with voices from others †† Talk to a trusted family member, friend or
professional. They can help you test your
belief

2011 www.heretohelp.bc.ca 7
 preventing relapse of mental illnesses

Problem-solving skills are also useful when Moving beyond the basics
you’re facing a challenging situation. This is a So far, you’ve learned how to recognize warning
structured approach to help you think through signs, take action when warning signs come up,
problems and solutions in a logical way. There manage stress and build your wellness. Now
are six basic steps: it’s time to fine-tune your skills. There may be
situations where troublesome symptoms come
• Define the problem. Figure out what is up, despite your best efforts. It’s helpful to plan
causing the problem and how it’s causing for these situations ahead of time, so you know
problems. what to do right away.
• Set goals. Decide what you want your
solution to address. It’s important that your The first step is reviewing your early warning
goals are realistic and concrete. signs. Think back to your timeline and consider
• Think of solutions. Brainstorm possible where you might be on the timeline. Do your
solutions. You can also ask friends or loved warning signs tell you that you have time to
ones for ideas. cope with the situation on your own, or do they
• Look at the pros and cons. Pick a few possible say that you need help soon? If your warning
solutions that you think might work best, and signs show that you are close to relapse, it’s time
consider the positives and negatives of your to get help.
choices.
• Pick a solution. Remember, it should describe If you have time to cope with the situation on
who does what and what you want to your own, you can think about strategies you’ve
achieve. used in the past. Think back to a strategy that
• Evaluate the results. After you put your plan has worked for you and put that strategy into
into action, see if it worked as expected. If place. You can even try to make it better. For
it didn’t work, see if your solution needs to example, you might take a few days off work
be modified or if you need to try a different when you notice symptoms. You might improve
approach. that strategy by scheduling an activity you enjoy
or spending time talking with a trusted loved
one or a mental health professional. But if you

"
aren’t confident that you can carry out your
plan, seek help. It’s always better to ask for
help early.

"
If you aren’t confident that
you can carry out your
plan, seek help. It’s always
better to ask for help early.

8 2011 www.heretohelp.bc.ca
 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.

Part three: Seeking outside • Signs that show you aren’t feeling well
help when needed • At what point you want outside help: As soon
At times, you may need extra outside help. as you notice warning signs? When you can
Warning signs may come up very suddenly no longer manage symptoms on your own?
or you may feel that your self-management • Where to go for help or who to contact in an
strategy isn’t enough. Seeking outside help emergency situation
doesn’t mean that you’ve done anything wrong • What treatments you’d prefer
and it isn’t a sign of weakness. In fact, asking • A list of your current medications and any
for help when you need it is a sign that you other treatments (including alternative
understand how the mental illness affects you treatments)
and you want to take action. • Contact information for your health
professional, the nearest emergency room,
Talking with your health care professional and contact information for the loved ones
is a good first step. You may schedule more you want notified
frequent visits, and your health care professional
may adjust your treatment, such as adding Your action plan may also include practical steps
medication or changing medication, or adding that your loved ones agree to take. For example,
therapy techniques. Loved ones and members of a loved one may contact your employer and
your support network can also help, even if you keep everything in order (like rent or bill
just need to talk to someone. payments) if you need to spend time in the
hospital.
Planning for relapse
You can plan ahead for times you need extra If your plan or agreement involves the care
help. Planning ahead may help ease worries of of your children, access to your financial
what might happen if you experience a relapse information or other important matters, it’s best
because you know there is a plan if you need to talk with a lawyer about your options. There
it. Your plan may be a formal agreement with are a number of different legal tools to help
your health care professional, or it may be you plan for your care, but there are important
an informal plan among loved ones or other differences between these tools. A legal
members of your support network. Whatever professional can help you make the best choice
you choose, your plan will outline what will for your unique situation.
happen if you or others notice warning signs
and what each person should do. It might
include:

2011 www.heretohelp.bc.ca 9
 preventing relapse of mental illnesses

Activity: Relapse prevention plan

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)

10 2011 www.heretohelp.bc.ca
 preventing relapse of mental illnesses

Crisis Plan
My crisis plan (what can be done if I am in crisis):

Ways I can relieve stress, regain balance, calm myself or make myself safer:

People I can call (friends, family members, cousellors or other mental health professionals):

Resources I can use (support groups, organizations, etc):

Things I or others can do that I find helpful or keep me safe:

Medications that have helped in the past:

Medications that have not helped:

Types of medication(s) I take:

If I become unable to handle my personal affairs, the following people have agreed to help
(for example, look after pets, notify family and workplace, etc):

name and phone number:

what they will do:

(Source: Western New York Care Coordination Program)

2011 www.heretohelp.bc.ca 11
preventing relapse of mental illnesses
where do I go from here?
In addition to your family doctor, BC Schizophrenia Society: Visit FORCE Society for
check out the following resources for www.bcss.org or call 1-888-888-0029 Kids Mental Health: Visit
managing mental disorders: (toll-free in BC) or 604-270-7841 (in www.forcesociety.com or call
Greater Vancouver). BCSS provides 1-855-887-8004 (toll-free) or
BC Partners for Mental Health support to people with serious mental 604-878-3400 (in Greater Vancouver).
and Addictions Information illness and their families, public The FORCE raises the awareness
Visit heretohelp.bc.ca for info sheets education, advocacy and research. and need for early intervention for
on mental illnesses and other mental the mental health of children and
health topics, such as Coping With Canadian Mental Health Association’s youth and assists families in finding
Mental Health Crises and Emergencies, BC Division: Visit www.cmha.bc.ca or information and help.
Finding Help for Mental Disorders, call 1-800-555-8222 (toll-free in BC) or
and Relapse Prevention. You can also 604-688-3234 (in Greater Vancouver). Jessie’s Legacy Program, Family
find personal stories from people who CMHA promotes the mental health Services of the North Shore: Visit
are working through recovery, our of all British Columbians through www.familyservices.bc.ca or call
Wellness Modules, and self-tests. education, advocacy, research and 1-888-988-5281 (toll-free in BC) or
direct services. 604-988-5281 ext 204 (in Greater
WRAP: Wellness Recovery Action Vancouver). Jessie’s Legacy provides
Plan WRAP is a recovery and Centre for Addictions Research eating disorders prevention education,
prevention tool for mental illnesses. of BC: Visit www.carbc.ca. CARBC is resources and support for BC youth,
Visit www.mentalhealthrecovery.com dedicated to research and knowledge families, educators and professionals.
to learn more about the program, try related to substance use, mental health
practice exercises, or purchase WRAP and wellbeing. For referrals to service Mood Disorders Association of BC:
materials. providers, contact the Alcohol and Visit www.mdabc.net or call 604-
Drug Referral Service at 1-800-663-1441 873-0103. MDA provides support,
AnxietyBC:Visit www.anxietybc.com (toll-free in BC) or 604-660-9382 (in education, and hope of recovery for all
or call 604-525-7566. AnxietyBC Greater Vancouver). British Columbians living with a mood
increases awareness about anxiety disorder or other mental illness.
disorders, provides education and
increases access to evidence-based
resources and treatments

This the third module in a three-part series. The other two modules are
"Dealing with a mental illness diagnosis" and "Working with your doctor for mental illnesses."

This info sheet has been adapted from an older resource from BC Partners and HeretoHelp: Macnaughton, E. (2003).
"Module 4: Developing an Early Warning System and Action Plan." In Mental Disorders Toolkit: Information and Resources
for Effective Self-Management of Mental Disorders. Canadian Mental Health Association, BC Division.

This info sheet was written by the Canadian Mental Health Association’s BC Division. The references for this
fact sheet come from reputable government or academic sources and research studies. Please contact us if
you would like the footnotes for this fact sheet. Fact sheets have been vetted by clinicians where appropriate.

HeretoHelp is a project of the BC Partners for Mental Health and Addictions Information.
The BC Partners are a group of nonprofit agencies working together to help individuals and
families manage mental health and substance use problems, with the help of good quality
information. We represent Anxiety Disorders Association of BC, BC Schizophrenia Society,
Canadian Mental Health Association’s BC Division, Centre for Addictions Research of BC,
FORCE Society for Kids’ Mental Health, Jessie's Legacy Program at Family Services of the
North Shore, and Mood Disorders Association of BC. The BC Partners are funded by BC
Mental Health and Addiction Services, an agency of the Provincial Health Services Authority.