Sunday, August 5, 2012

Creating a Relapse Prevention Plan

The best way to do crisis planning is to do crisis prevention planning. When you love someone who has a mental illness, that's called relapse prevention.

Mental illness, especially bipolar disorder and schizophrenia, is episodic, meaning that symptoms vary significantly over time.  One of the hardest aspects of living with the illness in the family is that you know that things could change dramatically on any given day.

That's why it's smart to get the family together, including the person with the illness if at all possible, to develop a plan for how to prevent a relapse that could lead to a crisis. Writing down the answers to the questions below will help you to prepare the plan. 
  1. Who should attend family meetings if warning signs occur?
  2. What are your relative's early warning signs of a relapse? What was the very fist sign of crisis? (Do not write down more than five signs. Only write down the earliest or most important signs.  Typical signs could include irritability, severe insomnia, depression, social withdrawal and refusing to go to the doctor.  We'll cover more of the typical signs in an upcoming post.)
  3. How will you evaluate whether your relative is taking medication regularly?
  4. If your relative is not taking medication regularly, what will be the plan to help him or her resume doing so?
  5. How will you evaluate whether your relative is abusing drugs and alcohol?
  6. If your relative is abusing drugs or alcohol, what will you do?
  7. What situations have been too stressful for your relative in the past?
  8. If your relative is overwhelmed with stress, what will you do? 
Complete the plan by writing down this information:
  • The nearest psychiatric emergency facility's address and telephone number
  • Suicide Hotline number
  • Psychiatrist name and number
  • Case Manager  name and number
  • Therapist name and number
  • Social worker name and number
  • Any other services you could use
Then finish by setting a date six months into the future for when the family will meet again to discuss this.

Although I have no experience with this, some people with mental illness do create advanced psychiatric directives. This gives them the ability, while they are healthy, to name a health care agent to make decisions for them in an emergency. The directive also can cover preferred hospitals, physicians, psychiatric medication, electroconvulsive therapy, emergency medical interventions, people to be notified if they enter a psychiatric facility,  and the care and temporary custody for any minor children.


Anonymous said...

WOW a care plan for another person that does not even mention one time ASKING for their input...STUNNING!

Karen Twinem said...

Thanks for the comment. The third paragraph indicates that the person should be part of developing the plan, if at all possible. So their input is always important.

Athena said...

Anonymous raises an interesting point. Perhaps input from the relative is not mentioned or valued because the true purpose of the family meeting is to enforce some sort of predetermined treatment adherence. (See points 3 & 4.) If enforcing compliance is the foundational purpose of the meeting, then input from the psychiatrically labeled relative is inconsequential.