Effective relapse prevention requires early intervention through access to appropriate supports and services. This means, firstly, the development of effective personal coping skills and illness self-management strategies in response to early warning signs. Secondly, it requires a service system that responds to early warning signs, not just acute crises. Furthermore, relapse prevention needs to commence during the earliest stages of treatment; as part of the ongoing process of continuing care that needs to be put in place at the outset. Relapse prevention requires a different service response. It requires truly listening to consumers and their families and carers and taking their concerns seriously. If intervention is early enough, it should not require an acute service response. The aim is to prevent crises in the form of rehospitalisation and police intervention. This is not, however, the experience of many people seriously affected by mental illness.
- It's not the consumers who you need to ask about whether they are having a relapse; it's about whether the services can respond at that time and whether they take what consumers say about the state of their health when they go to be admitted to a service. A friend of mine went to an acute ward and knocked on the door and said 'Can you please admit me' and they said 'No go away' and there was a bit of a scene and she threw an ashtray through a window, so they called the police and the police took her to the station and she was interviewed and then the CAT team came down and assessed her and she was admitted to hospital. This is not an uncommon story. —Consumer
There is an urgent need for respite, time-out, and safe places that consumers can go to when they are starting to feel unwell, but do not need the full response of the acute system. Increased availability of step-up and step-down facilities is essential. Too often, people are discharged from a hospital admission to no service response whatsoever. Due to the demands on hospital beds, consumers may be discharged while still experiencing their current episode. Consumers need better supported accommodation options for re-entry to the community after a hospitalisation. Similarly, there is a need for more supported community options for people who are beginning to become unwell again, but do not require hospitalisation.
A background paper developed by the Northern Territory Government (2003) identifies the following as some of the different types of community support options required to provide effective continuing care in the community: assertive community treatment; mobile intensive treatment teams; mobile crisis teams; hospital at home; group crisis residences; family sponsored homes; crisis apartments; and day hospitals.
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- Relapse unfolds, it doesn't usually happen overnight, usually over a period of days to weeks, but people still need a timely access to some point of the service that understands and is a collaborator in the process that is being described and has the knowledge and skills to know what those general and specific interventions can be. There's a permeability about re-entry that is really critical. So often family members will say 'Oh, I phoned up the mental health service', and the family member wasn't satisfied because the mental health service said 'get the person to come in', and has not appreciated the issues that the family has picked up which is something is changing here that needs some supported direction beyond what the family member can provide themselves. —Clinician
The role of the acute and specialist mental health system
The role of case management
The role of primary care including general practice