It is important to realise that the rhetoric surrounding these issues is contentious, potentially confronting and certainly not universally agreed. Nevertheless, it is necessary to attempt to develop definitions for these ambiguous terms in order to provide a common language for discussion and a platform for progress. Consequently, the following preliminary definitions are offered for relapse, relapse prevention, recovery and rehabilitation:

  • Relapse is a subsequent episode of mental illness. It is a recurrence of symptoms of mental illness similar to those that have previously been experienced. The threshold of symptoms required to identify a relapse varies according to the differing perspectives of the person experiencing the symptoms, their family and carers, and service providers. Relapse is generally agreed to have occurred when the person experiencing the symptoms is not able to cope using their usual supports and requires a greater intensity of intervention. The word 'relapse' is viewed by many as a negative and medicalised term, and the words 'episode' or 'being unwell' may be preferred.

  • Relapse prevention is a specific component of the recovery process. It entails maximising wellness for people with mental illness by reducing the likelihood and impact of relapse. It involves empowering people with mental illness to recognise early warning signs of relapse and develop appropriate response plans. It requires identifying risk and protective factors for mental health, and implementing interventions that enhance protective factors and eliminate or reduce the impact of risk factors. Relapse prevention is based on communication and understanding between the person experiencing mental illness, their family and carers, primary health care, the specialist mental health system, and community support services about access to support or treatment if there are early signs of relapse. Relapse prevention is an essential, but not sufficient, component of the recovery process for people with mental illness.

  • Recovery1 is "the development of new meaning and purpose in one's life as one grows beyond the ... effects of mental illness" (Anthony 1993). It means maximising wellbeing, within the constraints that might be imposed by symptoms of mental illness.

  • Rehabilitation is also known as 'psychiatric rehabilitation' and is a set of targeted interventions that are intended to prevent further, or reduce the disability that is associated with, mental health problems. It is a process of assisting people to acquire and to use the strengths and skills, supports, and resources necessary for successful and satisfying living, learning, and working in the environments of their choice (NSW Health 2002a p5).
Within the spectrum of interventions for mental health, relapse prevention and rehabilitation are placed under the arc of recovery, which comprises treatment and continuing care. Relapse prevention and rehabilitation are elements that form part of and facilitate the recovery process. From this viewpoint, Deegan notes, "Rehabilitation refers to the services and technologies that are made available to disabled persons so that they might learn to adapt to their world. Recovery refers to the lived or real experience of persons as they accept and overcome the challenge of disability." (Deegan 1988 p11). Relapse prevention is part of continuing care where there is a deliberate focus on ongoing illness management aimed at reducing the likelihood and impact of future episodes of illness.

The spectrum of interventions can, therefore, be modified to incorporate growing understanding of this section (see figure 3). Best practice treatment incorporates provision for continuing care, comprising plans for relapse prevention and rehabilitation, which must be provided within a recovery orientation that prioritises the lived experience of the person with mental illness and works to maximise their wellness and wellbeing, along with that of their family and carers.Top of page

Figure 3. Modified spectrum of interventions for mental health

Refer to the following list for a text equivalent of figure 3. Modified spectrum of interventions for mental health

Text equivalent below for Figure 3

The spectrum of interventions for mental health is presented as a semi-circle, with each segment in the semi-circle representing a particular intervention.The spectrum is underpinned by mental health promotion.

The interventions that make up prevention are:
  • universal (general)
  • selective (at-risk)
  • indicated (high-risk).
The interventions that make up treatment are:
  • illness identification
  • early treatment
  • standard treatment.
The interventions that make up continuuing care are:
  • self-management
  • relapse prevention
  • rehabilitation.
At a higher level, early intervention encompasses three interventions: indicated (high-risk), illness identification, and early treatment. Recovery encompasses four interventions: standard treatment, self-management, relapse prevention and rehabilitation.

Footnotes

1 The concept of recovery is more fully explored in the document, Sharing Responsibility for Recovery, Queensland Health, 2005.