Survive and Thrive

Relapse: Why does it happen and how can we prevent it

Let’s picture a patient in a mental health facility. Before this patient’s discharge, he or she is given prescriptions. In most facilities, this person has also worked with a therapist or case worker to come up with a safety plan, or in other words a plan for what to do if symptoms re emerge and become unbearable, even unsafe. Someone may arrange a ride for this patient and even housing for after the discharge. With all of these things provided for them, one may think that this person is set up for success and will most likely not be needing inpatient services again anytime soon.

But maybe a month or even a week later, this patient comes back. Why does this happen? As a registered nurse for one of these mental health facilities, I have seen this happen countless times. It’s heartbreaking, discouraging and leaves me wondering what we could have done differently.

After some research, I’ve found that a significant percentage of patient’s experience relapse within the first year after leaving the hospital. These are some of the reasons that go into that.

1. Lack of continuity of care: One of the main reasons for relapse after discharge is that many individuals may not have access to appropriate mental health services, or may face barriers in continuing with their treatment after leaving the hospital. Without ongoing support and monitoring, patients are at a higher risk of relapse.
2. Social Isolation and Stress: Lack of social support, financial difficulties, and other stressors can exacerbate psychiatric symptoms and make it challenging for individuals to maintain their mental health post-discharge
3. Medication Non-Adherence: This might be the biggest one. Due to stigma, side effects or just lack of understanding about the importance medication plays in the patient’s well being, patient’s either gradually or all at once will decide medication just isn’t for them. They may have seen it as a temporary thing while in the hospital. Maybe they never intended to stay on it. Or maybe it’s a matter of the price of these medications, something that is not discussed enough.

With all that being said, what do we do about this? 

1. Push for IOP (intensive outpatient) or PHP (partial hospitalization): Both of these options provide more care than just sending these patient’s back to where they were when they first started struggling. It allows individuals in this populations to be monitored more closely while still being able to go home, but more slowly rather than all at once. In PHP, the individual is in groups, receives medications in an outpatient setting for several hours each day and then goes home. With IOP, you spend even fewer hours in this setting before returning home. They typically encourage individuals to stay 2-6 weeks, sometimes even longer.
2. Encourage more family sessions while inpatient: If a trigger for a patient is the conversations had between them and their spouse or roommate, wouldn’t it make sense to have more sessions involving them? Most facilities only require one family session and in some cases that’s to make plans for discharge. Imagine being able to get issues out in the open with a trained professional and working things about before discharge so that a patient can go home without fear of old issues still being around.
3. Education: I feel that I say this all the time, but it is so important. Education on medications, what to expect, what to look out for can help a person understand so much more than being handed a cup of pills and saying “Take these” and providing only the drug name. I am thankful to say that I do not work with any nurses who do this where I work now, but I have heard of it happening. If you are an individual who takes any medication, doesn;t even have to be a psych med, please do your education on it especially if your provider is not doing his or her part in providing education for you.

In a nutshell, proper discharge planning, ongoing monitoring, and access to mental health education are essential components of preventing relapse and supporting recovery.