Relapse and recurrence are common setbacks for people with behavioral health problems.
- Relapse refers to worsening symptoms while still being treated.
- Recurrence refers to worsening symptoms after treatment has ended.
Even after a person has had improvement or remission of symptoms, it is important to have a plan if there is a relapse and symptoms begin to worsen. Patients need to understand that relapse is not failure and that learning from the circumstances of a relapse can help to avoid known triggers in the future. Furthermore, side effects from treatment can also create setbacks for people with behavioral health problems.
Effectively building patient understanding of setbacks can prepare patients with what to look for and how to respond.
Shared care plans include self-management information on symptoms to watch for, what to do to prevent setbacks, how to recognize the onset of a setback, and how to respond, including when to contact the care team.
How Do You Do It?
Develop a Relapse Prevention Plan
A relapse prevention plan can help patients be ready to deal with setbacks. The plan helps patients think about what symptoms may arise if/when conditions begin to worsen and what they can do when they notice those symptoms. A relapse prevention plan usually includes steps for behavior changes pertaining to sleep, diet, and/or physical activity, in addition to health care system activities such as making an appointment with a primary care provider or counselor. Patients and providers should work together to develop a relapse prevention plan that emphasizes avoidance of triggers and tips for managing situations that make behavior change difficult.
Be sure to consider the patient’s unique beliefs, learning preferences, literacy, and cultural factors to identify appropriate teaching and communication methods and tools.
Your care team might facilitate patient self-management through the following methods:
- Sharing printed materials (e.g., handouts, brochures, note cards, newsletters).
- Offering Web-based resources (e.g., links to videos, Web-based documents, online forums or support groups, and other online resources).
- Conducting group visits to facilitate patients learning from each other and to reach patients more efficiently than on an individual appointment basis.
- Connecting patients with outside resources (e.g., external support groups, community-based organizations).
Monitor Response to Treatment
The care team should continue monitoring patients even after symptoms have improved to help identify relapse. You might consider adding reminders in the care plan to ensure that discussions occur regularly. Keep in mind that measures of response to treatment can vary across targeted populations.
How Others Are Doing It
The Community Health Plan of Washington has been administering the Mental Health Integration Program at federally qualified health clinics statewide since 2009. To support the program, the Care Management Tracking System registry allows providers to track patient progress over time. When patients are not meeting benchmarks, the case is flagged as a reminder to the care coordinator. Read more about Community Health Plan of Washington.
What Not To Do
- Don’t assume that “no news” is good news for people with common behavioral health conditions such as depression and anxiety. Checking in with the patient during and after treatment helps with identifying and addressing any setbacks.
- Don’t stop communicating with patients after their behavioral health symptoms have started to improve.
- Don’t set too high an expectation for the treatment timeline. Make patients aware that setbacks can occur, and make patients feel comfortable about alerting you regarding potential setbacks.
A template for an initial relapse prevention plan.
This resource provides an overview of preparing and implementing group visits at Massachusetts General Hospital.