Understanding and addressing mental illness relapse

In this article I explore the concept of mental health relapse at a high-level, drawing on evidence-based understanding. While it provides valuable insights, it is not an academic research nor is it intended to provide any mental health advice. If you are seeking support for your mental health, please reach out to a qualified professional (plug to Bossa Health) . I also recognise the evolving language in mental health; terms such as 'mental health condition,' 'challenges,' and 'difficulties' are often used interchangeably with 'mental illness'.

Recovery from mental illness is often a journey with ups and downs, rather than a linear path. A significant aspect of this journey, which is crucial to understand and address, is the concept of relapse. Mental illness relapse refers to the return or worsening of symptoms after a period of partial or full recovery (Lader, 1995). It is a common experience for individuals with various mental health conditions, including depression, anxiety disorders, schizophrenia, and bipolar disorder. Relapse is not a sign of failure but rather a recognised part of the recovery process for many. Understanding that setbacks can occur is the first step towards building resilience and developing effective strategies to manage them.

Relapse can manifest differently depending on the specific mental health condition, involving a return or intensification of its characteristic symptoms. For individuals with depression, a relapse might involve a return of persistent low mood, loss of interest or pleasure in activities, changes in appetite or sleep, feelings of worthlessness, or suicidal thoughts (NHS, 2022a). In anxiety disorders, such as generalised anxiety disorder or panic disorder, relapse could present as a resurgence of intense worry, panic attacks, avoidance behaviours, or physical symptoms like a racing heart or shortness of breath (NHS, 2022c - Note: A general NHS page on anxiety disorders). For those with schizophrenia, relapse can be characterised by a re-emergence or intensification of psychotic symptoms like hallucinations, delusions, disorganised thinking, or severe social withdrawal (NICE, 2014). In bipolar disorder, a relapse might involve a return to either a manic or depressive episode. A manic relapse could include elevated mood, increased energy, racing thoughts, reduced need for sleep, and impulsive behaviour, while a depressive relapse would mirror the symptoms of major depression (NHS, 2022b). Understanding these varied presentations is crucial for early identification and intervention.

Why is it important to discuss relapse?

Openly discussing and planning for the possibility of relapse is vital for several reasons. For the individual, it can be an empowering process that helps them to recognise early warning signs and take proactive steps to prevent a full-blown episode. This can lessen the severity and duration of a relapse, leading to improved long-term outcomes and a better quality of life (Orygen, 2023).

From a broader perspective, relapse has significant implications for families, who often provide a great deal of support, and for healthcare systems. Frequent relapses can lead to increased hospitalisations, greater use of emergency services, and higher economic costs (Ali, S. et al., 2017; Yang, C., 2020).

Alarmingly, statistics highlight the prevalence and impact of relapse. For instance, a study by University of York researchers, in collaboration with NHS clinicians, found that around 53% of patients treated for depression and anxiety experienced a relapse within a year of completing psychological treatment (Ali et al., 2017). While extensive literature reports a similar trend in other populations, this figure alone critically underscores the importance of focusing on prevention and long-term management. By prioritising relapse prevention, it is possible not only enhance individual well-being but also alleviate the strain on these vital support systems.

Risk factors for relapse

A multitude of factors can increase an individual's risk of relapse. It is important to note that these factors can be highly personal and vary from one individual to another. Some of the most commonly identified risk factors include:

• Medication non-adherence: This is one of the most significant predictors of relapse. Stopping or inconsistently taking prescribed medication without medical guidance can lead to a return of symptoms (Birhan, B., Rtbey, G., & Gelaw, K. A., 2025).

• Comorbidity: The presence of other co-occurring mental or physical health conditions can complicate treatment and increase the likelihood of relapse.

• Stressful life events: Major life changes, such as relationship breakdowns, job loss, or financial difficulties, can act as triggers for a relapse (Inspire Lancashire, n.d.).

• Lack of social support: A strong support network of family, friends, and peers is a protective factor. Conversely, social isolation can increase vulnerability to relapse (Lancaster University, n.d.).

• Residual symptoms: Even after successful treatment, some individuals may experience lingering, less severe symptoms. These residual symptoms can be a predictor of a future relapse (Ali, S. et al., 2017).

• Substance use: The use of alcohol or illicit drugs can interfere with treatment and trigger a relapse of a mental health condition (NICE, 2016).

How to address and prevent relapse

A proactive approach to relapse is key. This involves creating a comprehensive relapse prevention plan, ideally developed in collaboration with a mental health professional. This plan should be a personalised and practical guide to staying well. Key components of an effective relapse prevention plan include:

• Psychoeducation: Understanding the nature of the mental illness, the purpose of treatment, and the process of recovery is fundamental for both the individual and their family.

• Identifying early warning signs and triggers: Learning to recognise personal triggers and the subtle changes in thoughts, feelings, and behaviours that may signal an impending relapse is crucial. These can be unique to each individual and may include changes in sleep patterns, mood, or social behaviour.

• Developing coping strategies: Having a toolbox of coping strategies to manage stress and difficult emotions is essential. This can include mindfulness, relaxation techniques, and problem-solving skills.

• Medication management: Adhering to the prescribed medication plan is vital. Any concerns or side effects should always be discussed with a GP or mental health professional to find the best solution/alternative.

• Ongoing professional support: Regular check-ins with a therapist, psychologist, clinical pharmacist or psychiatrist (in essence, the professional involved in the person's care) can provide ongoing support, help to refine coping strategies, and address any emerging issues.

• A strong support network: Building and maintaining a supportive network of family, friends, and peer support groups can provide a crucial buffer against relapse.

• Lifestyle factors: A healthy lifestyle, including a balanced diet, regular exercise, and adequate sleep, can have a significant positive impact on mental well-being and reduce the risk of relapse.

Conclusion

Mental illness relapse is a common and understandable part of the recovery journey. By understanding what relapse is, recognising its risk factors, and proactively developing a personalised prevention plan, individuals can be empowered to manage their mental health effectively in the long term. Openly discussing relapse helps to reduce stigma and encourages a more compassionate and realistic approach to mental healthcare. With the right support and strategies in place, it is possible to minimise the impact of relapse and continue on the path to a fulfilling and meaningful life.

References

• Ali, S., Rhodes, L., Moreea, O., McMillan, D., Gilbody, S., Leach, C., Lucock, M., Lutz, W., & Delgadillo, J. (2017). How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study. Behaviour Research and Therapy, 94, 1-8. https://doi.org/10.1016/j.brat.2017.04.006

• Beshai, S., Dobson, K. S., Bockting, C. L., & Quigley, L. (2011). Relapse and recurrence prevention in depression: Current research and future prospects. Clinical Psychology Review, 31(8), 1349–1360. https://doi.org/10.1016/j.cpr.2011.09.003

• Birhan, B., Rtbey, G., & Gelaw, K. A. (2025). Relapse and associated factors among psychiatric patients in Africa: A systematic review and meta-analysis. BMC Psychiatry, 25(1), 1-13. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-025-06759-7

• Inspire Lancashire. (n.d.). Relapse: Understanding the risk and how to prevent it. Retrieved from https://inspirelancs.org.uk/relapse-understanding-the-risk-and-how-to-prevent-it/

• Lader, M. (1995). What is relapse in schizophrenia?. Journal of Clinical Psychopharmacology, 15(1 Suppl 1), 5S-9S. https://pubmed.ncbi.nlm.nih.gov/7622834/

• Lancaster University. (n.d.). Support a relapse prevention/staying well plan. REACT. Retrieved from https://www.lancaster.ac.uk/reacttoolkit/toolkit/managing-mood-swings-2/support-a-relapse-prevention-staying-well-plan/

• National Institute for Health and Care Excellence. (2014). Psychosis and schizophrenia in adults: Prevention and management (NICE guideline CG178). Retrieved from https://www.nice.org.uk/guidance/cg178

• National Institute for Health and Care Excellence. (2016). Coexisting severe mental illness and substance misuse: Community health and social care services (NICE guideline NG58). Retrieved from https://www.nice.org.uk/guidance/ng58

• National Institute of Mental Health. (2022). Relapse. Retrieved from https://www.nimh.nih.gov/health/topics/relapse

• NHS. (2022a). Clinical depression. Retrieved from https://www.nhs.uk/mental-health/conditions/clinical-depression/

• NHS. (2022b). Bipolar disorder. Retrieved from https://www.nhs.uk/mental-health/conditions/bipolar-disorder/

• NHS. (2022c). Anxiety, fear and panic. Retrieved from https://www.nhs.uk/mental-health/conditions/anxiety-fear-panic/

• Orygen. (2023). Preventing relapse in first episode psychosis. Retrieved from https://www.orygen.org.au/Training/Resources/Psychosis/Clinical-practice-points/Preventing-relapse-in-FEP/Preventing-relapse-in-first-episode-psychosis

• Yang, C., Zhong, X., Zhou, H., Wu, Z., Zhang, M., & Ning, Y. (2020). Physical comorbidities are independently associated with higher rates of psychiatric readmission in a Chinese Han population. Neuropsychiatric Disease and Treatment, 16, 2073–2082. https://doi.org/10.2147/NDT.S261223