Social Work Practice in Psychiatric Settings

UNIT I: Introduction to Psychiatric Social Work [15 HRS]

Psychiatric  Social  Work  –  Concept  –  Definition,  Meaning,  Scope  –  History  of  Psychiatric  Social 
Work  in  India  -  Problems  of  Psychiatric  Patients  during  Pre-hospital,  Post-hospital,  family, 
Community Perspective, History of Social Work in USA and UK 
Concept and Meaning of Psychiatric Social Work
Psychiatric  social  work  is  a  specialized  type  of  medical  social  work  that  involves  supporting, 
providing  therapy  to,  and  coordinating  the  care  of  individuals  who  are  severely  mentally  ill  and 
who require hospitalization or other types of intensive psychiatric help​. 
Psychiatric  social workers complete a variety of tasks when working with clients, including but not 
limited  to  psychosocial  and  risk  assessments,  individualized  and  group  psychotherapy,  crisis 
intervention  and  support,  care  coordination,  and  discharge  planning  services.  Psychiatric  social 
workers  are  employed  in  a  wide  range  of  settings,  ranging  from  intensive  inpatient  wards  to 
outpatient psychiatric clinics. 
Psychiatric  Social  Work,  a  specialized  branch  of  Social  work,  which  concerns  with  theoretical  as 
well  as  clinical  work  and  the  knowledge  of  Psychiatry-which  primarily  deals  with  problems  of  the 
mind  and  associated  disorders.  The  essential  purpose  of  Psychiatric  Social  Work  is  to  help  the 
people  with  problems  of  the  mind  and/or  with  behavior  problems  or  we  can  say  precisely  the 
problems of mind and brain and their solutions. 
Scope of​ ​of Psychiatric Social Work 
Psychiatric  Social  Work,  a  specialized  branch  of  Social  work,  which  concerns  with  theoretical  as 
well  as  clinical  work  and  the  knowledge  of  Psychiatry-which  primarily  deals  with  problems  of  the 
mind  and  associated  disorders.  The  essential  purpose  of  Psychiatric  Social  Work  is  to  help  the 
people  with  problems  of  the  mind  and/or  with  behavior  problems  or  we  can  say  precisely  the 
problems of mind and brain and their solutions. 
It  has  grown  as  the  result  of  the  need  felt  and  its  realization  for  people  with  mental  or 
emotionally  disturb  could  be  helped  more  effectively  by  understanding  their  social  and/or 
environmental  factors  responsible  for  the  problems  of  mind  and  brain in their management. 
Professionally  trained  Psychiatric  Social  Worker  is  the  qualified  member  of  psychiatric  team 
treating  comprehensively  the  patients  with  psychiatric  disorders  or  behavioral  problems. 
These  professionals  utilize  social  work  principle,  techniques  for  the  purpose  of  diagnosis, 
patient  care and treatment and finally plan the rehabilitation of the patients in the family and 
in  the community. Besides  they  also  provide  other services  to mentally challenged people like 
therapeutic  treatment,  social  rehabilitation,  crisis  intervention  or  outreach  services  in  the 
community.  
A psychiatric  Social Worker (PSW) works in close association with psychiatrist, child guidance 
clinics,  social  services  department  as  the  team  in  the  psychiatric  hospital;  and  they  also 
extend  their  work  in  families  and  communities  for  mentally  challenged people. The role  and 
responsibilities  of  the  psychiatric  social  worker  is  fast  increasing  never  before  and  he  is  no 
longer  confine to the  hospital or psychiatric clinic, but they are accepting the  new challenges 
as  the  mental  health  hygienist  in various  public activities and helping the preventive mental 
schemes of the government for the people.  
Different  Legislations  related  to  the  care  of  the  mentally  disabled  and  those  related  to 
empowering  the  people  facing  various  challenges  in  medical,  health,  human  resource 
development  and  rehabilitation  domains  enlarged  the  scope  of  Psychiatric  Social Workers  in 
our country. However, the  numbers  of  professionally  qualified psychiatric social workers who 
are available in our country are very limited. 
Professionally  trained  Psychiatric  Social  Worker  is  the  qualified  member  of  psychiatric  team 
treating  comprehensively  the  patients  with  psychiatric  disorders  or  behavioral  problems.  These 
professionals  utilize  social  work  principle,  techniques  for  the  purpose  of  diagnosis,  patient  care 
and  treatment  and  finally  plan  the  rehabilitation  of  the  patients  in  the  family  and  in  the 
community.  Besides  they  also  provide  other  services  to  mentally  challenged  people  like 
therapeutic  treatment,  social  rehabilitation,  crisis  intervention  or  outreach  services  in  the 
community.  A  psychiatric  Social  Worker  (PSW)  works  in  close  association  with  psychiatrist,  child 
guidance  clinics,  social  services  department  as  the  team  in the psychiatric hospital; and they also 
extend  their  work  in  families  and  communities  for  mentally  challenged  people.  The  role  and 
responsibilities  of  the  psychiatric  social  worker  is  fast  increasing  never  before  and he is no longer 
confine  to  the  hospital  or  psychiatric  clinic,  but  they  are  accepting  the  new  challenges  as  the 
mental  health  hygienist  in  various  public  activities  and  helping  the  preventive  mental  schemes of 
the government for the people.  
Mental  health  professional  includes  various  professional  includes  all  practitioner  who  offers 
their  services  for  improving  an  individual's  mental  health  or  to  treat  mental  illness  include 
psychiatrists,  Clinical/Psychiatric  social workers, clinical  psychologists, , psychiatric  nurses, 
mental  health  counsellors,  professional  counsellors,  pharmacists,  as  well  as  many  other 
professionals  like  medical  anthropologists.  These  professionals  often  treat  comprehensively 
the  psychiatric  illnesses,  disorders,  conditions  and  other  issues,  however,  their  scope  of 
practice varies cases to case. 
HISTORICAL DEVELOPMENT IN INDIA 
Ayurveda  
Mental  disorders  are  represented  in  Ancient  India  in  various  types  of  literature.  The 
aetio-genesis  of  these  disorders was thought to  be endogenous  because of provoked humours 
like  vatonmad,  Pittonmad & Kaphonmand. Exogenously the causes were attributed to sudden 
fear  or  association  with  ill  influence  of certain mythological  gods or demon,  Charak Samhita 
designated Psychiatry as ‘Bhuta Vidya’.  
The  description  of  personality  is  to  be  in  terms  of  sathvik,  Rajasik  &  Tamasik  representing 
intellectual  &  moral,  emotional  &  passionatic  &  impulsive  respectively  &  Tamsik  is  more or 
less  near  mental  subnormality  or  angry.  Treatment  of  mental  disorders  mainly  included 
psychotherapy,  physiotherapy,  shock,  drug  treatment,  hypnotism  &  religious  discourses  by 
Sages.  Psychotherapy  used  to  be  in  the  form  of  talismans,  charms,  prayers  &  sleeping  in 
temples  with  rituals.  The  indigenous  manner  of  giving  shock  to  the  patient  was  terrorizing 
them  by  snakes,  lions,  elephant  or  men dressed as bandits. Then use  of  10 to  100  years old 
medicated  ghee,  Drugs  Cordfolia,  horse  radish  (shigru)  with  asafetida  &  rock  salt,  centella 
Asiatic (brami) with catechu & honey & powder of roots of serpentine were widely used.  
Unani System  
Najabuddin  Unhammad  (1222  A.  D),  an  indian  physician,  described  seven  types  of  mental 
disorders  viz.  :-Sauda-a-  Tabee(Schizophrenia);  Muree  Sauda  (depression);  Ishk ( delusion of 
love);  Nisyan  (Organic  mental  disorder);  Haziyan  (paranoid  state);  Malikholia-a-maraki 
(delirium). Psychotherapy was known as Ilaj-I-Nafsani in Unani Medicine.  
Siddha System  
‘Siddhi’  means  achievement and Siddhas are men  who  have  achieved results in medicine,  as 
well  as  yoga  and  tapas.  The  great  saga  ‘Agastya’,  one  of  the  18  Siddhas  has  contributed 
greatly  to  the  Siddha  system  of  medicine  of  the  South.  He  formulated  a  treatise  on  mental 
diseases called as ‘Agastiyar  kirigai  Nool ‘, in  which 18 psychiatric disorders with appropriate 
treatment methods is described​.
Growth of Mental Health after Independence 
On  the  recommendation  of  Bhore  committee  (in  1946),  All  India  Institute  Mental  Health  was  set 
up  in  1954,  which  became  the  National  Institute  of  Mental  Health  And  Neurosciences  in  1974  at 
Bangalore. 
Hence,  first  community  Mental  Health  unit  (CMHU)  was  started  with  the  Dept.  of  Psychiatry  at 
NIMHANS  in 1975. For short term training of primary care personal, a Rural Mental Health Center 
was  inaugurated  in  Dec’1976  at  Sakalwara,  15  km  from  Bangalore.  Mental  Health  clinic  was 
opened  in  a  General  Hospital  in  Bangalore  to  involve  General  Practitioners  in  Mental  Health, 
Seminars  and  orientation  programs  for  General  Practitioners  &  school  teachers  were  conducted. 
The  first  training  program  for  Primary  Health  Care  was  started  in  1978-79.  During  1978-1984 
Indian  Council  of  Medical  Research  funded  &  conducted  a  multicentre  collaborative  project  on 
‘severe  Mental  Morbidity’  in  Bangalore,  Baroda,  Calcutta  &  Patiala.  Various  training programs for 
psychiatrists,  Clinical  Psychologists,  Psychiatric  Social  Workers,  Psychiatric  nurses  and  Primary 
Care  doctors  were  conducted  at  Sakalwara  unit  between  1981-82  (Ministry  of  health  &  family 
welfare, 1989). 
Till  early  sixties,  Mental  Hospitals  were  the  only  place  available  for  the  treatment  of  mentally  ill. 
However,  as  compared  to  the  number  of  mental  ill  patients,  the  services  available  were  very  less. 
Hence  General  Hospital  Psychiatric  Units  were  started  to  deal  with  the  Increasing  number  of 
patients. 
The  first  GHPU  was started in R. G. Kar Medical College & hospital, Calcutta in 1933 & GMC R. J. 
J.  group  of  Hospital  Bombay  in  1938.  (khanna  et  al  1974).  The  number  has  gradually  increased 
since  then.  Gradually  GHPU  started  the  PG  training  centres  at  Delhi,  Chandigarh,  Lucknow, 
Bombay, Madurai etc resulting in development of District Psychiatrist unit. 
Mental Health Camps in India 
The  first  psychiatric  mental  health  camp  in  India  was  organised  in  1972,  at  Bagalkot,  a  taluka 
town  of  Mysore.  Earlier  some  service  centers  were  organized  by  members  of  team  of  Kripamayee 
Nursing  Home,  Miraj.  Following  this,  Indian  Psychiatric  Society  also  started  taking  active interest 
in  Mental  Health  camp  organization  and  various  health  camps  were  arranged  in different parts of 
India (such as Nandi, Ghosh, Sarkar, Banerjee in 1978, Luktuke in 1976). 
Voluntary Health Sector (VHS) in Mental Health 
There  have  been  strong  mass  media  movement  all  over  India  in  last  decade  where  various  issues 
related  to  Mental  Health  are  brought  in  public  domain.  The  social  movements  in  relation  to 
Darubandi  are  doing  commendable  work  and  are  very  well known. Other organization like SCARF 
(Chennai),  Richmond  fellowship  foundation  (Banglore),  Cadbum  are  also  helping  people  in 
rehabilitation and integrating them in the society 
In  these  various  organizations, active efforts have been taken to improve quality of care of patients 
&  rehabilitate  them  in  society.  Various  self  help  groups  such  as  Alcohol  Anonymous,  Narcotic 
Anonymous,  have  been  organized  by  people.  The  major  effort  of  VHS  is  evident  in  the  area  of 
suicide  &  Deaddiction  where various kind of activities are being carried out to help people in crisis 
eg : Sanjeevani in Delhi, Sneha in Madras, Prerna in Mumbai. 
Psychiatric Social Work 
The  establishment  of  Mental  Health  organization under the directorate of Health services was first 
recommended  in  1946  by  the  health  survey  &  development  committee of the government of India. 
The  first  Psychiatric  Social  worker  was  appointed  in  the  Child  Guidance Clinic started in 1937 by 
Sir  Dorabji  Tata  Graduate  School  of  social  work  (now  Known  as  Tata Institute Of Social Sciences) 
in  Mumbai.  Banerjee  was  the  pioneer  of  Psychiatric  Social  Work  training  in  India;  Institute  of 
training  in  America  appointed  her  the  leader  of  Department  of  Medical  &  Psychiatric  Social  Work 
established  in  1948.  The  other  Social  Workers  &  psychiatrists  who  gave  a  major  boost  to 
Psychiatric  Social  Work  in  India  were  Vidyasagar,  Sarada  Menon,  U.  B. Kashyap, B. D. Bhatia, P. 
B. Buckshey. 
Gradually  training  for  social  work  started  in  various  centers  such  as  National  Institute  of 
Neuropsychiatry  in  Bangalore  (now  known  as  NIMHANS)  Indian  Council  of  Mental  Hygiene 
(Institute of Psychiatry & Mental hygiene). 
Lunatic  Asylum  act,  Act  36  of  1856  was  modified  to  form  Indian  Lunacy  Act,  Act  4  of  1912.  The 
enactment  of  act  resulted  in  opening  of  new  asylums  and  improvement  in  the  condition  of 
asylums.  The  name  lunatic  asylum  was  changed  to  mental  hospital  in  1920.  In  1946,  the  Bhore 
committee  recommended  changes  in  Indian  Lunacy  Act  1912,  as  it  had  become  outdated.  Indian 
Psychiatric  Society  formed  in  January  1947  quickly  acted  on  the  recommendation  and  a 
committee  consisted  of  Dr.  J.  Roy,  major  R.  B  Davis,  Dr. Hasib was formed. It was finally enacted 
on 22nd May 1987. 
HISTORICAL DEVELOPMENT IN ABROAD 
Till  about  17th  century  all  abnormal  behavior  was  believed  to  be  act  of  the  ‘devil’  i.  e.  ‘Against 
God’,  ‘  Mentally  ill’  were  considered  evil  &  described  as  witches.  Gradually  over  the  passing  time, 
mental  illness  was  considered  as  ‘deviant  behavior  &  mentally  ill  were  considered  socially 
unacceptable  &  put  in  jails  along  with  other  criminals.  In  the  modern  era,  there  was  a  shift  from 
‘evil’  to  ‘ill.  Mentally  ill  were  called  as  ‘mad’  or  ‘insane’  and  were  placed  in special places called as 
‘asylums’.  However,  gradually  these  asylums  became  the  place  for  human  exploitation.  Phillipe 
Pinel  was  the  first  Psychiatrist  to  free  these  mentally  ill  from  asylum.  Clifford  Beers  work  ‘The 
mind  that  found  itself’  brought  in  light  the  treatment  meted  out  to  these  people  in  asylums, 
resulting  in  a  strong  reaction  to  the  plights  of  mentally  ill.  This  uproar  resulted  in  starting  of 
‘mental-hygiene’ movement 
In the early period when psychiatrists  had  to work unaided, they rarely had the time to probe 
into  the patient’s  personal or social history  without which  it was impossible to get a complete 
picture  of  patient  in  relation  to  the  problem.  In  consequence,  the  diagnosis  was  very  often 
merely  conjectural,  limited  to  the  physical  symptoms  and  psychological  factors.  These  were 
based mostly on hurried physical examinations of the patient, and without any understanding 
of  the  patient’s  personal  and  social  background,  which  had  necessarily  so  much  to  do with 
the nature and extent of the problem.  
The evolution  of psychiatric  social  work was the result of the awareness about the paramount 
need  to  look  into  the  social  implications  and  personal  background  of  the  patients,  and  the 
need to maintain  detailed case  records indicating the patient’s reaction to treatment over long 
periods.  Thus  psychiatric  social  workers  are  charged  with  the  responsibility  of  gathering 
social  data,  examining  the social responses  and  interpreting all these in  relation to  the main 
task of reaching meaningful diagnosis and initiating effective treatment.  
Psychiatric  social  work  as a profession  had  its  origin in the West in  the second decade of the 
nineteenth  century.  However,  there  has  been  a  lot  of  confusion  about  the  term,  psychiatric 
social  work.  As  far  back  as  1929,  two  different  definitions  of  psychiatric  social  work  were 
formulated  in  USA.  The  first  definition  emphasizes  the  setting  in  which  social  case  work  is 
practiced.  It  defines  psychiatric  social  work  as,  “Social  case  work  established  within 
psychiatric agencies as a form of service essential to the medical program of such agencies.  
The  second  definition  lays  stress  on  the  qualitative  aspect  of  the  practice  irrespective  of 
setting.  It  defines  psychiatric  social  work  as  a  practice  possessing certain  qualities, deriving 
from  knowledge  of  psychiatric concepts and forms the ability  to adapt them to the social case 
work process.  
According  to  the  second  definition, the  work  of social workers, who find  new positions in the 
family  welfare  agencies  or  child  welfare  agencies,  has  to  presume  that  all  activities  of 
psychiatric social workers are related to psychiatric social work.  
A  third  definition  has  also  been  given  that,  “Psychiatric  social  workers  are  those  who  work 
with psychiatrists  as opposed to those who do not”. In that sense a social worker working in a 
family  welfare  agency or any agency where the service of a part time consultant psychiatrist is 
available will say that hers is psychiatric social work. 
PROBLEMS OF PSYCHIATRIC PATIENTS 
The  trend  toward  brief  psychiatric  hospitalizations  may  place  increased  demands  on  caregivers 
both  during  and  after  patient  psychiatric  hospitalization.  Short  inpatient  stays  may  increase 
caregivers’  need  to  adjust  and  resolve  seemingly  insurmountable  circumstances  with  little-to-no 
external  support,  both  during  and  after  discharge.  Furthermore,  caregivers  may  need  to  support 
the patient after discharge because symptoms persist. 
Caregivers  are  heterogeneous  in  their  reaction  to  the  psychiatric  hospitalization;  however,  many 
report  distress.  Caregivers  also  often  report  that  they  experience  stigma,  disruptions  in  daily  life, 
worse  physical  health,  economic  strain,  and  changes  in  relationships  following  hospitalization. 
Negative  reactions  to  the  hospitalization  may  decrease  over  time,  but  can  remain  elevated  when 
compared  to  the  general  population.  Nonetheless,  many  caregivers  also  experience  positive 
changes  as  a  result  of  the  hospitalization.  The  reaction  of  caregivers  may  be  influenced  by  the 
severity  of  the  patient’s  psychiatric  problems  as  well  as  the  caregiver’s  demographics  and  style  of 
coping. 
What is psychiatric hospitalization? 
It’s  when  a  patient  is  admitted  into  a  mental  health  establishment  for  a  length  of  time, 
anywhere  between  a  few  days  to a few months, and provided in-patient care. Psychiatric 
hospitals  are  meant  to  provide  a  safe  environment  where  patients  can  recover  with  the 
help of a structured environment and therapy. 
What are the types of psychiatric hospitalization? 
There  are  two  kinds  mentioned  in  the  Mental  Healthcare  Act,  2017  (​Act​):  voluntary  and 
supported  admission.  The  first  is  in  the  case  of  someone  who  has  the ​capacity​ to  make 
decisions  about  their  mental  healthcare  and ​treatment​.  The  mental  health  professional 
who  is  in  charge  will  determine  if  the  person  in  question  has  this  capacity  as  per 
procedure  under  the  Act.  Where  the  person  is  admitted  as  an  independent  patient  they 
can  ask  to  leave the hospital at any time of their choosing and can do so without asking 
for  consent  as  well.  The  mental  health  professional  in  charge  can  —  for  a  period  of  24 
hours — ask the independent patient to stay in the hospital for the purpose of conducting 
an  assessment  to  make  sure  that there is no risk of them causing themselves or anyone 
else bodily harm or damaging any property. 
Supported  admission,  the  second  type,  is  when  a  person  does  not  have  the  capacity  to 
make  a  decision  about  their mental healthcare and treatment, or when they are a minor 
and  a  decision  about  their  treatment  is  made  by  their  legal  guardian.  For  the  period  of 
time where a person is lacking the capacity to make their own decision, someone who has 
been  nominated  (the  nominated  representative)  by  them  can  make  decisions  on  their 
behalf.  The  moment  they  have  regained  their  capacity,  the  nominated  person  will  no 
longer have the right to continue making any decisions on their behalf. 
In  the  absence  of  a  nominated  representative, the nearest of kin can provide consent for 
the  person  to  be  admitted  into  a psychiatric hospital. Rules for reviewing capacity of the 
patient  (section  89  (8));  maximum  period  of  stay  permitted  in  the  hospital  under 
supported admission (section 89 (2)); reporting to the relevant Board (section 89 (9)); and, 
in  case  of  stay  that  extends  beyond  30  days  (section  90)  are  mentioned  in  the  Act  in 
Chapter XII. 
Psychiatric  hospitalization can also be divided according to the length of admission, kind 
of care and aim of the hospitalization. 
Acute hospitalization 
This  is  when  a  patient  is  extremely  unwell  and  needs  urgent  medical  help.  It  is  also 
known  as  an  emergency  admission  to  an  acute  psychiatry  unit.  The  aim  of  this  kind  of 
hospitalization  is  to  control  the  symptoms  and  ensure  the  safety  of  the  patient  and  the 
people around them. 
Who  is  it  for:​ People  with ​psychosis​,  mania,  severe ​depression​, depression with suicidal 
ideation and withdrawal from ​substance use​. 
Psychiatric intensive-care unit 
 This is when the patient is in imminent danger of harm to self or others. Their needs are 
higher and the nursing care is of a higher degree. Two nurses assigned for every patient.  
Who  is  it  for:​ Patients  who  are  in  danger  of ​self-harm​ or  are  so  violent  they  need  to  be 
contained. 
Long-stay ward or long admission 
Here,  the  patient  is  admitted  for  rehabilitative work. This includes treating patients with 
therapy to help them recover from their mental illness and restore their ability to function 
in the ​community​. 
Who is it for:​ Patients with addiction or, chronic and enduring mental illnesses. 
Before the d​ einstitutionalization movement ​ of the late 1960s, patients could be committed 
to living in an asylum/institution for the rest of their lives. Following the movement, this is no
longer an option. Now there is an attempt to integrate patients back into society and community
care (such as assisted living and half-way homes). 
Respite 
A short stay of about a week to ten days to get away from immediate​ stress​ such as the loss of a
job, a change in the family situation or even after a stressful project. 
Who is it for:​ Patients who are dealing with stress or have just gone through a high-stress situation. 
In some hospitals, psychiatric facilities may be divided by age group. For example, a children's
psychiatry ward may have patients below the age of 18 whereas a geriatric ward may have patients
above 65. This is so that everyone can receive care according to their specific needs. 
When do patients require admission? 
In the following instances (a non-exhaustive list) 
When there is a risk of bodily harm to self or others 
When their condition is acute but they refuse treatment 
When a patient needs to be observed for a clearer diagnosis 
When the patient is prescribed complex medication which requires time for their symptoms to 
stabilize 
Lack of adequate social support in the community to support recovery (for eg, a student 
who is living away from home and does not have a social support system, who is in need of 
a structured environment for the period of their recovery) 
Drug detoxification 
When there is a physical and mental illness that needs to be treated holistically 
Even if a patient fits any of the above criteria, a mental health professional must be consulted
before considering in-patient admission.

Q
What do I do if someone I know is refusing admission?
A
The law has a provision for someone who is refusing admission. Supported admissions are beneficial
to people who have a high need for care that can be provided by mental health professionals, and
that their ​caregivers​ can’t provide; and who don’t have an understanding of the extent of the issue
due to the nature of their illness. For example persons with schizophrenia may not be aware that they
are in need of treatment due to psychotic episodes.
In these circumstances, at the request of a nominated representative or (where there is no nominated
representative) the closest family member, a mental health establishment can accept a person as a
patient even when they are refusing admission. Two psychiatrists are required to assess and agree
to the need for admission against the will of the person. Treatment though is always given with the
consent of the patient except in cases of emergency or when the patient lacks the capacity to give
such consent (in which case, the nominated representative or nearest of kin can give consent on
behalf of the patient for treatment).

The Act grants more power to the person who is getting admitted to the psychiatric hospital and
aims to create a rights-based language that will lead to fewer instances of injustice when it
comes to admission to a hospital. To access detailed rules of admission, treatment and
discharge at a psychiatric hospital, read Chapter XII (section 85 to section 99) of the ​Act​.

Recovery in a mental illness is a process of healing and change that enables individuals to
regain their mental health and wellness so they can resume their activities as before. However,
due to reasons not foreseen, some symptoms of mental illness can make a comeback, which
hampers with the recovery. In the case of severe mental illnesses such as schizophrenia and
bipolar disorder that require lifelong care, the possibility of relapse are very high. However, the
effect of relapse depends on the nature of the condition and its severity.

For common mental illnesses such as depression, relapse could mean a loss of productivity and
a drop in motivation or social interaction. For more severe mental illnesses, relapse could mean
a drastic drop in everyday functions, social withdrawal, experience delusions or hallucinations or
become aggressive.

Q
What is relapse?
A
Relapse is the onset of symptoms after recovery. Relapse usually occurs in phases, and each
person’s relapse has a specific pattern, that is, a list of symptoms that recur with every episode.
If the person has experienced relapse once, being aware of symptoms of relapse can help them
and the caregivers manage it better together or seek help at the right time.
Q
Why does relapse occur?
A
A change in the medication, a change in the dosage or sudden stoppage of medication can
bring about the warning signs of relapse. As a person with mental illness, if you feel that the
medication or dosage is being changed, it is best to talk to your psychiatrist to ask them what
you can expect; and get in touch with them if you notice any change in your behavior or
thoughts. As a caregiver, observe whether the person with mental illness is feeling better or
worse with the change of medication, and talk to the treating psychiatrist about it.
Relapse can also occur due to substance use, drugs or alcohol. It could also occur due to stress
from life events such as job promotion, marriage, pregnancy and the birth of a baby; or
challenges such as the loss of a job or the death of a loved one.
Q
Is it possible to predict a relapse?
A
 Usually, the early warning signs of relapse can be noticed a few days or weeks before by the
person with illness or their caregivers. These early warning signs can be changes in the
person’s thoughts, behavior and perceptions.
● Sleep deprivation
● Loneliness
● Changes in appetite
● Feelings of unease, not being able to relax
● Feeling tense or irritable
● Lack of attention to appearance and personal hygiene
● Inability to concentrate, forgetfulness
● Unexplained pains and aches (for depression)
Planning for help during relapse

As caregivers, it is important to know that the signs of mental illness can make a comeback after
recovery. You can also involve the person with illness and their mental health professional in
creating the outline. Here are some steps to take when preparing for a relapse:

● Specific signs of changes/early warning signs:​ Caregivers can recognize the specific
changes in thoughts, behavior and emotional status of person with illness - are they more
irritated than usual? Is there any drastic change in the sleeping patterns? The caregiver can
note down the degree of intensity, and the frequency of the signs.

● Discuss the relapse episode:​ If the person with illness is completely dependent on their
caregivers, it is important for both of them to discuss the relapse episode. If the person is
moderate or high functioning, the caregivers can discuss the warning signs with them, and
create a plan for management.

● Track  their  medication  -​ be  it  a  change  of  dose,  change  of  medication,  or 
consumption patterns. This helps the person with illness note the changes that come 
along  with  it.  The  caregiver  can  also  consult  the  treating  psychiatrist  to  create  an 
action plan. 
● Mark  stressful  events:​ If  the  person  with illness is anticipating any major life event, 
even positive ones, it is important for caregivers to be aware of them and discuss with 
the person on how to manage the symptoms.   
Recovery after relapse 
Recovery  after  a  relapse  episode  can  be  a challenging time and requires support and 
patience  from  the  caregivers.  If  the  person  with  illness  has  not  made  sufficient 
recovery in their illness, relapse can feel de-motivating and affect their self-esteem. As 
a  caregiver, you can reassure them that they have your support. If you as a caregiver 
are  feeling  emotionally overwhelmed with the situation, you could consult a therapist 
to  talk  about  it.  It  is  important  to  clarify  any  doubts  that both the caregiver and the 
person with illness may have about relapse with the treating psychiatrist. 
.