THE COMMUNITY MENTAL HEALTH NURSES EXPERIENCES IN
UTILISING RELAPSE PREVENTION FOR PERSONS WITH PSYCHOSIS
ELIZABETH WYCHERLEY RPN, DipN, B.Sc,
Post Grad Dip in Acute & Enduring Mental Health Problems
Post Grad Dip in Psychosocial Intervention in Mental Health Care.
Background
It is understood that psychosis is associated with a
diversity of contributing factors such as biological,
psychological and social factors. Depending on the
contributing factors, the length of the resulting psychosis
can vary from hours to years (Sainsbury Centre for
Mental Health, 2003). Psychosis has a cyclical nature and
therefore most service users endure episodes of relapse
and remission.
Traditionally, persons with psychosis were predominantly
treated with pharmacological interventions. However this
has not been effective in all cases as there are high
relapse rates in persons following their first episode of
psychosis.
Even though a therapeutic dose of anti-psychotic
medication is essential, psychosocial interventions are
also vital in order to reduce the risk of relapse. The
provision of psychosocial interventions for persons with
psychosis is recognised to be an important part of
treatment (Brooker & Bradden, 2003). Nationally and
internationally the effectiveness of psychosocial
interventions have been supported and endorsed
(Department of Health 2006, National Institute of
Clinical Excellence, 2009) (NICE).
Recommendations for Service Provision
Psychosocial interventions for persons diagnosed with an
enduring mental illness are viewed as being fundamental
to the provision of a proficient and responsive mental
health service. NICE (2009) recommends psychosocial
interventions should be routinely implemented in the
treatment of psychosis.
Environmental stress and the individual’s vulnerability to
mental distress could contribute to exacerbation of the
person’s psychotic symptoms (Healy et al, 2006). The
management of potential environmental stress may
alleviate the chances of triggering the person’s psychotic
symptoms. Programmes of family intervention were
developed to reduce the risks of relapse of psychotic
symptoms and re-hospitalisation, enhance the persons
social functioning, curtail family burden and to increase
quality of life for the family as a whole.
Concordance with anti-psychotic medication is of utmost
importance in preventing relapse in persons with
psychosis (Harris, 2002). As previously discussed there is
a high incidence of non-concordance of medication
resulting in increased relapse rates and the “revolving
door phenomenon” (Kemp et al, 1997). The provision of
psychosocial interventions have been proven to be
effective to enhance medication concordance in persons
with psychosis.
The aim of CBT for psychosis is to change the thoughts,
behaviours and emotions of individuals by providing
them with psycho-education on skills to confront and
alter their beliefs, which they have regarding their
symptoms.
Managing
emotional
distress
and
environmental stress are important in preventing an
exacerbation of psychotic symptoms. Therefore CBT is
central to the management of psychotic symptoms.
The purpose of relapse prevention is to educate the
person who is working on changing their behaviour, preempt and manage the difficulties of the setback or
relapse. The principles of relapse prevention are
underpinned in the social learning theory, in that it
comprises of a combination of behavioural skills,
cognitive interventions and lifestyle adjustments. Relapse
prevention strategies are paramount in the treatment of
psychosis to promote early recognition and early
intervention, alleviate distress and potential disability and
enhance social inclusion.
Proposed Study
Aim:
To explore the community mental health nurse’s
experiences in utilising relapse prevention for persons
with psychosis.
Objectives:

To examine current literature available on this area
of interest.

To explore the models of care that nurses provide in
utilising relapse prevention.

To consider any concerns, which arise for nurses in
their provision of this intervention.

Identification of any educational requirements in
relation to relapse prevention for persons with
psychosis.
Design:
A qualitative descriptive methodology will be applied to
answer this research question. Up to eight community
mental health nurses who work within one Health Service
Executive region who meet the inclusion/exclusion
criteria will be interviewed individually. It is proposed
that interviews will be guided by a semi-structure, tape
recorded, transcribed and analyses by utilising Burnard’s
(1991) thematic content analysis.
ADMISSIONS OF PERSONS WITH PSYCHOSIS
IN NORTH LEE MENTAL HEALTH SERVICE 2005-2008
Year
F23.x Admissions only
1st Admissions
Male
Female
2005
4
0
1
3
2006
6
2
2
4
2007
14
8
10
4
2008
21
12
13
8
F23.x Admissions by Age
0-15 years
16-17 years
18-35 years
36+ years
Total
0
0
4
0
4
0
0
3
3
6
0
0
9
5
14
0
1
9
11
21
References
Department of Health and Children (2006) A Vision for Change: Report of the Expert Group on Mental Health Policy,
Dublin: Department of Health and Children.
Harris, N., Williams, S., Bradshaw, T. (2002) Psychosocial interventions for people with schizophrenia: a practical guide for
mental health workers, Hampshire: Palgrave Macmillan.
Healy, H., Reader, D., Midence, K. (2006) ‘An introduction to and rationale for psychosocial intervention’ in Gamble, C.,
Brennan, G., eds., Working with serious mental illness: a manual for clinical practice, 2 nd ed., Edinburgh: Elsevier, 55-70.
Kemp, R., Haywood, P., David, A. (1997) Compliance therapy manual, London: Bethlem and Maudsley NHS Trust.
National Institute of Clinical Excellence (2009) Schizophrenia: core interventions in the treatment and management of
schizophrenia in primary and secondary care, London: National Institute of Clinical Excellence.
Sainsbury Centre for Mental Health (2003) A window of opportunity: a practical guide for developing early intervention in
psychosis services, London: Sainsbury Centre for Mental Health.