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Helping plan for future crises
Target
a) The CRT develops or reviews partial relapse prevention plans with service users.
b) The CRT routinely develops thorough relapse prevention plans with service users.
c) CRT staff help service users to use structured self-management programmes to promote recovery or respond to future difficulties.
d) The CRT has systems to help service users develop advance directives where appropriate and to ensure existing advance directives are followed wherever possible.
Why this is important
The period of crisis can present an opportunity for service users and carers to think about how to plan for and respond to future crises or to review what helped and what didn't work from a previous relapse plan. CRT staff can help with this process by introducing service users to self-management tools and relapse prevention plans, which the service user can be assisted to complete and make personally relevant. The CRT may also play a role in developing advance directives, and should have systems in place to ensure these are followed if service users already have an advance directive in place.
Ways of doing this well
Developing relapse prevention plans
This section includes several good examples of relapse prevention plans, which vary in length and their specific focus. Depending on the needs of the service user different plans may be more appropriate and useful for them as they attempt to avoid relapse.
North West Sussex CRHT use the following short relapse prevention plan with service users to help them identify their personal symptoms and indicators precipitating a crisis. This is a good example of how the necessary information can be condensed into a small amount of space.
South Tyneside Initial Response Team (IRT) use the following comprehensive Recovery Journal with service users. This allows them to reflect on their experiences and note their protective factors and support contacts, and also provides more space for reflection.
The following guide to relapse prevention from Cambridgeshire and Peterborough NHS Trust is focused on psychosis, and the specific needs of service users who wish to avoid relapsing into a psychotic episode.
In Avon and Wiltshire Partnership Trust resources have been produced for crisis, relapse and contingency planning:
The Mental Health Recovery website has more information on WRAP plans and how to complete them:
- Crisis WRAP plans and
- Post crisis plans
Other useful resources
Self-help CBT programmes have been developed as books and online courses: these might be one good way to explore how CBT can help. Two free online courses (both recommended by the Royal College of Psychiatrists) are:
- Mood Gym: https://moodgym.anu.edu.au/welcome
- Living Life to the Full: http://www.llttf.com/
Examples of good practice
In our fidelity review survey of 75 crisis teams in 2014, the following team achieved good model fidelity, and can be contacted for advice about how they achieved this:
- South Tyneside Initial Response Team, Northumberland, Tyne and Wear NHS Foundation Trust