After recovery
What is Recovery?
Recovery involves a journey of building up personal interests and abilities. Even though patients’ symptoms may not fully disappear, they should be encouraged to face the challenges posed by the illness, develop their true potential and to engage with work, study and spiritual life.
Recovery can be simultaneously interpreted as reduction of symptoms. Having been on medication for few days to few weeks, most patients display fewer delusional beliefs and hallucinations, though this varies from person to person. Some patients may be influenced by the symptoms for a longer duration, and some symptoms that had resolved may even recur. The above situations may undermine their confidence in recovery, make them worried, disappointed and may even despair. Patients should actively reflect their conditions to medical workers, as they will advise suitable treatments to the patients. In spite of a lengthy process, most patients with psychosis will achieve remission. In general, most patients on medication for one to two years will show less negative symptoms and are able to resume past activities and social life. Some patients are also able to return to work or school. However, it is possible that some patients remain influenced by residual symptoms, so that they have difficulty in taking care of themselves, a lack of interest and motivation in interacting with surrounding people and things, have decreased speech, insomnia or hypersomnia, and have mood problems, etc. Patients may feel uneasy to reacquiring habits in life. In this case, apart from medications, we should also encourage patients to participate activities and skill training in the community to assist them to learn through this recovery process, and gradually adapt to and face challenges.
Can Patients with Psychosis go to School?
A school offers ex-mentally ill persons a chance to improve and learn; thus, if a patient’s condition stabilizes after treatments, one should progressively resume normal life. Furthermore, returning to school or community also facilitates recovery progress. However, if the student is not yet ready, returning to school will be hasty. Undue pressure impedes recovery.
Provided that they receive treatments leading to a stable condition, some ex-mentally ill students can meet their past standard in learning. Yet, treating some symptoms may require longer time, particularly negative symptoms (e.g. emotional numbness, poverty of speech, inability and lack of motivation to form relationships) and cognitive deficits (e.g. deterioration in attention and memory). These symptoms are likely to affect students’ performance in early phase of resuming school life. They may require all-party supports. The school, the families, the patients and the medical professions should establish effective communication which matters a lot in this stage. Furthermore, students may need follow-up consultations which may affect their attendance to school. So, we should closely observe ex-mentally ill persons’ situation, and adjust our expectations. We should collaborate with the school when necessary.
It is likely that students take a long sick leave to undergo treatments. After returning to school, pressure to students and parents may arise from changes in routine life, catching up learning progress, handling examinations and assignments. Therefore, the school and the parents can make appropriate adjustments for the students. Besides, some symptoms may affect learning progress, such as lack of motivation and interest in social life. The symptoms are caused by psychosis, but owning to its ambiguous nature, families and friends may mistakenly attribute patients’ behaviours to their personalities and attitudes, misjudging that the patients are lazy, uneager to improve themselves and make changes. Thus, they may blame the patients wrongly. It is a crucial step but not an end in recovery that the students can return to school, so families, friends and schools should help ex-mentally ill students to resume their normal life at school.
On account of the symptoms, ex-mentally ill students may exhibit aberrant behaviours triggering discrimination, exclusion and even bullying in school. Research demonstrates that 30% of patients with psychosis in Hong Kong experienced verbal and non-verbal bullying in school, such as mocking and teasing at them. In this case, teachers, parents, schoolmates and social workers pay close attention and intervene.
Can Patients with Psychosis go to Work?
Work maintains people’s participation in society. Even though patients may encounter difficulties in finding a job, we should encourage patients to overcome difficulties and lead a fruitful life.
People with a history of mental disorder may experience the following difficulties when looking for a job.
| Possible Difficulties | Solutions |
| Patients with more experience in working may think their current job is low-paid and less respected compared to their previous jobs. | Some patients (especially with high education) may think salary and job nature do not meet their standards, being frustrated and daunted. Besides, side effects of medication may lead to tiredness and difficulty in concentrating, undermining working performance. Therefore, families and friends should listen to patients’ job expectations and plans, and provide opinions and encouragement. If the expectation is over-high, we can help them adjust their working expectations. |
| Unable to account for the “gap year”. | Some patients feel reluctant to reveal to employers that they suffered from psychosis. We can strike a balance between privacy and needs in mental health, before deciding whether to reveal to the employers the illness history. |
| Teenagers who lack working experience deficit in self-knowledge, interview skills, working experience and knowledge of employment market. Consequently, they give up easily. | Many non-governmental organizations offer career counselling and vocational training, etc. Besides, we can establish short-term and long-term goals which are realistic and concrete. Short-term goals include refining personal resume, sending 3 cover letters each month, completing a certificate course within half a year, etc. Long-term goals include successfully finding a job, and doing that job for at least a year. Establish reasonable goals in concerted effort help patients work towards their goals. |
| Returning to work may bring pressure to patients | Psychosis may undermine patients’ confidence. Patients may heighten self-expectations. In addition, the work may not provide instant rewards. These factors bring pressure and displeasure to returning to work. Therefore, families should encourage patients to appreciate themselves, meanwhile treat themselves well and equip themselves. They should also encourage patients to talk over their problems. We can encourage patients to participate in voluntary services or part-time work, so that they can polish up their social skills, bolster confidence, develop personal interests and enhance coping skills for finding better jobs in the future. For sure, everyone’s path is different. Not everyone’s goal is to find an ideal job which is generally acknowledged to be good, but some may want mindfulness and wellness in life. |
Meanwhile, under the influence of the symptoms, some patients are not ready for work, such as those who show lack of motivation and interest in social life. The symptoms are caused by psychosis, but owning to its ambiguous nature, families and friends may mistakenly attribute patients’ behaviours to their personalities and attitudes, misjudging that the patients are lazy, uneager to improve themselves and make changes. Thus, they may blame the patients wrongly. In fact, it is unwise to urge them to return to work, as undue pressure hampers recovery.
What are the risk factors for relapse?
It is possible for a recovered patient to relapse. Studies show that approximately half of the patients display positive symptoms again (such as delusions, hallucinations, thought disorders etc.) again within 1-3 years of recovering.
There are many risk factors for relapse, with some of the more prominent ones being:
- Not taking medication as directed
A recent study in Hong Kong shows that about 80% of the patients experience relapse within a year of stopping medication.
- Substance Use Disorder
Abuse of drugs such as ketamine, cough medicine can also increase the chance of relapse.
- Stress
The patient’s lifestyle and how they handle stress is also associated with relapse.
It is important to understand that it is possible for a recovered patient to relapse. However it is crucial to remain hopeful as there are many ways to improve the situation and prevent relapse; moreover, information learned from a patient’s relapse can make it easier for future prevention.
It is difficult for clinicians to accurately estimate each patient’s chance of relapse due to the uniqueness of every individual, but it is very important for patient and family to be knowledgeable about the possibility of relapse, signs of early relapse and strategies of prevention. The sooner the symptoms of relapse are noticed, the sooner the patient can seek help and ensure a smoother recovery.
If you would like to learn more about relapse prevention, please click here.
How can Relapse be prevented?
Patients can prepare themselves in case of relapse in order to reduce relapse rate. If past symptoms recur, families and patients should pay extra care.
Four steps in relapse prevention:
- Understand cues in relapse
- Find out relevant issues
- Propose preventive measures
- Establish supporting systems
Step One: Understand Cues in Relapse
Cues in relapse vary from person to person. Early detection benefits early intervention, resulting in better relapse prevention. The cues fall into several categories:
| Cognitive and Affective Level | Behavioural Level |
| Difficulty in concentrating, worrying, mood problem, anxiety, suicidal ideation, suspicion, suspecting that one is under surveillance, reappearance of auditory hallucination, oversensitivity to sound | Frequent insomnia, loss or increase in appetite, alcohol or drug abuse, aberrant behaviours, repetitive behaviours, disorganized speech, social withdrawal, lack of interest to surrounding things, indifference to appearance, behaviours and changes in habits |
Alert to the cues, families can encourage patients to talk over the problems openly and consult doctors together to prevent the situation from deteriorating.
Step Two: Find Out Relevant Issues
Relapse is caused by inducing factors. Patients should identify issues related to relapse, propose measures to enhance coping abilities, and attempt to handle the problem optimistically. It helps stabilize the condition. The inducing factors are as follows: lack of sleep, difficulties in learning, social conflicts, challenges in life, abusing alcohols and drugs, taking drugs without following instructions, facing setbacks, etc. The abovementioned situations are just examples, as everyone’s experience and reaction are different, we should cope with patients’ situation optimistically.
Step Three: Propose Preventive Measures
After identifying relevant issues, patients and families can propose measures to prevent relapse, for example, acquiring habits of taking drugs regularly, setting healthy living patterns and handling the source of stress. Families can propose the measures together, and provide support and assistance when necessary. Some patients may think that they can stop medication themselves provided that the symptoms get better. However, this heightens the chance of relapse. Taking medicines and going to follow-up consultation does not indicate that the patients have not yet recovered. Despite the disappearance of symptoms, doctors will advise patients to take medicines for duration of time based on different needs, so as to prevent relapse.
Step Four: Establish Supporting Systems
Patients may display involuntary symptoms and emotions. If they lack understanding of the illness, the families will blame the patients wrongly. Thus, families should criticize less, know more about psychosis, and provide cares, encouragements and supports. Over-high expectations should be avoided in order to reduce relapse rate and adapt to new life. Besides of families, people who have close relationship with the patient, such as friends, colleagues and medical professions, can also become part of the supporting system.
Patients and families and adopt the following method, to jot down some simple preventive measures:
