Because mental illness is often episodic, our loved ones can slide into relapses. You also may hear professionals say your loved one is “decompensating.” Many relapses in major mental illness happen when our loved one stops medication, experiences stress, or abuses alcohol or drugs.

When you see your loved one’s particular set of warning signs, you can take these 10 steps. NAMI, Mental Health America and my own family’s experiences provided resources to create this list.

Ten Steps to Take

1. Meet as a family to discuss the concerns as soon as possible.  When it’s possible, include the ill person. Explain to him why you are concerned. Describe the specific changes you see in behavior and for how long. Reach a consensus about whether you have a problem or not.
2. Find out whether the person has been taking medication.Start checking as soon as you see the warning signs if you don’t check every day. If the person lives with you, you can count the pills in their medication bottles daily. If the person has stopped taking medication, talk to them about how to improve compliance. They may agree to increased monitoring or receiving reminders. Notify the treatment team if they have stopped taking medication altogether and won’t resume it.
3. Determine whether your relative has been abusing drugs and/or alcohol. Check for evidence. Remove alcohol and drugs from the house. This is another topic to discuss with the treatment team.
4. Evaluate your relative’s stress level. What happened just before these changes happened? Do you see any trigger events?
   • Has he experienced a recent life event that’s stressful?
   • Has there been a significant change in routine over the last two weeks or so?
   • Has there been a change in the treatment plan or team?
   • Have there been conflicts with family, friends, coworkers or others?
   • Has there been a change in an important relationship?
   • Has there been an increase in responsibilities?
   • Did he stop participating in activities he enjoyed?
5. Check current behavior and circumstances against your loved one’s relapse signature. (The information about that is here.
6. Some classic trigger events are:
   • Staying up too late or all night.
   • Loss or grief.
   • Conflict among loved ones.
   • A change in the season.
   • PMS.
7. Ask the relative about the answers in your stress evaluation. If stress has been building, find a way to reduce it:
   • Reduce responsibilities.
   • Reduce work or school hours.
   • Add more leisure time.
   • Get or give a temporary loan to reduce money problems.
8. Call the psychiatrist and case manager to express your concerns. Consider a medication change.
9. Keep monitoring but try to keep life normal. Regular routines and family fun help to reduce stress for everyone involved. About all, use your toolbox of support ideas for YOU. Taking time to do things you enjoy will help you stay strong enough to be supportive when needed. When you are not feeling well, it’s easy to stop doing things that are good for you. Here are some ideas:
   • Set aside time for extra sleep.
   • Attend a peer support group.
   • Spend time in nature, like going to a park.
   • Write in a journal.
   • Spend extra time in prayer and meditation.
   • Volunteer.
   • Watch a funny movie or TV show.
10. Help your loved one think about things to stop doing. This could include staying up late, spending time with people who are not supportive, or drinking.
11. Check back in a few days. Evaluate the situation. Is it better? Or worse?