Illness Management Training: Transforming Relapse and Instilling Prosperity (TRIP) in an Acute Psychiatric Ward: A User’s Perspective

Abstract

Participation in transforming relapse and instilling prosperity (TRIP), using the strategies learned from illness management including knowledge enhancement, behavioral tailoring, relapse prevention development, cognitive behavioral technique, and related coping skills (Mueser et al., Psychiatr Serv 53:1272–1284, 2002), helps the clients adhere to treatment recommendations and minimize relapses. Moreover, TRIP leads them to identify ways to redesign or reestablish a goal-driven healthy lifestyle. By learning how to manage their illness effectively, participants can be further reinforced to take part in their respective occupations.

Transforming relapse and instilling prosperity (TRIP) is a ward-based intervention program that aims to decrease treatment noncompliance and relapse by improving insight and health during the visits to acute psychiatric care of clients with schizophrenia.

Appendices

The Case Study of David

Keywords

TRIP program, insight, illness management

Introduction

The theme of this case study concerns the illness management for a person with mental illness.

The students’ task includes:

• 1. Strategies and research in illness management (Mueser et al. 2002, 2006)

• 2. The TRIP program (Chan et al. 2007; Chao 2013)

• 3. Relapse prevention in serious mental illness (Walling and Marsh 2000)

As a starting point, the students should use the following references to gather background information.

Important references are:

Chan SHW, Lee SWK, Chan IWM (2007) TRIP: a psychoeducational program in Hong Kong for people with schizophrenia. Occup Ther Int 14:86–98

Chao JYW (2013) The impact of teaching illness management to psychiatric in-patients: a one-year follow-up. Paper presented in Hong Kong Hospital Authority Convention 2013, 15 May 2013. https://gateway.ha.org.hk/f5-w-687474703a2f2f7777772e68612e6f72672e686b$$/haconvention/hac2013/proceedings/en_oral.html

Mueser KT, Corrigan PW, Hilton DW et al (2002) Illness management and recovery: a review of the research. Psychiatr Serv 53:1272–1284

Mueser KT, Meyer PS, Penn DL, Clancy R, Clancy DM, Salyers MP (2006) The illness management and recovery program: rationale, development, and preliminary findings. Schizophr Bull 32:32–43

Walling DP, Marsh DT (2000) Relapse prevention in serious mental illness. In: Frese FJ (ed) The role of organized psychology in treatment of the seriously mentally Ill. New directions for mental health services. Jossey-Bass, San Francisco, pp 49–60

Overview of the Content

The major goals of the TRIP program are to:

• 1. Improve insight and health among clients with schizophrenia during acute psychiatric care ;

• 2. Reduce the treatment noncompliance;

• 3. Prevent relapse; and

• 4. Build up personal healthy goals within clients’ respective occupations.

Learning Objectives

By the end of studying this chapter, the learner will:

• Be familiar with the content and the process of the TRIP program

• Be able to teach the strategies in illness management to clients with mental illness

• Be able to focus on the topics of mental illness and related signs and symptoms as well as treatment

• Be able to focus on the topics of relapse prevention and healthy lifestyle

The Background History of Clinical Case Study

Personal data:

David is a 37-year-old gentleman. He lives with his parents and his younger brother in a public housing estate. He studied up to university level. He worked as a sales representative in a department store.

Psychiatric diagnoses and prognoses:

David was diagnosed with schizophrenia when he was 25 years old. He had a history of psychiatric hospitalization twice in the past. This is his third hospitalization due to poor drug compliance. The relapse of his symptoms included auditory hallucination and persecutory delusions of being harmed by his colleagues.

Occupational therapy interventions:

After David’s mental state was stabilized after 3 days of hospitalization, he was introduced to occupational therapy program . He was invited to join the TRIP program which was the first time he got in touch with this kind of intervention. In the first two sessions, David revisited the knowledge of his illness and related signs and symptoms. He got a new insight about his recovery pathway during the group discussion with other participants. He started to notice poor sleep was his key early warning sign. He then developed his own relapse prevention plan and established personalized recovery goals to facilitate redesign of his lifestyle in the subsequent two sessions.

Finally, he was discharged after 2 weeks of hospitalization. He revealed a different experience in this admission: insight gained, illness management learned, and action plan developed. He understood regular drug compliance is important for his successful community integration and accepted it as an essential element for him to strive for personal life goals. He was found to pay effort to maintain his action plan active during 3-month and 1-year follow-up.

The Student’s Report

The following guiding questions have been identified in developing possible solutions to David. These questions are generated from the available literature references and our clinical experiences:

Questions

• 1. What are the major definitions and concepts used in this case?

• 2. What are the important issues and goals when implementing the TRIP program for David?

• 3. What would be the strategies used in the illness management and relapse prevention?

• 4. What would be the short- and long-term goals for David?

• 5. What is the role of the occupational OT in the above process?

• 6. How did the concepts of illness management incorporate well with the recovery process among people with mental illness?

• 7. What is the research-based evidence for illness management program (e.g., TRIP program)?