'Relapse' is a word that is used in many different ways in a variety of contexts. It is defined in the Macquarie Dictionary as "to fall or slip back into a former state, practice, etc". In the Australian Concise Oxford Dictionary, it is defined as "deterioration in a patient's condition after a partial recovery".

It is used most commonly within a medical context, where it is a word that is clearly understood by health practitioners to mean returning to a diagnosable state of mental illness: a mental state that has previously been diagnosed and the symptoms of which have returned to the point where the threshold has again been reached for diagnosis. Relapse is evident by recontact with services in the form of another acute episode of illness that requires service intervention, often hospitalisation. Most acute service providers within the mental health care system use the word relapse and believe that it is a useful and commonly understood term.

We all understand, clinicians that is, what we mean by relapse in a mental health context. It's another acute episode that requires intervention, often hospitalisation. —Clinician
Relapse is a term that is less well accepted and less clearly applied within the more personal context of the experience of people with mental illness. It is seen as a "clinical term", "not the usual language" and "not used in everyday language". In general, most people who have experienced mental illness do not use the term relapse at all and are more likely to talk in terms of being "well" or "unwell". For many people who have experienced mental illness, relapse has an underlying negative sentiment; it implies "going backwards", "failing" and "back to square one".

Relapse is a sense of failure. Relapse means this kind of concept of falling right back into it, back where you were. When what's really happening is that I'm moving on all the time; sometimes it's two steps forward one step back, but I'm always learning and moving on. Relapse means going right back to the start and nobody can stand to think like that. —Consumer
The negative connotations of the term 'relapse' are evident in that it is a term used primarily in the context of mental illness and substance use disorders; it is not generally applied to other illness conditions. As one consumer noted:

If you have had a heart attack and have another heart attack, no-one says you have relapsed; they say you had another heart attack. —Consumer
Furthermore, some consumers seriously affected by mental illness argue that the notion of relapse is irrelevant to them because they "have not really been well since the first time". The chronic nature of their illness has meant that while they have periods of being more or less well, they do not think that they have been well enough to have been able to 'relapse'.
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I've never been to hospital myself and my episode has lasted 17 years. I've never had a relapse because I've been there ever since. I mean I go up and down but I don't think I've ever been well. —Consumer
There are also degrees of relapse, and what one person defines as a relapse, another may not. In contrast, the medical diagnosis of relapse depends on meeting specific thresholds that dichotomise experiences into either illness or health.

I sometimes think about it in terms of if someone's got a problem with their knee and they limp, some days they'll be better than others and they might still limp all the time but they'll still be able to do the things that they want to do. So, in terms of having a mental limp is a way of looking at the extent of mental illness: some days it might be crutches, some days it might be the wheelchair, some days you might be fine. —Consumer

It depends whether relapse means a complete hospital experience — whether you come back to the very, very lowest of low or just not being as well as you want. —Consumer

Most people with mental illness do not think of their life course in terms of relapses. Generally, the reality of experiencing mental illness is a process of change and development: the same process experienced by all people as they age and mature. Few people think in terms of going backwards to a previous state as implied by the term 'relapse'.

The negative associations of the word 'relapse' are not congruent with a recovery orientation to mental illness. Consequently, some consumers argue that relapse is a "non-word" and that "it doesn't exist". When consumers were asked during the consultations what would be a better word, they had difficulty coming up with a preferred term, but generally agreed that they tended to use the term 'episode' rather than 'relapse'. The experience of recurrent symptoms of mental illness is perceived as a continuous move forward through the life course. This is consistent with a recovery orientation, where people with mental illness are acknowledged to change and mature, as all people do.

I see episodes - it's just a pattern of life – this is part of my life. Relapse is a sense of failure. Episodes is a more neutral term. It's just the reality of certain people in our community. To relapse means a sense of it's our fault when the reality often is that we have done an amazing job to stay calm and healthy for such a long time. —Consumer
Families and carers are also aware that "illnesses fluctuate". They can become aware of "something happening", "all's not well", "a feeling" and the "need to do something". They agree that the term 'relapse' is generally applied within the context of medical intervention; it is when an acute episode of illness occurs that requires medical intervention. However, it is also applied by family members to acknowledge the change from when the person is "coping" to when they are "not coping and need help". Relapse implies upheaval and disruption for families and carers and for some it implies a constant process of monitoring and source of distress.

I'm always watching for the signs. I'm horribly fearful of a really bad patch starting all over again. —Family member
Differences of opinion sometimes occur between the person with a mental illness and their family members regarding whether a relapse may be occurring, but there is also frequently agreement.

I can always tell when another episode is on the way, it's so clear to me, but he can sometimes get really angry and accuse me of being smothering and hypervigilant. —Carer

It might take my mum to say you really don't seem to be feeling very well and then I'll realise and it will all click into place. It does creep up sometimes. —Consumer
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The concept of relapse is also less clear for providers of psychiatric disability support and rehabilitation services compared with acute and clinical services. While a "full-blown relapse that requires hospital admission" is clearly understood as a relapse, providers of support services are also aware of periods of more or less "wellness" as experienced by their clients. Periods of being "unwell" can affect clients' ability to cope with their lives, and it is this level of complexity that is evident to non-clinical and non-acute service providers who argue that they are in a position to recognise variations in wellness.

We see them when they're well, sometimes when they're really unwell, and everyplace in between. —Rehabilitation services provider
Finally, it is important to note that there does not need to be an agreed definition of the term 'relapse' in order to consider ways to prevent relapse. There are no generally accepted criteria for relapse; it is a relative term and must take into account: the person's condition before the original onset of illness; his/her level of functioning before the present episode; and the severity of the relapse in terms of symptom severity, duration and interference with personal functioning. Relapse needs to be evaluated at the symptomatic, phenomenological and behavioural levels (Lader 1995). It impacts on interpersonal, social and occupational activities and has wider implications for the family in general, the provision of medical and social services, and for health economics.

Regardless of lack of total agreement on what comprises relapse, maximising wellness by reducing the recurrence or exacerbation of symptoms was universally acknowledged in the consultations as an important goal for people who have experienced mental illness, their families and carers, and mental health and community support services.