This fact sheet helps families recognize a crisis situation and offers suggestions on how to deal with a crisis.
Families Coping with a Crisis
This information not to be substituted for the advice of a professional. Always consult a physician regarding individual circumstances. Supported by an educational grant from JANSSEN-ORTHO Inc.
“To alleviate the suffering caused by schizophrenia”
Family support and education • Public education, awareness and understanding • Advocacy for better services for people with schizophrenia and their families • Promote research into the treatment and cure for schizophrenia
The British Columbia Schizophrenia Society (BCSS) is a family-based organization. We understand what it’s like to live with schizophrenia. For more information, contact: British Columbia Schizophrenia Society 1100 – 1200 West 73rd Avenue, Vancouver BC, V6P 6G5 (after June 18, 2015) Tel: 604-270-7841 Fax: 604-270-9861 Toll Free: 1-888-888-0029 email@example.com www.bcss.org
RECOGNIZING A CRISIS
A psychotic episode can be frightening for everyone, but most especially for the person experiencing it. If someone with schizophrenia is experiencing psychosis, they may not know what is real and what is not. Because the person cannot think logically, they may behave strangely or have inappropriate emotional responses. Visual, auditory or other sensory hallucinations can cause people to become agitated or even hostile. They may believe they or someone they love is in danger.
CAN A CRISIS BE PREVENTED?
Not all crises are preventable. But there are some things you can do to be prepared. Learn to recognize signs that trouble is pending. Be alert to things that can trigger a crisis – high stress situations, going off medications, or using drugs and alcohol. If a crisis occurs, it’s important to:
- Try to stay calm and evaluate the situation. Can it be controlled? How? What are the risks?
- Protect the ill person, yourself and others around you from harm
- Try to stop the behaviour from escalating or becoming worse
HAVE A CRISIS PLAN!
A plan is always better than no plan! You may never need it — but it’s wise to have an emergency plan. The plan should include important phone numbers, contact names, and any necessary papers.
- Learn what crisis services are available in your area.
- Keep a list of emergency phone numbers handy. Include names of friends and relatives who have agreed to help.
- Create a Medical Emergency Form that clearly lists the ill person’s name, health care number, medications, any allergies, psychiatrist’s name and contact, and your phone number. Keep it handy.
- Talk about the plan with everyone who might be involved, including the person with schizophrenia.
- Consider a representation agreement or power of attorney with your ill relative. These legal documents will allow you to make health care and other decisions on their behalf if needed. (or Ulysses agreements)
- Learn about the BC Mental Health Act, which clearly sets out procedures for involuntary hospitalization if necessary.
ANGRY OR THREATENING BEHAVIOUR
Communicating with a person who is having a psychotic episode can be difficult. Obstacles that can get in the way of communication include:
- Lack of contact with reality
- Breakdown of logical thinking
- Loss of certain social skills
- Low tolerance for stress
Tips for communicating:
- Give the person extra personal space
- Use a moderate, non-threatening tone and body language
- Speak at a moderate pace, answer all questions calmly
- Be patient, wait for an answer — there is often a delay in responding
- Repeat your answers if asked
- Communicate your expectations in a clear and concise manner. Use short, simple sentences — one idea per sentence
- Do not take anything personally. Remember, it is the illness talking…
- Do not respond to challenge or power questions
- Do not assume anything
- Do not argue about delusions. The ill person may need to be hospitalized. If the crisis continues to escalate and you cannot manage on your own, act as quickly as you can to get medical help. If someone with schizophrenia is unpredictable or threatening on a regular basis, you may want to consider alternative housing away from the family.
SHOULD WE CALL THE POLICE?
- If someone is severely ill and will not willingly go to hospital — call 911.
- Stay calm when you talk to the 911 operator.
- Explain that your relative has schizophrenia and needs to go to the hospital for medical help.
- Describe what the ill person is doing or saying.
- When the police arrive, give them your Medical Emergency Form to help when they take your loved one to hospital.
- Make a note of the date and time, and the names of attending police officers. When the police arrive, explain that the person is ill and that the immediate need is for appropriate medical care. If your ill family member is charged by the police, contact a legal professional who understands schizophrenia as a brain disease and knows about the crucial need for ongoing care and treatment.
SUICIDE: A REAL RISK
Suicide rates for people with schizophrenia are extremely high. Approximately 50% attempt suicide, and 12-15% die. Sometimes suicide occurs due to psychosis. Suicide is also a risk when someone is discharged too early from hospital, before their illness is stabilized. In addition, clinical depression is not uncommon with schizophrenia and places the person at higher risk for suicide. All people with schizophrenia should be screened for depression.
WHAT ARE COMMON WARNING SIGNS?
- Withdrawal and isolation from family and friends
- Hearing voices instructing them to do something dangerous
- Giving away prized possessions
- Talking or writing about suicide
- Putting affairs in order
- Recent attempt at suicide or other form of self-harm
- Questioning own value and worth
WHO IS MOST AT RISK?
- Young men, particularly during the first six months after hospitalization
- People with a history of attempted suicide
- People who are preoccupied with thoughts of suicide or death
- People who have feelings of hopelessness and see a bleak future ahead
- People with a history of substance abuse
- People who also have co-existing depression and schizophrenia
WHAT CAN FAMILY MEMBERS DO?
- Be aware of the warning signs of suicide
- If your family member has thoughts of suicide, encourage them to talk about it. Be willing to listen
- Do not keep weapons in your house
- Contact a doctor or other mental health professional immediately if your loved one expresses thoughts of suicide or behaves in a way that may indicate suicide plans
- Do not leave the person alone if you have concerns they may attempt suicide
Where can we get more help?
The British Columbia Schizophrenia Society (BCSS) is a family-based organization. We understand what it’s like to live with schizophrenia. Click here for the contact near you.
For more information, contact:
British Columbia Schizophrenia Society
1100 – 1200 West 73rd Avenue, Vancouver BC, V6P 6G5 (after June 18, 2015)
Tel: 604-270-7841 Fax: 604-270-9861
Toll Free: 1-888-888-0029