To learn more about handling crisis situations, please speak to an Pathways support worker. You may also consider joining our Family-to-Family education course.
Here are a few guidelines on how to deal with an escalating situation, adapted from a fact sheet by the National Alliance on Mental Illness (NAMI).
When a person with a psychotic or mood disorder is in crisis, you can take steps to help de-escalate the symptoms and protect and support the ill person.
Before a full-blown crisis occurs, you may notice changes in your loved one’s behavior that is causing you concern, including suspiciousness or unpredictability, an inability to sleep, and a preoccupation with certain activities. Usually this indicates the ill person is having difficulties with, or has stopped taking, medication. If you suspect this is the case, you can encourage the person to visit a physician and possibly avert a larger crisis.
The more psychotic the person is, the less likely you will succeed in getting them to see a doctor. Psychosis places a person in an altered state of reality, and you have no way of knowing what they are experiencing. They may be terrified themselves of losing control of their feelings and thoughts.
In extreme situations, they may act out hallucinations that seem perfectly real to them. If you feel frightened, trust your intuition and take action to keep everyone, including yourself, safe. Remain calm. If you are alone, contact someone to join you. In this way, one person can call a mental health professional while the other remains with the person in crisis.
As the crisis unfolds:
• Convey a sense of calm. Speak softly, using only simple sentences.
• Don’t threaten the ill person, or do anything to agitate the situation. Don’t shout, argue, or criticize.
• Avoid direct eye contact and refrain from touching them, as these actions may be interpreted as threatening.
• If your family member is seated, don’t stand over them, as this may also be interpreted as threatening. If they are upset and suddenly stand up, you may want to also stand in case you need to leave the room quickly. Maintain adequate space between yourself and the ill person, and try to keep yourself between your ill relative and an exit.
Your family member may have to be hospitalized. If possible, try to convince them to go voluntarily by saying the hospital will provide relief from their symptoms, and they won’t need to stay if care can be provided at home or from somewhere safe outside of the hospital. The ill person may believe treatment in hospital is a form of punishment, so it’s important they don’t feel threatened or powerless by seeking help for their symptoms.
When involving the police, tell the officers that your ill relative is in need of a psychiatric assessment. Explain the situation as best you can, and mention if the ill person has access to any weapons. Have your record of the person’s medical history, diagnosis (if any), symptoms, and behaviors on hand when the officers arrive.
Early Intervention is key to optimum outcomes: The sooner that a psychosis is treated, the better the long-term prognosis or outcome. The converse, unfortunately, is also true: The longer that a psychosis is left untreated, and the more psychotic breaks suffered by someone with the illness, the lower the level of eventual recovery.
Early intervention material
Early Psychosis Intervention (epi)
The importance of EPI, signs, and symptoms of psychosis, by the five British Columbia Health Authorities. Provides extensive resources for families and those with an illness, including a psychosis toolkit.
Schizophrenia in Children
The early warning signs in youngsters with schizophrenia, plus guidelines for parents.