Friday, October 3, 2014

Crisis and mental illness

Sooner or later, if a family member is diagnosed with schizophrenia, bipolar disorder, or major depression, a serious crisis (psychotic episode) is likely to occur. What should you do? How can you avoid a disaster?  Ideally, you need to reverse any increase of the psychotic symptoms  and provide immediate protection and support to the individual with the mental illness.

Sometimes well-meaning, uninformed family members do and say things that they regret. “If I had only known better,” they frequently say as they come to an understanding in the NAMI Family-to-Family Education Course. The course material frequently and gently reminds them, “You can’t know what no one has ever told you.”

First, let’s put this episode in perspective. Seldom, if ever, does a person suddenly lose total control of thoughts, feelings, and behaviors. Look back a few days, a few weeks before the episode. Was there behavior that caused concern: sleeplessness, ritualistic preoccupation with certain activities, suspiciousness, unpredictable outbursts. Sometimes, with experience and knowledge, family members become aware of the early signs and can avert a full-blown crisis. Often the person has stopped taking medication. A visit to the doctor should be encouraged. However, the more psychotic the loved one is, the less likely they are to cooperate. Learn to see the early signs. If you feel the fear and panic of an impending crisis, do what you can to help your loved one regain control. Do nothing to further agitate the scene.

You must remain calm. If you are alone, get someone to stay with you until professional help arrives.

In the meantime, the following guidelines might be helpful:

Don’t threaten. This may be interpreted as a power play and increase fear or cause assaultive behavior by the patient.

Don’t shout. If the mentally ill person seems not to be listening, it could be that other “voices” are interfering.

Don’t criticize. It will only make matters worse..

Don’t squabble with other family members over what to do or who to blame.

Don’t bait the patient into acting out wild threats; the consequences could be tragic.

Don’t stand over patient if he or she is seated. Instead, seat yourself.

Avoid direct continuous eye contact or touching the patient.

Comply with requests that are neither endangering nor beyond reason. Or ask your loved one gently, “What do you need?” This provides the patient with an opportunity to feel somewhat in control.

Don’t block the doorway. However do keep yourself between the patient and an exit.

It will help you to know that the patient is probably terrified by the experience of loss of control over thoughts and feelings. Furthermore, the “voices” may be giving life-threatening commands; messages may be coming from the light fixtures; the room may be filled with poisonous fumes; snakes may be crawling everywhere.

Accept the fact that your loved one is in an “altered reality state.” In extreme situations the patient may “act out” the hallucination, e.g. shatter the window to destroy the snakes.

In the final analysis, the family member may have to be hospitalized to be safe, comfortable, and stable. If you cannot get your loved one to go voluntarily to the doctor or the hospital, you can call law enforcement or 911. Explain that your relative or friend is in need of a psychiatric assessment. Ask for officers who have had Crisis Intervention Training. Your family member will be safe with these officers, especially if they have been trained to handle someone with mental illness.

This information is based on or directly comes from material in the Family-to-Family Education course.

For more information contact the NAMI SWLA office at 337-433-0219 or email us at

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