What to do in a crisis .

Most families reported that a crisis or psychotic episode - that is, a severe break with reality - occurred a few months to a year after they began to notice unusual behaviour. Some said, however, that the crisis occurred with little or no warning.

During a crisis episode, your relative will exhibit some or all of the following symptoms: hallucinations, delusions, thought disorder,and disturbances in behaviour and emotions. Families who have been through these psychotic episodes warn that no amount of preparation can fully protect you from the shock, panic, and sickening dread you will feel when your relative enters this stage of schizophrenia. Understand also that your relative may be as terrified as you are by what is happening: "voices" may be giving life-threatening commands; snakes may be crawling on the window; poisonous fumes may be filling the room. You must get medical help for your relative as quickly as possible, and this could mean hospitalization.(.)

Guidelines that May Help You In Crisis

DO'S - Try to remain as calm as possible. Decrease other distractions; turn off the television, radio, etc. If other people are present, ask them to leave the room. Talk one at a time. Try saying, "let's sit down and talk," or "let's sit down and be quiet." Speak slowly and clearly in a normal voice. Make statements about the behaviour you are observing: "You are afraid/angry/confused. Please tell me what is making you afraid, etc." Avoid patronizing, authoritative statements such as "you are acting like a child," or "you'll do as I say, young lady." Repeat questions or statements when necessary, using the same words each time. Don't rephrase the question in the hope that this will make it clearer. Allow your relative to have personal "space" in the room. Don't stand over him or her or get too close. Understand that too much emotion on your part can upset your relative further.

DON'TS - Don't shout. If your relative appears not to be listening to you, it may be because other "voices" are louder. Don't criticize. Your relative cannot be reasoned with at this point. Don't challenge your relative into acting out. Avoid continuous eye contact. Don't block the doorway. Don't argue with other people about what to do.     

It is far better, if possible, to have your relative go to the hospital voluntarily. If you do not think your relative will listen to you, see if a
friend can talk the person into doing so. Some have found that presenting their relative with a choice seemed to work. "Will you go to the hospital with me, or would you prefer that John take you?" Such an approach may serve to reduce the person's feeling of helplessness. Offering choice, no matter how small, provides some sense of being in control of the horrible situation in which they find themselves.

Families warn that sometimes a psychotic episode will involve violence. In such situations, there will be no time to talk calmly to your relative, or to phone the doctor or psychiatrist to ask for advice.  Because your relative is in an altered state of reality, he or she may try to act out the hallucination - for example, shatter a window. Your relative may threaten to harm him or herself, to hurt you, or to damage property. One mother said that her son kept yelling that God was ordering him to kill her. In such situations, you must do whatever is necessary to protect yourself and others (including the ill person) from physical harm. It may be that the wisest course is to leave the premises. The alternative might be to secure your relative in a room while you phone or go for help. Such an action, however, would be advisable only under extreme circumstances. In such charged situations, probably your only choice is to phone the police 1 . It may be unwise to drive your relative to the hospital by yourself: do so only if someone else can go with you. (.)

Emergency Planning
Contributing families recommend strongly that you have an emergency plan ready for crisis episodes.
1.Have handy a list of phone numbers for: the police, the doctor, the psychiatrist, and an emergency centre for psychiatric admissions 2 .
2.Ask your relative's doctor or psychiatrist ahead of time which hospital to go to in case of an emergency.
3.Know which family members and friends your relative may trust more than others in an emergency.
4.Find out whom you can phone for support at any time of the day or night.
5.If applicable, decide who will take care of other children.
6.Consider explaining the situation ahead of time to your local police department to get advice about what to do.
7.Know that the crisis situation may be less frightening to your relative if the emergency procedure has been explained and is anticipated.

Text from:
SCHIZOPHRENIA, A Handbook for Families,
Published by Health Canada in co-operation with the Schizophrenia Society of Canada.

On the web:
www.hc-sc.gc.ca/hppb/metalhealth/pubs/schizophrenia/index.html

1 If waiting a few hours is not a problem, a request can be made to the court for a psychiatric evaluation.
2 Also at a crisis center.