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what to do in a crisis

How do I recognize a crisis?

Schizophrenia is a brain disease that has many differentsymptoms. People with schizophrenia may have trouble thinking logically, they may behave in strange ways, orthey may have emotional responses that seem odd.

People with schizophrenia sometimes have "psychotic episodes," where they can’t tell what is real and what is not real. During these episodes, they may have hallucinations or hear voices. They may become agitated and hostile, thinking that they or someone they love is at risk of being harmed. These episodes can come on slowly or all of a sudden.

A psychotic episode is frightening, both for the person experiencing it and those around them. It is oen referred to as a "crisis" situation.

Can I prevent a crisis?

Not all crisis situations can be prevented. But if you are caring for someone with schizophrenia, there are steps you can take to ensure you are prepared ahead of time:
  • Learn to recognize signsthat a crisis could occur. Watch their behaviour. 
  • Be alert to those thingsthat could trigger a crisis, like not taking medication, use of street drugs or alcohol, or high stress situations.
  • Develop an emergency plan.

During a crisis situation, the role of a caregiver is to: 
  • Try to stop the behaviourfrom getting worse.
  • Protect your family member from harm.
  • Keep yourself and those around you safe.
  • Stay calm. Evaluate the situation: How urgent is it? What are the risks?

Develop an emergency plan

An emergency plan includes important phone numbers, contact names, and papers. As you develop a plan, you’ll involve other family members, professionals, and your loved one. Here are some suggestions for getting started:
  • Talk to a psychiatrist and a lawyer for advice on how to respond in a crisis. 
  •  Find out what crisis support services are available in your community.
  • Make a list of emergency phone numbers and keep it available. Include the names of friends and relatives who have agreed to help. 
  • Make an Emergency Information Form. This should include information about their medications, allergies, health card number, health care coverage, and the psychiatrist’s name and phone number.
  • Discuss what isto be done in a crisis with everyone who would be involved, including the person with schizophrenia.
  • Talk about getting a "power of attorney for personal care." This is a legal document that allows another person to make important decisions on someone’s behalf, such as decisions about health care.
  • Learn about provincial laws on involuntary hospitalization. In Ontario, contact the Ministry of Health and Long-Term Care (www.gov.on.ca/health/index.html).

What if I am being threatened?

The most effective way to handle verbal or physical threats depends on your family member. Over time, you will learn what works best. Here are some suggestions:
  • Speak softly, firmly, and clearly.
  • Try not to argue orreason. Be reassuring. Say things that are not threatening like, "What do you think?" or "I don’t know."
  • If they make reasonable requeststhat don’t put anyone in danger, try to go along with them.
  • Allow them to have physical space. They may need more space than usual and may not want to be touched.
  • Encourage them to sit down.
  • Position yourself at an angle,ratherthan directly in front of them (a nonconfrontational and non-threatening position). Avoid eye contact.
  • Neither of you should be ‘cornered’ in a room. Each of you should have a clear way out.
  • Leave the situation. Go to another room, or leave the house.
  • Ask a friend or family member for support.
Sometimes you won’t be able to manage a crisis on your own. You will need professional help. At these times, it’s important to get help as quickly as you can.

It’s possible that your loved one may need to be hospitalized during a crisis.

Sometimes a person with schizophrenia is so unpredictable or threatening that they disrupt the rest of the family or put other people at risk. In this case, the person may need to live in supervised housing away from the family.

When should I call the police?

  • If you think that your ill relative or someone else is in immediate danger, call 911. 
  • Stay calm. Your behaviour may affect how the police respond.
  • Explain the situation over the phone. Tell the 911 operatorthat your relative has schizophrenia, needs medical help, and needs to get to a hospital. Describe what they are doing, and whether they are armed. 
  • When the police arrive, give them your Emergency Information Form. This information will be helpful if they have to take your loved one to the hospital.
  • Write down all contact you have with the police, including their names.
  • If you are asked to lay a charge against your family member, consult a lawyer first