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| Where can treatment take place? |
| What is a crisis? |
| Whom do I contact in a crisis? |
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Most people who are experiencing a psychosis can be supported at home by their family or friends as long as they receive regular support and are in close and regular contact with mental health professionals. Sometimes it may be necessary for the person to receive treatment in hospital.
Usually hospital treatment is reserved for situations where the psychotic symptoms that a person is experiencing puts them at risk of hurting himself/herself or other people as occurs when, for example, the sufferer is seriously considering suicide, or has tried to harm themselves. In these situations, hospitalization helps ensure that the person is properly assessed and treated so that they remain safe. However, hospitalization may also be essential in the early assessment and treatment of a psychotic state when no caring or close or functional family is available (For details about the professional treatment team involved in treatment refer to the brochures Treatment team or Inpatient admission.)What is an involuntary admission?
(For additional details about the involuntary patients refer to brochure Inpatient admission)In some cases, admission to hospital may need to occur against the person's will or without them having given consent, at least for a short time. When a person is admitted to hospital against his/her will or without him/her having given consent, this is called involuntary admission. This is reserved for people who may act aggressively towards others, and are at risk of harming themselves or others. In these cases, treatment is resumed at home as soon as is feasible.
What is a crisis?
During an acute psychotic episode, when symptoms are at their most obvious, individuals and families can find themselves in severe crisis or emergency situations in which help is needed straight away. Remember that during an acute psychotic episode, individuals will often not recognize that they need assistance, and families will need to seek assistance on their loved one's behalf, even against their will. Sometimes families are not sure if a situation is a crisis or an emergency. In these circumstances it is wise for the family to trust their feelings - if they are feeling overwhelmed, afraid, and unable to manage the person's behaviour, then prompt action should be taken. Some crisis situations are noted below.
- The individual talks about or is trying to hurt or kill themselves, or hears voices directing them to hurt themselves. All threats or gestures of this type need to be taken very seriously, and help needs to be sought straight away.
- The individual threatens or seems likely to harm others. If the person is behaving in a threatening or aggressive manner towards another person, or if the individual is hearing voices directing them to hurt somebody else, then this must be taken very seriously indeed and help needs to be obtained straight away. Sometimes people who are experiencing delusions believe that another person is trying to harm, poison or kill them or someone they love, and they may take violent action against someone to prevent this happening. However, it is important to remember that in general, people who are experiencing a psychosis are not necessarily more dangerous or violent than anyone else. Much depends on the type of disturbed thinking they are experiencing. Sometimes this can be concealed from the treating professional and it is vital that families, in such a situation, communicate their fears.
- The individual may become verbally aggressive, abusive, and becomes angry easily.
- The individual experiences very obvious symptoms of a psychotic state including hallucinations and delusions.
- The individual behaves recklessly, such as walking alone at night, or engaging in dangerous or inappropriate sexual behaviour.
- The individual has stopped eating or drinking.
Whom do I contact in a crisis?
In a crises or emergency situations such as those outlined above there are several agencies that can be contacted.- The emergency department of the local hospital. Families should try to gain the sick person's cooperation to accompany them to the local hospital. However, if the sufferer is feeling suspicious or paranoid they may not agree. In such a case it is best for families not to try to coerce the person. Coercion can make the individual feel even more unsafe and suspicious. Persuasion, done gently and skilfully, is the approach that needs to be used.
- Police. It may be necessary to call the police when there is a risk that the individual will cause harm to self or somebody else. When this is judged to be the case no time should be wasted. In situations like this, the police will normally assist by escorting the person to hospital to be assessed by a specialist. The individual will then be able to get the help that is needed.
- Emergency psychiatric teams. The local telephone directory will list the number of local emergency psychiatric teams who can respond in a crisis. Like the police, this team will usually assist by escorting the individual to hospital where specialist assessment and treatment are available.
- Ambulance. Actual self-harm and attempted suicides are extreme emergencies. Call an ambulance immediately and ask for directions about what can be done while waiting for it to arrive.
When the emergency is over, and the painful feelings that go hand-in-hand with these situations have eased, the time is then ripe to make a family plan for handling future emergencies of this type. It is also important for the individual and their family to express their own feelings about the state of affairs which preceded the emergency. The helpfulness of existing plans or planned actions need to be assessed. Mental health professionals can help individuals and their families make or amend these plans.
