Another very important risk-factor to be aware of
is that a person who is experiencing, or who has
experienced, a psychotic episode has an increased
potential for depression and suicidal thoughts. Any
threats or gestures of self-harm must be taken very
seriously. Seek medical and/or mental healthcare
assistance immediately if you think that your loved
one might harm themselves. Don't be afraid to talk
to them about how they’re feeling, asking them if
they feel safe, or if they’ve been thinking about
hurting themselves. To talk about suicide does not
make it happen, but can, in fact, make it possible
to take action in preventing it from happening.
Another issue to this risk-factor is that of
confidentiality. Often when dealing with someone who
is mentally ill, you be placed in an ethical
quandary on what to do when the person shares
“secret” thoughts or information with you,
especially regarding suicide or possible harm
towards others. This can put a huge emotional strain
on you, deciding between maintaining their
confidence or looking after their best interest.
Although everyone’s experience is different, one
thing that every caregiver must do is to make sure
and pass along any information received suggesting
that a person is at risk of harming themselves or
somebody else, to a doctor or other healthcare
professional, and get that person to a health
professional as soon as possible. Even if a loved
one seems to be angry or feels betrayed, you have a
clear duty of care that overrides any suicidal or
homicidal pacts or plans.
Just make sure that you don’t make them any
promises that can’t be kept, but remain supportive,
compassionate, and firm as to where actual
confidentiality must end. Things that you might want
to say when finding out about such plans include: "I
would like to help you”; "I can’t imagine what
you’re going through, but I am ready to listen"; "I
care about you and I think it might be a good idea
to talk things over with your doctor"; "I would like
to help you, however, you need to tell me how I can
best go about this"; "I can’t keep your suicide plan
to myself. I would like to arrange for us to go and
see a doctor together". Be sure to not say things
like: "You need to pull yourself together and snap
out of it"; "Let me tell you about my problems,
which I’m sure will help you to forget about yours".
These remarks aren’t supportive, helpful, or
compassionate, and may be dangerous.
With medication, therapy and time, your loved one
may show signs of being able to handle more
responsibility, once the psychotic episodes subside
and no longer pose a constant threat. Talk to them
about how they feel when it comes to doing more
things, and a good place to begin is with self-care
tasks like personal hygiene, getting dressed, and
eating scheduled meals. Start assigning simple
household chores, and observe whether they want to
work alone or with others. For example, they may
like to clean the living room, but they may not like
someone else dusting in there at the same time.
