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Caregiver and Schizophrenia:
How to Handle the Psychosis

(Page 2 of 3)

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.

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