Helping a Person with Schizophrenia

Schizophrenia and the family: How to help your loved one

If a family member or someone close to you has schizophrenia, you may be struggling with any number of difficult emotions, including fear, guilt, anger, frustration, and hopelessness. The illness may be difficult for you to accept. You may feel helpless in the face of your loved one’s symptoms. Or you may be worried about the stigma of schizophrenia, or confused and embarrassed by strange behaviors you don’t understand. You may even be tempted to hide your loved one’s illness from others.

In order to deal successfully with schizophrenia and help your family member, it’s important to:

• accept the illness and its difficulties
• be realistic in what you expect of the person with schizophrenia and of yourself
• maintain a sense of humor

Do your best to help your family member feel better and enjoy life, pay the same attention to your own needs, and remain hopeful.

Helping people with schizophrenia tip 1: Take care of yourself

In order to successfully deal with schizophrenia in a family member, you need to take care of your own needs and find healthy ways of coping with the challenges you and your loved one face.

Put on your own oxygen mask first

Keeping a positive outlook is much easier when you have others you can turn to for support. Like your loved one with schizophrenia, you too need help, encouragement, and understanding. When you feel supported and cared for, you, in turn, will be better able to support and care for your loved one.

• Join a support group. One of the best ways to cope with schizophrenia is by joining a family support group. Meeting others who know first-hand what you’re going through can help reduce feelings of isolation and fear. Support groups provide an invaluable venue for the relatives of people with schizophrenia to share experiences, advice, and information.
• Make time for yourself. Schedule time into your day for things you enjoy, whether it be spending time in nature, visiting with friends, or reading a good book. Taking breaks from caregiving will help you stay positive and avoid burnout.
• Look after your health. Neglecting your health only adds to the stress in your life. Maintain your physical well-being by getting enough sleep, exercising regularly, eating a balanced diet, and staying on top of any medical conditions.
• Cultivate other relationships. It’s important to maintain other supportive, fulfilling relationships. Don’t feel guilty for looking after your social needs. You need support, too. These relationships will help buoy you in difficult times.

The importance of managing stress

Schizophrenia places an incredible amount of stress on family members. If you’re not careful, it can take over your life and quickly burn you out. And if you’re stressed out and overwhelmed, you will make the person with schizophrenia stressed. That’s why Keeping your own stress levels under control is one of the most important things you can do for a family member with schizophrenia.

• Practice acceptance. The“why me?” mindset is destructive. Instead of dwellingon the unfairness or life, accept your feelings (even the negative ones). Your burdens don’t have to define your life unless you obsess about them.
• Seek out joy. Making time for fun isn’t frivolous or indulgent—it’s necessary.It isn’t the people who have the least problems who are the happiest, it’s the people who learn to find joy in life despite adversity.
• Recognize your own limits. Be realistic about the level of support and care you can provide. You can’t do it all, and you won’t be much help to a loved one if you’re run down and emotionally exhausted.
• Avoid blame. In order to cope with schizophrenia in a family member, it’s important to understand that although you can make a positive difference, you aren’t to blame for the illness or responsible for your loved one’s recovery.

Helping people with schizophrenia tip 2: Encourage and support treatment

The best way to assist the recovery of a family member with schizophrenia is to get them into treatment and help them stick with it. Often, the first challenge of treatment is convincing the ill relative to see a doctor. To people experiencing delusions, hallucinations, and paranoia, there is no need for medical intervention because the voices and conspiracy theories are real.

If a family member with schizophrenia is reluctant to see a doctor, the following strategies might help:

• Provide options – Your loved one may be more willing to see a doctor if he or she can control the situation somewhat. If your relative appears suspicious of you, suggest another person to accompany him or her to the appointment. You can also give your family member a choice of doctors.
• Focus on a particular symptom – A person with schizophrenia may resist seeing a doctor out of fear of being judged or labeled “crazy.” You can make the doctor less threatening by suggesting a visit in order to deal with a specific symptom such as insomnia or a lack of energy.

Helping people with schizophrenia tip 3: Monitor medication

Once your family member is in treatment, careful monitoring can ensure that he or she is staying on track and getting the most out of medication. You can help out in the following ways.

• Take side effects seriously. Many people stop taking their schizophrenia medication because of side effects, so pay attention to your loved one’s drug complaints. Bring any distressing side effects to the attention of the doctor. The doctor may be able to reduce adverse effects by reducing the dose, switching to another antipsychotic, or adding another medication that targets the troublesome side effect.
• Encourage your loved one to take medication regularly. Even with side effects under control, some people with schizophrenia refuse medication or take it irregularly. This may be due to a lack of insight into their illness and the importance of medication, or they may simply have trouble remembering their daily dose. Medication calendars, weekly pillboxes, and timers can help people who are forgetful. Two typical antipsychotics, Haldol and Prolixin, are also available in a long-acting injectable form, given as shots every 2 to 4 weeks, eliminating the need for a daily pill.
• Be careful to avoid drug interactions. Antipsychotic medications can cause unpleasant and dangerous side effects when combined with other substances, including certain prescription drugs, over-the-counter medications, vitamins, and herbs. Help your family member avoid any problems by giving the doctor a complete list of the drugs and supplements he or she is taking. Mixing alcohol or illegal drugs with schizophrenia medication is also harmful, so talk to the doctor if your relative has a substance abuse problem.
• Track your family member’s progress. You can help the doctor track treatment progress by documenting changes in your family member’s behavior, mood, and other symptoms in response to medication. A journal or diary is a good way to record medication history, side effects, and everyday details that might otherwise be forgotten.

Helping people with schizophrenia tip 4: Watch for signs of relapse

Stopping medication is the most frequent cause of relapse in schizophrenia, so it’s extremely important that your family member continues to take all medication as directed. Many people whose schizophrenia is stabilized or in remission still require medication to maintain their treatment gains and keep symptoms at bay.

Unfortunately, even if a person is taking medication as prescribed, relapse into an acute psychotic episode of schizophrenia can occur. But if you learn to recognize the early warning signs of relapse and take immediate steps to deal with them, you may be able to prevent a full-blown crisis. The warning signs of relapse are often similar to the symptoms and behaviors that led up to the person’s first psychotic episode.

Common warning signs of schizophrenia relapse

Insomnia Social withdrawal Deterioration of personal hygiene Increasing paranoia

Hostility Confusing or nonsensical speech Strange disappearances Hallucinations

Helping people with schizophrenia tip 5: Prepare for crisis situations

Despite your best efforts to prevent relapse, there may be times when your family member’s condition deteriorates rapidly and drastically. During a schizophrenia crisis, you must get help for your family member as soon as possible. Hospitalization may be required to keep your loved one safe.

Emergency planning

It’s important for the family members of people with schizophrenia to prepare for such crisis situations. Having an emergency plan ready for an acute psychotic episode will help you handle the crisis safely and quickly. A good emergency plan for a family member with schizophrenia includes:

• A list of emergency contact information for your loved one’s doctor, therapists, and the police.
• The address and phone number of the hospital you will go to in case of emergency for psychiatric admission.
• Friends or relatives who will take care of other children or dependents while you deal with the crisis.

It’s also wise to go over the emergency plan with your family member. The crisis situation may be less frightening and upsetting to your loved one If he or she knows what to expect during an emergency.

Helping people with schizophrenia tip 6: Explore housing options

Treatment for schizophrenia cannot succeed if your family member doesn’t have a stable, supportive place to live. But finding the right living situation for a person with schizophrenia can be challenging. When considering housing options, think about the individual needs of the person with schizophrenia:

• Can your family member care for him or herself?
• How much support does he or she need with daily activities?
• Does your family member have a drug or alcohol problem?
• How much treatment supervision does he or she require?

Living with family

For many families, the most difficult choice involves whether or not the relative with schizophrenia should live at home. Living with family can be a good option for people with schizophrenia if their family members understand the illness well, have a strong support system of their own, and are willing and able to provide whatever assistance is needed.

At-home arrangements are less likely to be successful if the person with schizophrenia uses drugs or alcohol, resists taking medication, or is aggressive or uncooperative.

Choosing the Right Housing Option for a Person with Schizophrenia
Adapted from: Schizophrenia: A Handbook For Families, Health Canada
Living with family works best if:
The person with schizophrenia functions at a fairly high level, has friendships, and is involved in activities outside the home. The interaction among family members is relaxed. The person with schizophrenia intends to take advantage of available support services. The living situation does not negatively impact the lives of any young children in the home.
Living with family is not advised if:
The main support person is single, ill, or elderly. The person with schizophrenia is so ill that there is little or no chance to lead a normal family life. The situation causes stress in the marriage or leaves children in the home feeling frightened and resentful. Most family events and concerns revolve around the person with schizophrenia. Support services are not used or are unavailable.

Try not to feel guilty if you are unequipped to house a family member with schizophrenia. If you can’t look after your own needs or those of others in the family while caring for your ill relative, he or she will be better off somewhere else.

Residential options outside the family home

If an at-home living arrangement isn’t the right fit, make contact with local mental health facilities, social service agencies, support groups, and public housing authorities. These organizations can help you explore the residential facilities in your community and put your family member’s name on the appropriate waiting lists.

Options in your area may include:

• Residential treatment facilities or 24-hour care homes – A more structured living environment for those who require greater assistance with medications and daily living tasks or for those going through an acute psychotic episode.
• Transitional group home – An intensive program that helps individuals transition back into society and avoid relapse after a crisis or hospitalization. Includes skills training and rehabilitation services.
• Foster or boarding homes – A group living situation for people with schizophrenia who are able to function relatively well on their own. Foster and boarding homes offer a certain degree of independence, while providing meals and other basic necessities.
• Supervised apartments – An option for those whose condition is less severe or well-managed with medication. Residents live alone or share an apartment, with staff members available on-site to provide assistance and support.

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Authors: Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: January 2012.