Brian Smith originally published this article in psych central journal as a guide for family members having someone with schizophrenia. The article is useful, especially in our situation where there is poor social welfare scheme and poorly developed community-based mental health services.
Family members often try to cope with someone, who has schizophrenia for a period. But once there seems to be lack of progress in treatment or dropping out of treatment, the family’s emotional support may wane, resulting in some family members cutting off all contact with their schizophrenic sibling. Friends may also lose interest in supporting a person with schizophrenia, as they cannot understand how to continue to give long-term support to such a person.
People with schizophrenia may need help from people in their family or community in numerous situations. They may often resist treatment, believing that delusion or hallucination is real and that psychiatric help is not required. Certain long-held beliefs and practices concerning mental illness in a particular community may frustrate efforts of some family members in getting relevant orthodox intervention for their relatives. The following hints may be useful for such family members and friends.
The closest family member or friend should be the advocate. Sometimes, only the family or others close to the person with schizophrenia will be aware of strange behaviour or ideas that the person has expressed. Since patients may not volunteer such information during an examination, family members or friends should volunteer to offer all relevant information.
Ensure ongoing compliance with treatment
Ensuring that a person with schizophrenia continues to get treatment after hospitalisation is also important. Discontinuing medication or not going for follow-up treatment, often lead to a return of psychotic symptoms.
Offer strong emotional encouragement
Encouraging the person to continue treatment and assisting him or her in the treatment process can positively influence recovery. Without treatment, some people with schizophrenia become so disorganised that they cannot care for their basic needs, such as food, clothing and shelter. Such patients may end up on the streets or in jail.
Know how to respond to bizarre comments
Those close to people with schizophrenia are often unsure of how to respond when patients make statements that seem strange or are clearly false. For the individual with schizophrenia, the bizarre beliefs or hallucination seems quite real — they are not just “imaginary fantasies.” Instead of “going along with” a person’s delusion, family members or friends can tell the victim that they do not see things the same way, while acknowledging that things may appear otherwise to the patient.
It is very important not to challenge the person’s beliefs or delusion. They are very “real” to the person who experiences them, and there is no point arguing with them about the delusion or false beliefs. Instead, move the conversation along to areas or topics where you both will agree.
Keep a record
It may also be useful for those who know the person with schizophrenia well to keep a record of types of symptoms, medication (including dosage), and effects of various treatments. By having this knowledge, family members may know better what to look for in the future.
Families may even be able to identify some “early warning signs” of potential relapses, such as increased withdrawal or changes in sleep patterns.
Thus, return of illness may be detected early and treatment may prevent a full-blown relapse. Also, by knowing which medication that have helped and which have caused troublesome side effects in the past, the family can help those treating the patient to seek better treatment more quickly.
Support the person
In addition to involvement in seeking help, family, friends and peer groups can provide support and encourage the person with schizophrenia to regain his or her abilities. It is important that goals be attainable, since a patient who feels pressured or repeatedly criticised by others will probably experience stress that may lead to a worsening of symptoms. Like anyone else, people with schizophrenia need to know when they are doing things right. A positive approach may be helpful and perhaps more effective in the long run than criticism. This advice applies to everyone who interacts with the person.