Getting Help for Schizophrenia
Family Education and Self-Help Groups
Very often, patients with schizophrenia are discharged from the hospital into
the care of their family; so it is important that family members learn all they
can about schizophrenia and understand the difficulties and problems associated
with the illness. It is also helpful for family members to learn ways to minimize
the patient's chance of relapse for example, by using different treatment
adherence strategies and to be aware of the various kinds of outpatient
and family services available in the period after hospitalization. Family "psychoeducation,"
which includes teaching various coping strategies and problem-solving skills,
may help families deal more effectively with their ill relative and may contribute
to an improved outcome for the patient.
Self-help groups for people and families dealing with schizophrenia
are becoming increasingly common. Although not led by a professional
therapist, these groups may be therapeutic because members provide
continuing mutual support as well as comfort in knowing that they
are not alone in the problems they face. Self-help groups may
also serve other important functions. Families working together
can more effectively serve as advocates for needed research and
hospital and communitytreatment programs. Patients acting as a
group rather than individually may be better able to dispel stigma
and draw public attention to such abuses as discrimination against
the mentally ill.
Family and peer support and advocacy groups are very active
and provide useful information and assistance for patients and
families of patients with schizophrenia and other mental disorders.
HOW CAN OTHER PEOPLE HELP?
A patient's support system may come from several sources, including the family,
a professional residential or day program provider, shelter operators, friends
orroommates, professional case managers, churches and synagogues, and others.
Because many patients live with their families, the following discussion frequently
uses the term "family." However, this should not be taken to imply
that families ought to be the primary support system.
There are numerous situations in which patients with schizophrenia may need
help from people in their family or community. Often, a person with schizophrenia
will resist treatment, believing that delusions or hallucinations are real and
that psychiatric help is not required. At times, family or friends may need
to take an active role in having them seen and evaluated by a professional.
The issue of civil rights enters into any attempts to provide treatment. Laws
protecting patients from involuntary commitment have become very strict, and
families and community organizations may be frustrated in their efforts to see
that a severely mentally ill individual gets needed help. These laws vary from
State to State; but generally, when people are dangerous to themselves or others
due to a mental disorder, the police can assist in getting them an emergency
psychiatric evaluation and, if necessary, hospitalization. In some places, staff
from a local community mental health center can evaluate an individual's illness
at home if he or she will not voluntarily go in for treatment.
Sometimes only the family or others close to the person with schizophrenia
will be aware of strange behavior or ideas that the person has expressed. Since
patients may not volunteer such information during an examination, family members
or friends should ask to speak with the person evaluating the patient so that
all relevant information can be taken into account.
Ensuring that a person with schizophrenia continues to get treatment after
hospitalization is also important. A patient may discontinue medications or
stop going for follow-up treatment, often leading to a return of psychotic symptoms.
Encouraging the patient to continue treatment and assisting him or her in the
treatment process can positively influence recovery. Without treatment, some
people with schizophrenia become so psychotic and disorganized that they cannot
care for their basic needs, such as food, clothing, and shelter. All too often,
people with severe mental illnesses such as schizophrenia end up on the streets
or in jails, where they rarely receive the kinds of treatment they need.
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 hallucinations seem quite
real they are not just "imaginary fantasies." Instead of "going
along with" a person's delusions, family members or friends can tell the
person that they do not see things the same way or do not agree with his or
her conclusions, while acknowledging that things may appear otherwise to the
It may also be useful for those who know the person with schizophrenia well
to keep a record of what types of symptoms have appeared, what medications (including
dosage) have been taken, and what effects various treatments have had. By knowing
what symptoms have been present before, 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, even better and earlier than the patients themselves. Thus,
return of psychosis may be detected early and treatment may prevent a full-blown
relapse. Also, by knowing which medications have helped and which have caused
troublesome side effects in the past, the family can help those treating the
patient to find the best treatment more quickly.
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 and/or repeatedly criticized 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.
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