What to Avoid

Threatening the patient will only make her troubles, and perhaps yours, worse. It may even prompt him to protect himself from the perceived increased threat that you have added to his crisis. Instead of administering any form of discipline or threats, tell him you want to help him deal with what is happening.

Alert

A person experiencing a psychotic crisis may vigorously resist your attempts to comfort her or help her get professional help. Unless a doctor examines her and recommends treatment, a person cannot be compelled to enter a hospital. Never threaten or try to force a person into a hospital by yourself.

Support and Understanding

The following dialogue is an example of one approach for communicating with someone upset by a delusion that is interfering with her ability to attend treatment. In this case the patient suffers from delusions of reference, the belief that messages just for her are encoded in television news broadcasts.

Patient: Leave me alone! I have to hear this! No one understands I have to listen to the news or people will die. I will die. You will die.

You: I understand that is very upsetting for you. It is very stressful.

Patient: It is. I can't miss the broadcast. I can't go with you.

You: Maybe we could work out a way to go to therapy later and discuss this. Maybe it will help you deal with what you have to do. I'll be there to support you. I'll make sure the therapist listens to you. I know how difficult it is for you.

If the compromise works one time, be sure to mention it to the therapist. Remember, the feelings a person with psychosis has are completely justified in her mind. They are logical responses to the false stimuli her brain is generating. If a person with schizophrenia is hearing voices, they are real voices for that person. The same is true for visual hallucinations. It will not do any good if you deny the existence of a lurking, threatening, or frightful image that, for the psychotic patient, is right there in the room.

Fact

It won't help the person if you tell her what psychiatric disorder you think she is experiencing. A non-expert cannot distinguish between the scores of mental disorders that share common symptoms at different times but require different treatments and approaches. Instead of telling the person she is acting depressed, schizophrenic, psychotic, insane, mentally ill, disturbed, nuts, or crazy, explain that you are concerned about her well-being.

No matter how bizarre or troubling the delusions are, try not to respond emotionally if the patient discusses them. Never laugh at or make fun of a person because her ideas are odd, unrealistic, or fantastic. Try to offer reassurance without being condescending or judgmental.

Screaming, yelling, crying, and even throwing and breaking things do not constitute signs of imminent threat. They could be signs of coming violence, but they can also be acts of frustration. Trust your instincts. Leave if you feel at all uneasy.

What to Do if You Cannot Succeed

If you feel you will not be able to calm someone who is having a psychotic emergency, you have several options for finding help. If the patient agrees to travel, you can take him to a nearby hospital emergency room. You also may get help from a psychiatrist or other mental health care provider who has agreed to handle emergency calls. Another option is to call a qualified rescue or ambulance service whose members are trained to deal with psychiatric emergencies.

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  4. What to Avoid
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