Work with a doctor or other mental health professional to develop an emergency contingency plan or an advance directive/relapse prevention plan. These written guidelines should tell you what to do, whom to contact, and how to contact them in the event a patient's psychotic symptoms become overwhelming and may result in a crisis.

Speaking to Someone Having a Crisis

Speak slowly, calmly, and clearly to the person without talking down to her. If you are talking to an adult, address her as an adult. Avoid using a condescending or threatening tone. Try to project a moderating image. Keep your sentences simple and brief. Remember that a person in crisis is going through a highly disturbing experience that may involve threatening thoughts, voices, and/or visions. You do not want to add to his stress.

Follow the patient's lead if she will talk to you. Let her talk about herself and her feelings, beliefs, experiences, concerns, and fears. Be sympathetic and encouraging by letting her know, at the proper time, that there are ways to ease some of her concerns.

Sometimes, if someone is coherent, she can provide hints that may help you as her caregiver. For example, if she has had similar crises in the past, she may be able to tell you who or what helped her deal with them. Was there anyone who was particularly helpful? Was a particular place soothing? Did removing a particular source of stress help? Ask what she thinks will help her, and assist her in finding it.

Let Her Know She Has Options

If the person indicates she wants to seek psychiatric help, support her emotionally as you assist her in finding appropriate and competent care. People's ethnic, religious, and cultural background may influence their behavior when they are ill. Be sensitive to these influences when speaking to someone dealing with the disease.

Give the person every opportunity to know that he still has some control of his situation. Ask if you can sit in a certain place or if you can approach the person in crisis. If she asks for something, or asks you to do something, agree if you can be sure it will not compromise her own safety or that of others.

Dealing with Patients Who Won't Talk

Some patients will not want to talk about what bothers them. They may be confused, embarrassed, or too disturbed by their symptoms. Others may not trust certain individuals enough to open up to them. Don't insist or try to force someone to talk to you. Instead, tell her you will be available if she wants to talk later. Ask her if there is anyone she would feel comfortable talking to, and offer to put her in contact with that person if possible.

If the patient in crisis is not a threat to herself, there is no reason to stop her from moving, walking about, or fidgeting. It is a normal response to the situation she is living through. It will do no good if you grab, restrain, or hold on to her to restrict her movement unless you think she is in imminent danger of harming herself.