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Mental Illness Guide: Care, Support, and Education
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Family Emergency Plan

It might be helpful to make an “Emergency Plan” for times when a person with schizophrenia is in crisis and needs to go to the hospital.  The purpose of having a plan is to provide an easy-to-get-to resource that contains the information you will need in case of an emergency. Listed below are some tips on what should go into your Emergency Plan, how to get the information, how to develop the workings of the Plan, and some examples.               

What is an emergency?

An emergency is a life threatening, or a violent situation that demands an immediate action or response.

How do you know if you are in an emergency?

Listed below are examples of emergency situations.  Generally, if someone does or threatens to hurt themselves or anybody else, this is an emergency situation.  Get help right away. 

Examples of emergencies

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A person with mental illness threatens to commit suicide.

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A person threatens to hurt someone else.

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If the actions of the person with mental illness would put his/her life in danger such as not eating, driving recklessly, or wandering around in a confused state.

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A person with mental illness is very disturbed (with or without a weapon) and agitated.  For example:

-The person yells and curses at people or becomes angry over small problems.

-The person shows mistrust in others such as accusing family members of poisoning his/her food or thinking someone is planning to hurt or kill him/her.

What to do in an emergency

Sometimes you may not know that you are in an emergency situation.  A psychotic episode can happen gradually over time or happen suddenly.  If you are unclear about if your situation is an emergency, or just need help figuring out what to do, try to contact the person’s therapist or doctor for advice.  If you cannot get in contact with those people, call (303) 440-5140 Explain your situation to the staff and they will get you help right away.

2. Emergencies involving violence

Sometimes a psychotic episode will involve violence.  In such situations, there will be no time to talk calmly to your relative, or to telephone the doctor or psychiatrist to ask for advice.  Because your relative is in a changed state of reality, they may try to act out the hallucination for example, shatter a window.  He/She may threaten to harm him/herself, to hurt you or to damage property.  One mother said that her son kept yelling that God was ordering him to kill her.  In such situations, you must do whatever is necessary to protect yourself and others (including the ill person) from physical harm.  It may be that the wisest choice is to leave the premises.

 In such charged situations, probably your only choice is to phone the police.  It may be unwise to drive your relative to the hospital by yourself: do so only if someone else can go with you.               

3. The Do’s and Don’ts of an emergency situation

Do’s:

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Try to remain as calm as possible.

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Take away distractions.  Turn off the television, radio, etc.  If other people are present, ask them to leave the room.

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Talk one at a time.  Try saying, “Let’s sit down and talk,” or “Let’s sit down and be quiet.”

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Speak slowly and clearly in a normal voice.

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Make statements about the behavior you are seeing.  For example, “You are angry.  Please tell me what is making you angry.”

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Avoid strong statements such as, “You are acting like a child,” or “You’ll do as I say.”

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Repeat questions or statements when necessary, using the same words each time.  Do not change the question in the hopes that this will make it clearer.

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Allow your relative to have personal “space” in the room.  Do not stand over the person with mental illness get too close.

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Understand that too much emotion on your part can upset your relative more.

Don’ts:

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Do not shout.  If your relative appears not to be listening to you, it may be because other “imaginary voices” are louder.

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Do not criticize.  Your relative cannot be reasoned with at this point.  Do not push your relative to talk or to react.  This can cause them to act out.

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Avoid continuous eye contact.

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Do not block the doorway.  Blocking the door may make your relative feel as if you are keeping them in the room when they want to leave. 

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Do not argue with other people about what to do in front of the person with mental illness.       

4. What do you want to happen during an emergency?

  1. Ensure that the ill relative and everyone involved in the emergency is protected and no one gets hurt.

  2. Take all the right steps to make the emergency more manageable.

  3. Notify all the people involved in the emergency plan of the situation.

  4. Reduce severe symptoms by talking with the ill relative and trying to understand what that person must be going through.

  5. Have all the people in the emergency plan carry out their responsibilities.

  6. Have positive interaction between the family and the ill relative.

  7. Know that before the emergency, the communication between the ill relative and everyone involved in the emergency had become better.

Emergency planning

Families and mental health workers recommend strongly that you have an emergency plan ready for psychotic episodes.  Create a back-up plan with people you will call to help, close friends, neighbors, and a peer support person.  Have numbers for each of them.

What to do ahead of time to plan for an emergency

Develop an emergency plan

  1. Have a list of important phone numbers and addresses.

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    Treatment team members (therapist)

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    911

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    Psychiatric emergency room

  3. Ask your relative’s doctor or psychiatrist ahead a time which hospital to go to in case of an emergency.

  4. Prepare a psychiatric advance directive. This is a way for the person with mental illness to let the mental health workers know what kind of treatment they do or do not want in an emergency situation.

  5. Have a file or diary of information for paperwork.  For example, the information taken from the family and the person with mental illness’s notes describing how the person responded to his/her medications and the warning signs of getting sick again.  

  6. Know which family members and friends your relative may trust more than others in an emergency.  For example, an involuntary hospital commitment may cause the ill individual to be very distrustful of the person committing him/her to the hospital.  Having another trusted relative or concerned person with authority beforehand helps to keep resentment from the ill individual from interfering with getting him/her to the hospital.

  7. Find out whom you can phone for support at any time of the day or night.  For example, someone that will sit and listen to your concerns and give suggestions on how to make your relative and you feel better, or a mental health professional that you can call on when you need help making decisions.

  8. Decide the role each person will take in an emergency.  For example:

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Who will call the police?

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Who will stay with the person with mental illness?

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Who will bring the emergency-related information to the hospital?

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Who will take care of other children?

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  1. Consider explaining the situation ahead of time to your local police department to get advice about what to do.  This gives your family the chance to find out if your local police department is trained to handle psychiatric emergencies.  If they are not, you have made them aware of your situation, and the officers will know your family and the person with mental illness.  This might help them to be a little more sympathetic.

  2. Know that the emergency may be less frightening to your relative if the emergency procedure has been explained to them far in advance and is expected.

  3. Decide on a convenient place where you will keep the emergency plan.

When you get to the hospital

In emergency situations, the family might normally expect their relative to be admitted, if not voluntarily, then involuntarily into the hospital.  However, this may not be the case.  Your relative may refuse to be admitted, and the doctor may say that your relative does not need to be admitted to the hospital.  If you are not able to be at the hospital, it is possible that your relative may be allowed to leave before you are notified.  If your relative is admitted, families who have been through the experience recommend strongly that you consider other possible courses of action, including, in some circumstances, leaving your relative on  his/her own.  Without the alternative of returning to the comfort of home, the hospital may appear to be a safe place to the ill individual, and he/she might be more likely to stay for treatment.      

 

Getting someone to go to the hospital on their own

It is far better, if possible, to have your relative go to the hospital voluntarily.  If you do not think your relative will listen to you, see if a friend can talk the person into doing so.  Some have found that giving their relative a choice seems to work.  “Will you go to the hospital with me, or would you prefer that someone else takes you?”  Such a method may serve to take away the person’s feeling of helplessness.  Offering choices, no matter how small, provides some sense of being in control of the difficult situation in which they find themselves.