Supporting a relative with psychosis

Ruby’s younger brother was diagnosed with schizophrenia four years ago. Ruby, a school principal, manages his medicines, his moods and her parents’ fear, and the relatives who suggest a pir, a marriage, or a stricter hand. Every relapse feels like her failure. She has never once been asked how she is.

An illustration drawn from common experience. The people are invented; the pattern is not.

Understanding supporting a relative with psychosis

Families often carry much of the care for serious mental illness. They can be left without information, with stigma from neighbours and relatives, and with conflict at home over medicines and behaviour. Families are often exhausted, frightened or guilty, and the tension can, without anyone meaning it to, make relapse more likely.

The finding worth knowing

A Cochrane review of randomised trials concluded that family intervention, structured work with relatives that includes education and problem-solving, may reduce the risk of relapse in schizophrenia and help people stay with their medication. The authors cautioned that the effects may be overestimated because many of the trials were of poor quality.

Signs worth noticing

• Constant conflict at home over medicine, sleep or behaviour
• Carers who are exhausted, isolated or unwell themselves
• Not knowing the early warning signs of relapse
• Pressure from relatives to rely on remedies alone, without treatment

How care helps

Family sessions explain the illness in plain language, agree a plan for early warning signs, reduce conflict, and look after the carers’ own health. Dr. Tajreen involves families, with the patient’s agreement, as partners in care.

What getting better can look like

In Ruby’s house, it might be a calmer kitchen, a written plan on the fridge for the first signs of relapse, and Ruby sleeping through the night.

Common questions about supporting a relative with psychosis

How can family help someone with schizophrenia stay well?

A Cochrane review found that family intervention, structured work with relatives that includes education and problem-solving, may reduce the risk of relapse in schizophrenia and help people stay with their medication, though the authors cautioned that the effects may be overestimated because many trials were of poor quality. Calmer conflict at home and a shared plan for early warning signs are part of it.

Can family members see a psychiatrist without the patient?

Yes. Families can come on their own first, to understand the illness, plan for relapse and look after their own health. With the patient’s agreement, they can then be involved as partners in care.

When to see a psychiatrist

If you are caring for someone with serious mental illness, you deserve support too. Families can come on their own first.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.

Sources

• Pharoah et al., Cochrane Database of Systematic Reviews, 2010 (PMID 21154340)