Dealing with Crises: Suicide, Violence, or Substance Abuse

Most families will face certain crisis situations at one time or another. Some of the more serious crisis situations involve suicide, violence, and substance abuse.

Suicide is a real risk for people with mental illness, and a tragic experience for families. You can help prevent suicide by becoming aware of warning signs, and by keeping lines of communication open. Sometimes if a person is feeling suicidal, they may say so directly. You should take the statements seriously, and contact treatment team members who may advise hospitalization. Sometimes a person may be feeling suicidal, but not telling people who are close. Warning signs for suicide include:

• Intense feelings of hopelessness
• Talking about death
• Hearing voices that tell the person to kill or hurt himself
• Giving away prized possessions or putting affairs in order
• Talking of troubles ending soon
• Prior attempted suicide

If you suspect your relative may be thinking of suicide, you should ask him directly, in an understanding manner. If your relative has developed a plan to hurt himself, and has the means to do it, you should seek emergency help. You may also want to remove the means if possible-if you have guns in the house, get them out. It is also important to remember that there is often nothing anyone can do to prevent a suicide.

Aggressive behavior can also be a serious problem for families. People with mental illness are more likely to be aggressive if they feel trapped or cornered. They may be more likely to lose control if they are psychotic or if they are under the influence of drugs or alcohol. To prevent violence:

• Look for cues to developing aggression
• Remain calm
• Tell your relative you expect them to remain in control
• Give your family member physical and emotional space
• Keep yourself safe-leave the room
• Call for help (the police) when needed
• Talk about the problem when everyone is calm

Substance abuse is a common problem among people with mental illness. Alcohol and drugs can make symptoms worse and complicate treatment. People with mental illness may turn to alcohol and drugs in an attempt to self-medicate, or to feel part of a community. If your relative is using alcohol or drugs, it is important to keep the lines of communication open, express your concerns, and gently encourage steps toward abstinence. Talk with your relative’s treatment team or other mental health professional for advice on dealing with your specific concerns.

Create an Emergency Plan

A plan of action, in case of psychiatric emergency, can be very helpful for someone with mental illness, as well as family members. Develop the plan together, along with your mental health professional. The plan should designate who will make decisions on the patient’s behalf regarding hospitalization or emergency care. It should also include:

• Emergency phone numbers
• Current medications (with dosages)
• Names of the current doctor and case worker, therapist, or counselor, and how to reach them
• Insurance or related information
• Names and phone numbers of family members or other caregivers who should be notified