How families and friends can help

• What should you expect from the doctors responsible for your relative's treatment?
• The importance of continuing treatment
• Responding to behaviour and symptoms
• Adding a positive approach

If one of your family members has been diagnosed with schizophrenia, you can play a very important role, by providing them with support, and helping them to receive appropriate care. It is important to gain a good understanding about the illness. Hopefully, the doctor involved should be prepared to answer any questions you might have about what schizophrenia is and how it is treated.

People with schizophrenia are sometimes not able to communicate during an assessment. In some cases, only the family or close friends will be aware of differing behaviour or ideas. Family and friends can be useful in supporting service users at appointments.

It will help to know about your family's medical history, and which medications your relative has been taking. You may also want to ask questions about medication, side effects, long-term health risks, and risk of hospitalisation. It is a good idea to write down your questions in advance, and to have paper and a pen with you in case you want to take notes.

Carers can find help through attending family support groups.

What should you expect from the doctors responsible for your relative's treatment?

As part of the process of diagnosis and treatment, the psychiatrist should:

• take a detailed history
• check for problems that may be related to other illnesses (physical and psychiatric)
• be well informed about antipsychotic medications
• follow up thoroughly
• adjust treatment when necessary
• review medications regularly
• be interested in the patient's entire welfare, and make appropriate referrals for aftercare, housing, social support, and financial aid
• explain clearly what is happening, and what is being planned for the patient's treatment
• involve the users and carers in the treatment process

The importance of continuing treatment

Because of the nature of the condition, some people with schizophrenia may deny they need medication, and may either refuse to take the drugs prescribed, or may stop taking them because of undesired side effects. Remembering to take medications may be difficult because of the nature of the illness. If relatives or friends are involved in the treatment process, they can provide invaluable support in various way

These include keeping a check on the patient's use of medications, prompting them when they forget to take the drugs or, reminding them of problems which may have occurred on any previous occasion when they may have decided against taking their medication.

Ensuring that a person with schizophrenia continues to get treatment after being in hospital is also important. A patient may discontinue medications or stop going for follow up treatment, often leading to a return of psychotic symptoms. Encouraging the patient to continue treatment and assisting him or her in the treatment process can positively influence improvement.

Without treatment, some people with schizophrenia become so unwell that they cannot care for their basic needs, such as food, clothing, and shelter. If this occurs people can become homeless or get into difficulties, that may lead them to prison.

Responding to behaviour and symptoms

Those close to people with schizophrenia are often unsure of how to respond when patients make statements that seem strange or are clearly false.

For the individual with schizophrenia, the bizarre beliefs or hallucinations are quite real; they are not just imaginary fantasies. Instead of 'going along with' a person's delusions, family members or friends can tell the person that they do not see things the same way or do not agree with his or her conclusions, while acknowledging that things may appear otherwise to the patient. Carers need to be careful not to challenge the individual's beliefs. Doing this may undermine their selfesteem and coping strategies, which could lead to relapse.

With the full agreement of the service user, it may also be useful for those who know the person with schizophrenia well to keep a record of what types of symptoms have appeared, what medications (including dosage) have been taken, and what effects various treatments have had. By recognising previous symptoms family members can look out for signs of a relapse. Families may even be able to identify some early warning signs of potential relapses, such as increased withdrawal or changes in sleep patterns. Thus, return of psychosis may be detected early and treatment may prevent a full-blown relapse. Also, by knowing which medications have helped and which have caused troublesome side effects in the past, the family can help those treating the patient to find the best treatment more quickly.

Adding a positive approach

In addition to seeking help, family, friends, and peer groups can provide support and encouragement for the person with schizophrenia to learn to cope. It is important that goals be attainable, since a patient who feels pressured and/or repeatedly criticised by others will probably experience stress, leading to a worsening of symptoms. Like anyone, people with schizophrenia need to know when they are doing things right. A positive approach may be helpful and can be more effective in the long run than criticism. This advice applies to everyone who interacts with the person.

Caring for yourself

Caring for someone with mental ill health can be challenging and have a big practical and emotional impact on your life. For that reason local mental health services will offer you as a carer separate support and guidance in your role. You can get this through requesting an assessment of your needs as a carer, and through getting in touch with your local carers support workers or carer groups.