Ask the psychologists...

My sister is 41-years-old and was first admitted to hospital 23 years ago and diagnosed with drugs-induced psychosis. Since then she has been diagnosed with schizophrenia, then manic depression and she has been prescribed anti-psychotics. Three months ago her consultant removed all medication and changed her diagnosis to 'behavioural and personality issues'. Since then she has become bulimic and lost over three stone. She has been living at my parents house on and off for the past five years and they are now at their wits end. She is continually contacting members of the family asking for help, but has refused to see her consultant when an appointment has been arranged. Consultants will not see us due to confidentiality. She has stolen my mother's car/ takes taxis on long journeys and has been arrested due to her different, distressing actions. The past three days has seen her attend A & E on three occasions, telling us she is suicidal, but they send her away, and tell her to go home. As a family we are at a complete loss and do not know what to do, and are losing our empathy. It seems that the hospital/ NHS trust has turned their back on her. Any advice?

 

Diagnoses typically depend on someone’s latest presentation and these do tend to change over time. With a personality disorder diagnosis, your sister’s attempts to get help are being seen as an over-reaction and her risk of acting on what she says is now assessed as less likely than if she had a schizophrenia diagnosis. Her history now of stealing your mother’s car, etc will all be seen as part of this ‘over-reaction’. There is less clear cut treatment recommended for personality disorder, and this is why A & E are not admitting her. Sending her home to calm down and think things through for herself is being suggested. Consultants will not want to see you without being clear your sister has agreed to this, and it is quite possible that she has asked them not to talk to her family at the moment.

 

I know this is very difficult to manage as a family.

 

What help does she ask you for at the moment? Is any of it realistic, such as wanting to talk to you, or wanting emotional or reasonable practical support? If any of you can offer it, then saying you will listen and try to help her solve some of her immediate problems might be useful, but this should not involve money or help that you cannot give. Unfortunately you may have to watch while things do not go well for her, until there is a crisis which means she will begin to accept help herself. This is a painful process. As a family, trying to offer a ‘safety net’ is all that you can do for the moment. Try to make it clear to her that you all still care about her, and want things to go well for her, but that she has to start looking after herself as well. Make it clear that you think she should go back to see her consultant in order to try to organise a treatment plan together, and that this will be more useful than trying to access help via A & E (who see their job as dealing primarily with physical ill health). If your sister would like another discussion about her diagnosis, she can ask for a second opinion via her GP.

 

Finally, you may find it helpful to find out about mental health support groups for family members that are in your area. Although they are less likely to be tailored to the specific needs of families of relatives with personality disorders, some families have found support groups to be helpful. Your local GP practice or library is likely to have information on existing  groups.

 

Is it possible for my son (who has a diagnosis of schizophrenia) to visit a psychologist without a referral from the GP?

 

There are some psychologists in private practice who might see your son without a referral from your son’s GP. However, we would not recommend this route. For people with a similar diagnosis to your son, the problems should be discussed with his GP, and his GP should recommend referrals that would be appropriate in your area. Your son’s GP needs to know about any other treatment he might be receiving. With this diagnosis, most psychologists who would be qualified to offer help such as CBT or family work, as currently recommended by the National Institute for Health and Clinical Excellence (NICE), would be likely to be based in community adult mental health teams, specialist teams or clinics. This is because it is can be unwise to see people with these diagnoses without the help of other people in the mental health team (social workers, nurses or psychiatrists), who can advise on all the other problems that are common, such as help with benefits, housing, getting back into work, help with medication.

 

I don’t know which psychologist you were hoping he might see, but please ensure they are not working on their own (ie without adequate supervision), and are registered with the Health Professions Council.

 

If there is a problem with your son’s GP, he can ask to be registered with another practice.

 

I have recently found my genetic family after many years of searching which is wonderful, but I also found out I have a step-brother who suffers from psychosis. He takes drugs and drinks. He has caused such a lot of pain in the family over the years, and the family have advised me not to encourage him. He found out my phone number through a member of the family and won't stop ringing me, he also say's such dreadful things on the phone. How do I deal with this? Should I go and see him?

 

I am sorry that your search has led to your finding someone who now seems to be harassing you. Ultimately, the decision of whether to meet your step-brother will be yours, but it appears that you are, understandably, somewhat ambivalent. Given the information you provide, I would take your new family’s advice, and would not go and see him. Next time he phones, ask him to stop calling and tell him you are changing your phone number. Many phone companies will not only do this, but will also block calls for you. It is worth noting that just because someone is a (distant) relative does not mean you have to like them, that you must have a close relationship with them, that you have to help them or that you are responsible for them or their current behaviour. It is great that you have found some new family, but do not feel you have to have good relationships with all of them. Of course, we are not aware of how things may develop for your step-brother in the future, but it seems the best course of action would be to not pursue this relationship at this time.

 

My younger brother is 20 years old and has taken drugs since he was 14. He comes from a loving home where he has grown up with nice things, good parents and in a supportive environment. We have always been anti-drugs and have found his choices and behaviour very hard to deal with. With that in mind, we have never given up on him and have gone to great lengths to try and help him.

Two years ago he was sectioned and placed hospital for about two months. Prior to this his behaviour was horrendous. He was angry, violent, aggressive, unreasonable, extremely threatening, out of touch with reality etc. The reason that he was sectioned was because he threatened my mum with a knife. Firstly, they diagnosed him with schizophrenia. They later back-tracked and released him, claiming that he was not mentally ill but in a state of psychosis. He was prescribed anti-anxiety medication, which helped slightly although he now refuses to take them and even when he does they do not really make any major difference to his behaviour. He was not offered any further support to re-integrate himself back into the community, so again, it was due to the support of my parents that he was able to function more normally again.

 

On New Year’s Day, he moved out of our family home as he wanted his independence. He also met a girlfriend who was very supportive and a great influence on him. She was staying with him most of the time and he seemed to be getting his life back on track. He was job-hunting and wanted to continue to make improvements in his life. However, over the last two months he seems to have been using drugs again. This is not due to a lack of support because my parents still see him at least twice a day, and he is living next door to my grandparents. Consequently, his girlfriend does not want a relationship with him whilst he uses drugs due to his violent and threatening behaviour, although she still offers him support on the road to recovery when he is reasonable towards her.

His behaviour is extremely worrying again at this point in time. He crashed his car due to suspected drug driving a few weeks ago. His behaviour is reckless, threatening, aggressive and unbearable. He attacks my parents verbally every day and he is making them ill. He shouts and screams at the top of his voice, often making no sense and using foul language. He squares up to my dad and threatens them both with physical violence. I think it is only a matter of time before this happens and I am extremely worried for them. Although we are advised to call the police in these situations, based on past experiences he is given a public order offence and my parents have to pay a fine. Also it is almost unbearable to watch somebody you love being arrested, particularly if you think they do not have the mental capabilities to make reasonable decisions.

We have been to see our family GP but they have said that due to the fact he is over the age of consent, there is nothing more we/they can do. I am afraid for both the safety of my parents and my brother himself. He has tried to commit suicide in the past. My brother does not see that he has any problems at all and the very last thing he would ever do would be to seek help. He also gets violent when he can't get his own way so this is frightening for us in terms of not allowing him in to the house - he would break in. I cannot highlight how terrible things are at the moment and I have never been so worried about the safety of my parents and brother.

Can you please offer some help / advice? We are running out of options before something very serious happens. How do we get him the support when he refuses to visit his GP? What happens when a GP will not help?

 

I am sorry to hear about your situation and how desperate you must be feeling. From your letter, it appears that you have tried a number of options and attempted to do the right thing on many occasions.

 

As you have already reported, if you, or your family, are concerned about your safety when your brother is around, you should call the police. Whilst it may be unbearable to witness their involvement, it is important for your brother and your parents’ safety that a situation is not allowed to escalate.

 

It is also important to set limits about his behaviour and to give your brother as clear a message as possible when you regard his behaviour as unacceptable. You must be explicit with your brother when you explain that his behaviour is unacceptable to you. Try to be consistent and use clear statements such as: ‘I am finding your behaviour intimidating at the moment, so I am going to... end the conversation/have to ask you to leave/I am going to leave’. As far as possible, try not to vary these statements as your brother will eventually recognise these as signaling that he has exceeded the boundaries.

 

Your parents should avoid, inadvertently, giving your brother mixed messages about his behaviour by paying his fine and mitigating the consequences for him. As he is now a 20year-old adult, not a 14-year-old, he has to be given adult responsibility for his own behaviour and the consequences. For instance, if he has crashed his car, your parents should not get involved in trying to get it mended or replaced; if he breaks into the house, the police have to be called and he has to be charged with criminal damage. Saying he does not have the mental capacity to make reasonable decisions may be part of this mixed message; he does not currently have a mental health diagnosis, neither is he accepting any treatment. By making these adult decisions, he has avoided the stigma of mental health problems, but has also cut off possible sources of help. Even if he was receiving help and did have a diagnosis, neither of these mean he can break the law and threaten your parents.

 

Given his current behaviour and as part of the process of limit setting, your parents (and perhaps your grandparents) should make a decision about whether your brother should visit their home or not. Then they must stick to this decision. Likewise, your parents should consider the frequency of their twice-daily visits to his home and the reasons for it. Is it helping your brother, reassuring your parents or adding to their stress and worry while irritating your brother? If it is just the latter, perhaps they should, mutually, fix a time once or twice a week when they will see your brother, while making the focus of the visit what has gone well that week. Again they need to be consistent about this.

 

It is not clear from your letter whether there is a pattern to your brother’s aggressive episodes. For example, is he more aggressive in his own home or when he visits your family? Does it happen at particular times of the day? Are there any specific triggers that you have noted? Are the arguments about money for instance, a very common trigger. If so, your parents need to make it clear they will no longer pay for things and stick to this. If your parents do agree to meet with your brother, it would be helpful to meet at public and more neutral location until the situation has become less volatile.

 

Although this may sound harsh, establishing clear limits about what you and your parents consider to be acceptable behaviour and the consequences of not observing these limits is required at this stage. This should help you to feel more in control and less helpless. You and your family may also find it helpful to draw up a simple ‘good behaviour’ contract and share this with your brother when you feel he is somewhat more calm than usual. It is important that you present the contract as a way of being able to spend more meaningful time with him. At the moment, it is difficult to spend time with him when there are aggressive and violent outbursts. Thus, you should make it clear in the contract when you would call the police or ask him to leave your home or end a conversation. It might be helpful to reassure him that he can resume contact when he has calmed down. Unfortunately, you may have to do this on a number of occasions to make the point. It is important to persevere.

 

Finally, I think you should express your concerns in writing about your brother and his care to his GP, then phone up and ask to speak to his GP or make an appointment yourself with the GP, emphasising how concerned you are and asking for advice. Again, you may need to be persistent about this.

 

It may in the end be necessary to focus on keeping your parents, your grandparents and yourself safe in all of this until your brother either accepts help himself or something changes so that some other agency gets involved. I think as part of this, although you say your brother will not accept any help, and does not see he has any problems, his previous suicide attempt, his relationship having broken up and his previous attempts to get a job, do suggest that he can at times see that there are problems and manage some things on his own. Offering to support him to get help with these issues, by him seeing his GP about his suicidal thoughts and/or his relationship, going with him to the job centre if he would like this, might be a starting point.

 

I am starting training soon to become a mental health nurse. Recently my cousin who I have not seen since he was 16 (due to a family breakup) was diagnosed with schizophrenia. He’s 30 now, and serving time in prison. He’s in an acute psychiatric unit and is likely to serve the remainder of his sentence there (he’s been in prison since he was 17). I am now back talking with that side of the family and planning to go and visit him. I am familiar with what life is like living with mental health problems, having borderline personality disorder myself and bipolar II (although I have been in recovery for three years) but I know little about schizophrenia except about how scared he was when he was first diagnosed, and what a difficult time he had when he was transferred from prison to hospital. He sent me some lovely written cards and poems when my mum died last year and was supportive despite obviously not being around, and I want him to know I’ll be a friend for him. How can I make him feel that I’ll be supportive for him?

 

Unfortunately, there is no manual for being supportive. For some, it can include making phone calls but for others it will include visits, practical help and emotional support such as listening are also often supportive. However, the initial thought is to ask your cousin what he would like and then to weigh up for yourself whether or not you can provide any of it. Just because you are becoming a mental health nurse does not mean that you have to become the family mental health support resource.

 

It is important to avoid putting unrealistic pressure on yourself. Try to take this new relationship slowly. You may have a lot to catch up on. Remember that your cousin may consider it enough that you have made time to visit and talk to him about things that are important in his life and in your own and to thank him for supporting you at a difficult time last year. Your conversation may include his experience of mental health problems, but it may also include more general topics such as his interests, hobbies, and plans for the future, which are equally important and likely to be a great support to be him. Remember, he is part of your family, but you are not going to be his nurse; offering to be a friend if he would like that, is the purpose of this contact. I expect you know how to do this, so do not assume that this friendship, if it works for you both, has to be so different. Good luck with the training.

 

How can you help someone with a diagnosis of schizoaffective disorder? My daughter seems to be going through a manic phase of spending all her money immediately she gets it. She is being influenced by a group of new so-called 'friends' to have a good time drinking alcohol, possibly using recreational drugs, and spending her benefits on them. This seems out of character for her and a worrying aspect of the illness. But she is 29 and wants to be independent of me, her mother. She is now living in her own studio flat but is clearly not really looking after herself on the financial front. She has told me that she doesn't want to behave like this but cannot control herself as she doesn't find it easy to say 'no' to herself or her friends. She was seeing a counsellor for a few weeks but is now stopping this as she doesn't think she needs it. This was a private arrangement as the NHS are unable to provide her with any talking therapy - so they say. What advice are you able to give me as a caring mother?

 

Supporting family members who have mental health problems that are deteriorating, but also refuse offers of help often ranks as one of the most distressing and frustrating aspects of the carer role. We know that it can be a huge worry for families when a service user’s mental health problems leave them in a vulnerable position and at risk of exploitation from others.

 

Is your daughter under the care and supervision of a local mental health team or GP? If yes, it is important that you share your concerns about her deteriorating mental health with her key worker or GP. It is also important to note that the job of managing a crisis (or relapse) with your daughter is not something that you are expected to do on your own. Although it can be difficult to hear, there will be limits to how much control and influence you have over your daughter’s behaviour.

 

You mention that your daughter has found it difficult to control herself or impose limits with her friends. Are you able to ascertain what strategies have been beneficial in the past with similar situations? Can she tell you what she might find helpful from you or others? Would it help her for instance to only take a limited amount of money (and no credit cards) out with her, so that she cannot overspend; or come to some agreement about when to come home in an evening even if she is enjoying herself? Does she have another friend who would help with this?

 

Once the situation has settled, your daughter may benefit from some individual cognitive behaviour therapy to address issues around her confidence and ability to say ‘no’ when necessary. This may be something that she can do with her current therapist, if they have suitable training and qualifications. It might also be helpful to work with your daughter and her team about an ‘early signs plan’; what the plan should be around managing her self care and money and when she should seek help herself, before her behaviour gets really out of control, which would be preventative for the future?

 

Please could you advise on how I go about getting family counseling for my 13-year-old son who is having difficulty at the moment coping with his father's mental illness?

 

The route to try to follow is to try to discuss with your local Child and Adolescent Mental Health Service (CAMHS) if they do this. Your GP is the first person to talk to and to ask about this kind of referral. I am not clear what difficulty your son is having so the reason for the referral would be because he’s depressed or showing health problems or whatever. Unfortunately CAMHS are not always well-resourced, and there can be long waiting lists.

 

An alternative is to visit young carer websites and to look at whether there is any help or support for young carers in your area. There are links on the Other useful websites page and on the For young people page of this website. Your son may not consider himself a young carer, but because he is affected he would fall into that category, and might find the support helpful.

 

Finally, he could talk to you. Is that possible?  What he is worried about? Does he know what is the matter with his father? Does he know it is NOT his fault? Is he worried that he will get it too? Can he talk to one or two friends about it rather than being isolated? A continuing discussion with yourself might in the end be more reassuring.

 

My mother has been diagnosed with a variety of mental illnesses over the years including simple schizophrenia, anxiety and depression. She had electric shock therapy aged 17 and has been on antipsychotic and antidepressant drugs for many years. She is currently in the midst of an episode of depression and anxiety that has lasted 4 months. My brother lives around the corner (he moved close to look after her) and he and his wife see her practically every day. When they do not, she calls them sobbing. I live in Australia.

 

It is putting an enormous strain on my brother's marriage and he doesn't know where to turn. My mother is refusing to agree to the mental health team being involved. The irony is, she doesn't believe she needs them and isn't capable of making the right decision but there is no help for the family without this agreement. My brother is talking about selling his house and moving away for the sake of his health. My mother simply could not look after herself if this were to happen. She flatly refuses any sort of cognitive therapy or self help.

 

What can we do under these circumstances?

 

I am very sorry to hear how difficult things are.

 

It seems from what you are saying that the ‘schizophrenia’ diagnosis is not currently relevant and that your mother’s problems relate to depression, anxiety and not feeling she herself can manage any problems. First stop again would be your brother’s GP, so that your brother can discuss how the problem is affecting him. Secondly, your brother could try to talk to your mother’s GP and ask for a referral and new assessment from a local mental health team.

 

If your mother continues to refuse all help, your brother might think of this as a management problem. What help can be realistically given day to day? A weekly visit? A 5 minute phone call a day? He needs to think of something he can manage all the time. He could then visit your mother and say that he is under terrible stress and can no longer offer her such a lot of support. He can say that he and his wife have thought they might move because of the stress. He can then suggest that what he can offer from now on is a weekly half hour visit and a 5 minute ‘phone call in the evening (say) or whatever he can manage. He needs to say that he can no longer offer more than this and if she needs other help she must talk to her GP/local service herself. He then needs to stick to this. During the 5 minute ‘phone call, he should just try to ask about what has gone well that day. Any other demands should be met with ‘well as I said, I can no longer deal with this. I’ll ring you tomorrow’ and then say goodbye and ring off. I’m afraid he may have to change his own phone number if he does this.

 

It will be very tough. Your mother has got used to relying on unending support. For whatever reason she does not feel she can manage on her own, and may feel she is too upset to try. This is why she needs professional help. You also need to decide about your own input – one 10 minute call a week? This would support what your brother is doing if you only talk to your mother about things that have gone well. There are no easy solutions, but persistence and calm consistency with your mother may begin to change things.

 

Finally, continue to support your brother and his wife, and vice versa, and try to obtain whatever other support you need from your own friends and wider network.

 

What's the best way of talking with someone who is experiencing psychosis? What's your advice for a mother trying to help her son during his first episode of psychosis?

 

Questions about how to communicate with someone with psychosis are very common, but there are no exact rules. It will always depend on the individual and what works for you both.  However, we know that individuals with psychosis can often benefit from communication that is clear and unambiguous. We also know that people with psychosis can be sensitive to criticism from others. Thus, it is important to be mindful about the tone you use when communicating; a calm and empathic tone tends to be most helpful.

 

In terms of specific advice for a mother, this is not easy. Your son may not want to talk to you, so this needs to be respected. However, if he does want to talk, focus on whether his experiences are upsetting, and if so, what can you do to help? Try not to get into arguments or prove him wrong, but try to find out what makes him feel better or worse, and ask him to tell you how to help him if he can. Encouraging him gently to start taking back his life, his old friends and his previous activities is also very helpful. We know the first episode of psychosis is a very stressful and confusing time for service users and their families. The experiences are new and often distressing, and it is not immediately clear to the service user how others can help them. As a family member, it is important to be sensitive to what your son feels able to do. The episode may have knocked his confidence and he will need time to regain this.  Try not to get angry with your son, or fall into the pattern of trying to everything for him. There will be a limit to the things that you are able to help with. Finally, it seems important to note that you can also help your son by trying to ensure that you are supported by friends/family and possibly staff from his mental health team. Make a point of having time to yourself and engaging in activities that you enjoy. You will always be in a much stronger position to ‘help’ your son when your health is good. 

 

A year ago, my 21-year-old brother suffered from a cannabis (skunk) induced psychosis and he has been on medication since. He has been stable and his dose has been reduced. However, he is sometimes non-compliant with the medication because of having to renew his prescription, leading to episodes of anxiety, which are also related to stress (submitting course work at uni). Although a psychiatric nurse has been visiting him on a weekly basis, I would like to know if providing him with sessions with a clinical psychologist would be beneficial to deal with his anxieties and help him understand what he went through?

 

The answer is yes – if it is available – this would be very helpful.

 

Your brother may find it helpful to meet with a clinical psychologist to talk about his anxiety difficulties and develop helpful management strategies.

 

It is possible that your brother may also wish to use the therapy sessions to discuss his initial episode of psychosis and its links with his current anxiety problems. However, it is worth noting that not all people with a recent episode of psychosis will want to talk about their experiences; some prefer to forget about it and focus only on events of the present day and future. Your brother will be able to negotiate the focus and objectives of the sessions with the clinical psychologist.

 

Finally, given the difficulties around non-compliance, your brother may find it helpful to establish a long-term plan with his community psychiatric nurse and local NHS pharmacy about the timely completion and collection of his prescriptions. This is likely to minimise any unnecessary delays in his treatment and reduce the negative impact on his functioning and university work.

 

My son is 19-years-old and talks to himself constantly, just as though someone is in the room with him, even when someone isn’t. This started about two years ago. He is currently not working or in education due to this. He has been prescribed various antipsychotic drugs, eg risperidone and quetiapine, none of which has made any difference to him hearing voices or talking to himself. He is being supported by a service for young people who refer him to see a psychiatrist on a regular basis, usually about every five months. He mostly stays home with me...he does have a few friends who he goes socialising with weekly, but he is very unhappy about what has happened to him. I am at a loss as to what to do to really to help him, and it does have an effect on me. He doesn’t sleep till about 3 am – just talks to himself – so neither do I, but I have to get up to go to work!! As you can imagine, I’m very distressed about this and I feel very concerned for my son’s future and well being. Can you offer any advice?

 

I am not surprised you are worried about your 19-year-old son. The situation sounds very distressing and exhausting for both of you. It also sounds as if you have been doing all you can.

 

Firstly, about your sleep. You do not say why you stay up with your son until 3am each night, despite having to go to work each day. Are there risk issues? A priority is to look after yourself in this situation, particularly as you have a job to go to. If your son is not unsafe at night, you need to go to bed yourself at a normal time and get rest. I cannot see that your staying up with him is any kind of help; you need to be able to get enough sleep yourself and be there to talk to him, say, in the early evening when you get home. If there are safety issues at night, this needs to be discussed with your son’s team and they need to let you know what other support they will offer – perhaps more supported accommodation, which has staff available at night for instance. The team should also be able to offer your son help with establishing a more regular sleep pattern.

 

Secondly, what does your son need? I am not sure from your report whether your son becomes upset from the content of the voices or whether there are some pleasant aspects that he likes or makes him smile? Has he been offered individual help with his own distress, feelings of loss and his voices? Individual cognitive behavioural therapy (CBT) for these problems might well be helpful and is recommended by NICE (National Institute for Health and Clinical Excellence) guidelines. You could discuss this with your son and he or yourself could ask the team to find a way to provide this for him. You might both benefit from family sessions, which are also recommended by NICE guidelines. Again your son’s team could be asked how they are going to offer this to you both – an opportunity to talk to each other and negotiate how to solve problems together.

 

Thirdly, your son needs more help with getting his life back again – with his recovery. This might include doing more activities each day, getting re-involved with education or vocational training, or starting up some of his previous interests. Again, your son’s team might have a specialist vocational worker who can help with this, or some other agency who would help with work skills. Maintaining regular contact with his friends is very important and should be encouraged. Have you noticed any impact on his experiences after he has been out with his friends? Perhaps you have noticed that he is slightly less preoccupied with his voices or his mood becomes slightly brighter.

 

It seems to me that perhaps you are waiting for him to get better, before asking for these things, which can be a common and understandable approach. However, it seems likely that the talking will get better if there is more for your son to do and more people to talk to, which is the other way round. Just waiting for things to get better on their own is not a good strategy for you or your son.

 

Fourthly, it sounds as if your son needs a medication review – his current medication seems to be having limited effects on these symptoms. Would your son discuss this with his psychiatrist when he sees him? Could you go with him and discuss with the psychiatrist how much his talking (probably to voices) is stopping him from getting involved in more productive activities? It is possible your son does not mention this, and that this problem only occurs at home, so that the team are not really aware of how distressing it is for your son and yourself.

 

Fifthly, do you have support yourself? We know that managing to keep a job is actually helpful, as it provides money, perspective, social roles and potential support, and takes you out of the house perhaps. However, you could also get specific support by joining a local carers’ group, perhaps one run by your son’s team or Rethink in your area, or by being able to talk the difficulties through with a trusted friend. It is always worse to be on your own with problems. If there is not a friend you could do this with, your GP might be able to at least listen, and might be aware of support available in your area. Your GP ought certainly to be able to discuss with you that your son’s problem are a worry, and might be able to help directly. We know care-giving roles can make people feel sad and depressed, not surprisingly, and it might be useful to talk this through as well.

 

I'm looking for information on ‘Expressed Emotion’ in carers of people with first episode psychosis. Can you tell me what Expressed Emotion is?

 

Expressed Emotion is a description of how people talk to and about each other. The term was first used in the early 1970s, as it had been found that the way care-givers talked about their relationship with their relative was predictive of whether he or she stayed well or not, if they went back home.

 

These kinds of ratings can be positive – warmth, for instance, or more negative – critical or over-concerned. The more negative aspects suggest that the relationship is not going well, and this is what seems to be the trouble; it can lead to the person becoming unwell again.

 

We all know having good relationships can be supportive, and this seems to be particularly true in psychosis, when relationships are likely to be put under immense strain, and many break down completely over the years.

 

In first episodes, it was thought that these difficulties had not yet developed, but some of our research has shown that very quickly the kinds of stresses families face can lead to negative relationships. None of this is surprising. It is also true that relationships can improve. Families can find out what is happening, can find out what kind of coping works for them, and find support. This is also helpful for people who are unwell. Family intervention is one way of helping relationships to improve and this is why it is sometimes suggested.

 

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