I think my family member with schizophrenia is off her meds. WWYD?

[Decoupage112]

Her condition is managed well with medication when she commits to taking it but a few times per year she will decide to stop and becomes unwell quite quickly.

I have woken up today to multiple rambling texts from her talking about how the royal family (a regular feature in delusions when she's not well) are conspiring with other celebrities to do this and that.

She isn't a conspiracy theorist at all, this only happens when she's on a mental health decline.

I'm concerned as whenever this happens it brings with it alot of stress and anxiety, she will do things such as coming to my home late at night and posting things through the letter box, banging on the door which frightens my small children, constant telephone calls etc.

I would appreciate some advice on how to deal with the situation.

Firstly, would you engage with the texts or not?

Also, if I make contact with her MH services will she know I've done that?

Thank you

Call 111

Contact the MH team they are very good in such instances. Having had my ExH back under section for a large chunk of lockdown and had to support my adult daughter deal with it ( despite the fact she lives 3hrs drive and an hour from her dad who is in his 70's) I totally get where you are coming from.
He has the paranoid version and is Bi-polar. It's an utter nightmare. He gets to a point approximately ever 7 years and stops medication then rapidly stops eating and then it goes downhill until hes Non-vocal and ends up under section for his own safety.
Over the years ( I've known him long enough for 4 episodes) I've got better at contacting quickly and insisting on support for him.
Unfortunately at the moment you may well struggle as the MH teams are not doing home visits etc due to C-19 however they do need to have this flagged to them so they can act.
Sending you hugs to get through this as I k ow how tough it is

There is an automated voice message when I call her team that says they are having technical difficulties and to try again later on. I'll give it an hour and call back.

If it weren't for my children I would go to her flat and at the very least keep her company for a bit and try to assess the situation.

Some of my earliest memories of her from when I was a child were when she was in the grips of an episode and it's frightening, on one of these occasions she was chasing my mother around the house with kitchen utensils threatening to harm her so I don't want to expose my own children to that

@MissCherryCakeyBun for you and your daughter, it's extremely emotionally draining isn't it.

I hope he is able to get back on track soon, for everybodies sake.

My loved ones official diagnosis is Schizoaffective disorder, so schizophrenia plus the bipolar-like mood disorder where she has episodes of mania and depression.

In my case it's my aunt so I'm a bit further removed from it than your DD. I really feel for her (and you!)

To be honest OP, the only thing you could do by going to see her is check she is safe, but it sounds that at the moment she is thankfully. It can inflame the situation, and you are right to protect your children, she will thank you for not putting them in a position to see her like that when she is in a better frame of mind. That's frustrating that their phone lines are down, fingers crossed it won't be for long.

It’s also important when you do get through to her team that you make them aware that usually your mum is a major support structure - explain she usually visits and stays and monitors her medication. Your mum isn’t well and that has now changed. So that is a massive red flag you need to wave to her team - what worked before can’t work now, if it was only working because your mum was there. They may need to have a community psychiatric nurse supervise her medication once she is stable. Don’t assume she will tell them about this change.

Hello, i work in a mh team and can give you a gist of what we would normally do

If we dont have consent to speak to you (which sounds like the case) then we can still take info, it can be frustrating because sometimes we cant then reassure you that we will visit or explain our plan as it may mean all we can do whilst on the phone is take details and cant share info. We would take it seriously though and be making those plans!

Call her CPN. She will hopefully have a relapse plan, which indicates her relapse signatures etc.
The CPN could then do a check in phone call and hopefully hear for herself / himself that your aunt is unwell, and step in.

I've managed to speak to her MH team and was put through to somebody who works with her personally and knows her well.

He said his opinion is that she only takes some and not all of her meds and that's why this is happening again and is a regular occurrence.

There is a community team who visit her some mornings and she will take the morning tablets under their supervision but won't take the later doses as she is supposed to which leads to the inevitable decline we're seeing again now.

He's going to call her today to assess the situation but won't tell her I've called the team.

It doesn't sound like alot can be done at this stage, which I do understand.

It's very frustrating because this cycle just repeats itself and then she'll end up having to go into hospital, then she'll be ok for a couple of months then do it all again.

It's a revolving door

Glad you managed to speak to them, and no, they'll probably just say something along the lines of just phoning to see how you're doing etc. The pattern of hospital - meds - come off meds - hospital is frustrating isn't it. What worked for my sister was having counselling too, which really helped unpick and learn coping strategies in addition to the tablets. Obviously everyone is different, but hopefully they can find something that helps.

Does she have a crisis plan at all?

Can you speak to her when she is well and suggest she has a depot injection which will cover the anti psychotic for a few weeks?
I guess she doesn't want to be unwell, and when she's well she can be more onjective about it all.
It's hard OP

That sounds really difficult and you are understandably concerned for your family. We have had similar with a family member, we also became 'the enemies' and I had to keep reminding myself that this wasn't, actually, personal to us , this was about their projections. You sound like you are doing everything you can, just make sure you look after yourself too. x

Any chance her medication exists in injectable form? It might be a better fit for her, if she consents in taking it.

It does sound as if they (her team) are aware of the situation, and I know it is hard when they are an adult and can't be forced to take the meds even for their own benefit. Beyond frustrating for you to know that their illness could be handled better if they'd just take the meds

Sending hugs @Decoupage112 my DM has a similar MH condition and it's SO hard. We no longer have contact due to it. Challenging them about taking medication seems all well and good in theory but can often lead to agression and violence. It's not necessarily a safe option.

Would residential be an option? If she's not medication compliant then it's clear that she needs 24/7 care.

Thank you all for the kindness

I'm not sure whether she has a crisis plan, I presume so as she has been under MH services for decades.

I'm also not sure whether her meds are available in injection form but that sounds like a very useful thing to look into. I'm sure it would help hugely for her not to have to be in control of her own meds.

This has been happening for years and everybody can see that she can't be trusted to comply.

Honestly it really frustrates me. Her life is 10x better when she takes her medication, she can lead a virtually normal life. Yes the antipsychotics have unpleasant side effects but surely that's preferable to life spiralling out of control and being locked up again

I've often wondered about residential myself, there's just no way she would agree to give up her flat.

She's in council accommodation and has lived there for around 30 years, it's her safe space.

I'm really sorry to hear what you've been through with your mum Aveis

I'm also not sure whether her meds are available in injection form but that sounds like a very useful thing to look into. I'm sure it would help hugely for her not to have to be in control of her own meds.

If this has been going on for years then I'd be suprised if this hasn't been explored already. And if she is on some sort of mood stabiliser this isn't available in depot injection form.

Sadly like all other medicwtion she would have to consent to a depot anyway so if she doesn't feel its necessary then she won't take it. Only way to enforce is for her to be sectioned and then placed on a community treatment order.
Its such an awful and sad situation for everyone.

If she is compliant with mornong meds then they will likely try to get everything in that one time, unfortunately this becomes hard when people are on split doses.

Would residential be an option? If she's not medication compliant then it's clear that she needs 24/7 care.

Funding for 24/7 care for mental health is like rocking horse shit. I work with incredibly high risk clients and they struggle to get funded for a few hours a day nevermind 24/7.

Some people with schizophrenia prefer to be upfront about their condition, are very aware of escalating symptoms and quite willing to discuss with friends and family. They may also discuss quite openly the sometimes miserably unpleasant symptoms of their medication and why they just stop taking it. Or (under medical advice) have to change dosage or medication . Then adjusting to new treatment or new dosage can also cause problems.

So, my advice is to talk to her , ideally face to face, much better than texting.   She may be  experiencing  either intrusive thoughts or voices in her head, and  in a live conversation it's very much easier to  appreciate  someone is  experiencing those interruptions.  

    Just be quite matter of fact and  say something like " Mary, I've noticed  you seem upset  lately   are you having some  bothersome  ideas and feelings? " and  see how she responds.  Take it slowly,  small steps, give her time.  

  If she has stopped taking meds, or is having problems  with a  new dose or different medication,  ask if you can help. She may be terribly relieved  that someone is willing to listen.   She may be well aware what the problem is ;  and  she may already be getting help from her Dr or CPN.   

     In any case,   I suggest  you contact her CPN or  MH support team  to make sure they  are aware she's struggling.

In my experience with a family member with bipolar, who has had many relapses even when they're taking all their prescribed medicines, there's very little you can do. Contact the relevant mental health professionals, do what you need to to protect yourself, call the police if they are harassing or threatening you.

Someone going through severe psychosis can't be reasoned with or persuaded and won't accept treatment, that's the nature of their illness.

It's only when they are fully healthy that you can try and get them to understand that mental health professionals are not the enemy and that the medicines are necessary even though they have horrible side-effects.

As much as I'd like to have a face to face conversation with her it isn't possible as I have my children and nobody to watch them whilst I go down there.

I don't want to take the children and for them to be frightened like I was when I was little and witnessed her episodes.

I tried to call but she rejected it. I suspect I'm now in the 'bad' category because I questioned the delusions.

I've sent a further message telling her not to worry herself with such thoughts but if it helps for her to get it off her chest I'm happy to listen and I hope she's ok. No reply.

Please don't be guilted into doing anything that puts you or your family at risk at the behest of someone over the internet.

Oh I definitely won't, I have my boundaries and that is one is non negotiable.

I've tried to reach out to her three times day and made her MH services aware so that's all I can do from my end now.