God, this is going to be long op- my heart sinks still , with these type of posts
I lived with my ex for 20 years with psychotic illness. We were married for 30 years.
In my experience, in England, if you call mental health team, they will NOT be able to respond unless he is already had a referral to the mental health team and is under their care. The mental health team is a secondary health authority- you need a referral first to even get to see them, form primary services E.g. GP, A&E etc. calling crisis tea, is not possible unless he is already under care of that secondary mental health trust. It’s a bit like you can’t just call an oncologist and demand an appointment- you have to be referred.
my advice would be to go to A and E - if needs be call an ambulance, or ask family members to convince him to get into car and go as well. In A&E he will eventually get to see the duty psychiatrist, but if he has never had mental health assessment before he will also have scans and see neurologist to rule out physiological issues . Yes, they will have to wait hours in A and E, but going to GP is not going to help- for starters GPs will not respond to a spouses request for mental assessment readily - they are too concerned about medical confidentiality. They will only respond to the husband asking for help and he is unlikely to do that right now by sound of it. Even then most GPs don’t understand psychosis and are bloody useless at picking up issues if a person is not very obviously delusional. E.g totally out there delusions like aliens, not something reasonable like him thinking his wife is unfaithful..they’ll assume she is and think he is depressed or stressed (been there, done that)
it is important that spouse attends with her husband to A&E to explain symptoms, behaviours to psychiatrists and CPNs that will do assessment . She needs to stand her ground in going into appointments - but generally most psychiatrist are keen to have you there. It is unlikely husband will be sectioned unless he is active danger to himself or others. If she is afraid she MUST clearly state he CANNOT be discharged to home as it is a SAFEGUARDING issue. They do not want to keep him in hospital as there are just no beds. She will have to be insistent and spell out risks
if she has evidence of being threatened, or feels threatened, then actually don’t mess around. she needs to call 999 and ask for police, not an ambulance. She needs to be gusty about this, police can arrest and then assess in station and make mental health referral. Yes, I know it’s a bloody stupid way to do it and dumping on the police , but believe me this is quickest route. Again learnt my lessons the hard way,
she needs to know that part of issue of psychotic delusional illnesses is that the person who is ill, has no comprehension of it. It is not that they are refusing to see it, denying it- it’s simply an inability to recognise their version of reality they’re experiencing is not reality in spite of all the evidence presented. This is called ANOSOGNOSIA. And I know, that you can’t prove to anyone you are not having an affair 🤷🏼♀️Let alone someone who is delusional.
what you are describing matches my Ex’s behaviours and symptoms. But, it is not a simple case of diagnosing paranoid schizophrenia. All mental health diagnosis come from the DSM, which lists all types . There are around 10 or more diagnosis’s that manifest in delusional hallucinations or thinking alone and many of them are very similar. It could even be one of the personality disorders. It can take months for a diagnosis to be reached through observation, and in my Ex’s case he had a total of 4 different diagnosis over the 20 years I was his carer. Some of it comes down to psychiatrist opinion and experience, some of it because symptoms vary over time. By and large these variations don’t unfortunately make a massive difference to treatment, because treatment is so crap.
she needs to start keeping a diary of events and incidences , this will help psychiatrists when she goes into the consults with her husband.
She should also try to determine through observation and listening carefully, if he is experiencing hallucinations in form of hearing voices or seeing people. Hearing voices is most common form of delusions. Sometimes it is not obvious- it may be sudden outburst of anger, or a feeling she’s walked into the middle of a conversation, or him taking words out of context and recreating a new narrative around that word minutes or hours later. It may also be useful for her to understand that the hallucinations are not something he can control ..the brain is literally receiving his internal voice as an external noise - and those voices can be escalating from a benign occasional “observational” commented, to constant critical commentary, to abusive shouting. Any stress he feels will pitch more and more into abusive voices. Can you imagine trying to have a calm conversation with someone when you have 2 people over your shoulder for hours hurling vile abuse at you. It is frightening, and scary- and that produces the threatening behaviour. And makes the delusions even worse. Ok, it’s not right ..but jeez it’s not something anyone could handle for any period of time.
My experience, for what it’s worth, is that I stuck with him for 20 years. It broke me twice causing me to have my own mental health crisis. This is not uncommon- sadly 50% of people who are carers for mental health patients end up in mental health crisis themselves. 90% of marriages/relationships break down within 5 years. I was very unusual to stick it out that long according to the mental health teams. The mental health teams literally dump on you as a spouse even if you are trying to hold down the only job in the house, and be an effective single parent to you kids. NHS Mental health has literally bugger all resources, so they dose patients up and release to “care in the community” - but there is literally no community.
I managed to stay for 20 years as my Ex did, most of time, recognise he was ill and was prepared to engage with mental health team and take medication. The medication is not great- yes it works but side effects can be horrible and affect quality of life (I say this as someone who worked for company who discovered the main antipsychotic medication ,and I am a chemist, and as someone who battled to get him switched to different meds until we found the least worse option).
due to another onset of Anosognoisa, my ex decided, after 20 years, that he no longer wanted to take meds ever again. He is 60. Fair enough- his decison. I asked for a divorce immediately and he didn’t contest . He knew as much as I did, that we simply could not live togther with him being unmedicated…it would have caused the same safeguarding issues it had 20 years previously. We remain in touch, friends, but at a careful distance. My kids also know not to step in and support his mental health - otherwise they’d get sucked into being his carers by the mental health team…they are close to him, love him, but tell him they cannot get involved in anything to do with his mental health anymore.
Your friend is in an extremely shitty situation. It is an enormously difficult decision for her to make to leave him. One of my fears of leaving when kids were small was that he’d have got joint custody- and I was genuinely afraid of the impact on the kids of being with him without me even if he was on a relatively stable period - way too unpredictable. I couldn’t have even considered it until the kids were old enough to decide and convey to courts themselves. And by then I had normalised the unreasonable behaviour so much I didn’t realise just how shit my life was and stuck it out even more. It was complicated by fact he was diagnosed with an illness- what sort of shit wife walks out on an ill husband. And there there is hope- boy does hope that he would get better have a big part to play in me staying.
my experience of these morbid jealousy delusions (that’s a term used or sometimes people still call it Othello syndrome) is that it results in some behaviours she may not want to discuss or admit to- the delusions are playing out from the deepest sexual fears of his mind, and it is quite possible there is some sexual abuse going on ..this may not be “rape” as such, but constant emotional blackmail for sexual, being woken in night being accused of calling out your lovers name or accused of masturbating, or him waking her by masturbating against her in middle of the night, and all sorts of other shit I don’t even like thinking about. It will be extremely hard for her to admit to you, or talk about it to anyone or possibly even admit this is actually abuse. Be aware, don’t push her into places she doesn’t want to go, or suggest it might be happening. Shame is a powerful emotion. Just be prepared if this sort of stuffs ones come out.
my advice, to you as a friend, is to try to focus on how she can get him under the care of the secondary mental health team asap. Just focus on that. Once he is seen and is stabilised with meds, then you can help her think about what her options are . Having even a provisional diagnosis may help her read up , talk to people and realise how much she has normalised unreasonable behaviour and whether she can cope for the long haul of staying.