This article is about helping peers in trouble.
Here is the scenario:
You are a peer. Meaning you have a chronic severe mental illness. Somehow you have learned how to manage your issues. You even studied counseling and have undergone behavioral training. You have also worked as a counselor. You’ve got many crises and hospitalizations under your belt but are now relatively stable. All seems well enough with the world.
Peers owe part of their success to other peers.
Peers are people who you relate with and who socialize with you. Peers are unique because they have gone through the fires of mental illness too. People who are brothers-in-arms. These are people you call your friends.
Even the peers you don’t know too well. They are part of the club. People may fall in the battle of life, so a friend and veteran of those wars need to be there when that time comes.
You get a call one rainy Saturday at 10 pm. It is a peer.
They are a professional, intelligent, a seasoned peer in recovery. But, something is not correct. Your friend’s speech is garbled and rapid. Something is wrong.
“Did you take your meds?” you ask—the fundamental, almost dull question. The answer is yes.
You tell the peer to try and sleep. You’ll check in with them in the morning.
Red flag! You feel it in your gut. Something is not correct.
In the morning, the phone rings at 7:15 am.
Your friend is calling and reporting that a fire alarm awakened them. People are being evacuated from your friend’s building.
You are pretty sure there is a psychotic episode brewing by now. The friend’s speech is bizarre. As a professional, you know there is a crisis headed your way. As a friend, you have to do something.
So, how does a peer deal with a friend in crisis?
First of all, you have to remember that it could be you. Nobody is immune. Nobody is invulnerable. When discussing severe and chronic mental illness, be aware relapse and crisis are unfortunate permanent pieces of the puzzle.
When mental illness strikes can be a complete mystery and baffling. I have dealt with many people who just had a fallout over the years.
In the beginning, before I knew what I knew now, I just called 911. That’s what the professionals tell you to do.
Well, if you are going to add insult to injury, trauma to episode, sure, make the call and sirens, ambulances, police, public humiliation, and handcuffs to the mix.
Call 911 for every incident? Bad idea.
Every patient should have a PRN. PRN is a drug prescribed as needed. A mild sedative. Or a stronger one, depending on the constitution of the patient. If the prescribing psychiatrist won’t give a sedating pill for whatever reason, and it may be a good reason, I am not judging- it forces
the patient to seek other remedies. After years of dealing with my psychotic exacerbations, I learned several coping skills, oral and otherwise.
After the early morning call from my friend, I do an assessment. It is a short-term intervention that goes a long way in managing my illness and their struggle.
I am retired and therefore have plenty of time. I went to the deli and bought carbohydrates- a couple of croissants and a buttered plain bagel. I got a carton of milk. Then I took a cab to their apartment. People suffering should NEVER feel alone
Interventions:
- Being physically present.
- Strategic use of meal and nutrition
In other words, bread induced relaxation. Complex carbohydrates are hard to digest. These carbs, along with the fats in butter on a delicious, timely croissant, can go a long way to mitigate an affective state and re-regulate your moods to avoid a crisis. How? When the body is digesting carbs, it slows down.
This technique is a way of inducing sedation. Also, fat gives the feeling of fullness and satisfaction. Eating often results in a calmer mood.
More importantly, their thought process slows down. Milk is a nutritious drink, and it also contains a chemical called tryptophan which is sedating chemical—a short-term intervention. After eating carbs, fat, and milk, the patient is often too satiated and full of giving attention to give attention to whatever is going on in their brain. At this point, sit and watch tv while your friend’s lays back and gets some rest.
In the case I just mentioned, my friendly presence was a calming factor. Helping was as simple and easy as being there.
Sometimes, the crisis doesn’t end with laying back and relaxing. Most exacerbated symptoms can last anywhere from three days to a week. After that week, the patient may take another day or two to get back to their norm.
Over-the-counter sleep aids like Motrin PM, Advil PM, and melatonin may also help induce sleep. My experience and research clarify that ten to one sleeping issues exacerbate mental health problems—people who have interrupted sleep or just stop sleeping break down.
In my case, insomnia had lasted a month. In a case like that, hospitalization was the only recourse.
My friend recovered in a few days. He was a professional and was aware he wasn’t well. He also, after some spotty sleep, was able to manage himself. He checked into a hotel to get peace, quiet, and solitude. He stayed in touch with me and another peer. He apprised his parents of the situation. He was alone but connected. People knew where he was, his situation, and how to contact him if there were a turn for the worse.
As a friend, help your peers floored by their illness. Be present with them physically. Provide some filling and relaxing food and innocuous sleep aids. The doctor may not always prescribe a PRN. Most of all, stay in contact by phone or text. I was able to get my friend’s relative’s phone number. That way, if he dropped off the map, I knew who to call.
Sometimes the hospital is necessary. However, I think it should be a last resort, especially if the peer is relatively older and has gone through that mill several times. My point here is that too many hospitalizations are disruptive, traumatizing, and costly.
In tandem with a seasoned peer and friend, people temporarily battling mental illness recover faster and remain more stable over the long term. Living in the community means you may need to know how to handle crises. Being realistic about your abilities and limitations will reduce exacerbated symptoms from flaring up.
Some triggers to crisis and relapse are:
- Change in season.
- An abrupt change in routine.
- School and work stressors.
- Change in meds.
- Death or sickness in the family.
- Romantic breakups.
Take care of your friends.
In the long run, you’ll be better for it.
Author Info:
mentalhealth
Max E. Guttman is the owner of Mindful Living LCSW, PLLC, a private mental health practice in Yonkers, New York.
