Self-help for schizophrenia

People with schizophrenia (and their loved ones) can contact various kinds of organizations:

• Social psychiatric services offer counseling, support in everyday life, and help in crisis situations.
• Psychiatric practices and outpatient clinics affiliated with hospitals can diagnose the disease and provide treatment.
• Psychotherapy practices offer talking therapies.
• Self-help groups provide an opportunity to share experiences with others in similar situations.
• Various telephone hotlines offer anonymous counseling and can help you find other types of suitable support.
• Psychiatric hospitals offer around-the-clock help in emergencies if immediate treatment is needed.

A whole range of psychosocial support services are available too. With their help, you can learn about ways to help yourself in everyday life and to cope with the disease. Another possible aim is to help you find solutions to problems in the family and at work.

Schizophrenia can make it more difficult to get a job or return to work. Various counseling services offer help for work-related problems. Employment agencies can do this, for example. As well as offering personal advice, they can help to arrange return-to-work measures and further professional training.

A joint treatment plan is a written document where you can specify how you want to be treated if you have another acute psychotic episode. You prepare it at the hospital you go to for treatment. The document is completed together with the therapist and a nurse, and possibly a family member, close friend or legal guardian.

The treatment plan may specify, for example,

• which hospital you want to be treated in, and by which doctor,
• whether the psychosis should be treated with medication,
• which medication (and dose) should be used,
• which other support should be given, if any (for example, things that have helped in the past),
• what treatments you don’t want,
• who should be contacted during an acute psychotic episode – and also who you don’t want to have any contact with,
• how to deal with forced treatment measures, and
• what personal matters have to be managed (at home, at work, regarding finances, care of family members, important appointments).

But doctors can do things differently if necessary – for instance, if there's a situation that isn't covered in the plan, or if a dangerous situation can’t be managed otherwise.

Warning signs of acute psychosis are sometimes noticeable a good while beforehand. This gives you a chance to react to typical signs and situations to try to keep things under control. Acute psychosis often happens in extremely stressful phases of life, for example in times of major life changes. The risk is greater if you have very strong emotions, like intense fear. Poor sleep can probably increase the risk too.

Because of this, it can be a good idea to check for possible risk factors: Is anything causing a lot of stress in your life? How can you reduce it? Are you anxious about anything? What can help you sleep better? Which hobbies help you feel better? Do you have any conflicts with other people right now? How can you solve them? Can you talk to your friends and family, and tell them about your problems? Or would you rather talk with a professional or go to a support group?

Other possible ways to react to signs of acute psychosis include the following:

• See a psychotherapist: If you’re already seeing a therapist, they can play an important role in deciding what steps to take next. But you can also make an appointment with a new psychotherapist.
• Visit a doctor: It is best to see someone who has already been treating you for some time, who knows your situation, and who you have a good relationship with. You can also talk with them about whether medication or a hospital stay would be a good idea.
• Use psychosocial crisis support: Some cities offer this kind of support, which can help in acute situations.
• Use strategies you learned to reduce symptoms: Talking therapy and patient education programs involve learning techniques that can help limit the symptoms.

If you notice signs of acute psychosis, you can also go to any hospital department of psychiatry and psychotherapy. Some cities also have specialized centers for early psychosis detection.

Schizophrenia doesn't only cause problems during acute psychotic episodes. Many people feel the effects of the disease between episodes, too. They might have very little drive to do anything or have trouble remembering things and concentrating. Some avoid contact with others, and find it hard to get a job and manage their daily life without outside help. Then a wide range of different things can help:

• Being active
• Taking up hobbies
• Sports and exercise
• Yoga, relaxation techniques
• Being involved in a group, such as a choir or sports club
• Clearly structuring your everyday life
• Reading
• Pondering religious or philosophical questions
• Getting involved at work
• Doing volunteer work

Research suggests that things like sports and exercise can reduce the symptoms and improve quality of life.

Many people say it’s important to them that the disease doesn't affect their self-image: They don’t want to be seen as schizophrenic, but as a person with many different qualities, just like other people. Empathy and understanding from others are especially important – so are people who you trust and feel comfortable with, can talk to, and share experiences with. As well as family members, friends, and acquaintances, this may include other people with schizophrenia, social workers or psychotherapists. Seeing meaning in your life despite the disease, and knowing that there are things you can do to help yourself, can make it easier to manage.

This can be a difficult decision that everyone has to make for themselves. Many people with schizophrenia ask themselves whether they should tell their coworkers about it, for example. Talking openly about the disease might help other people to be more understanding of your situation and better able to adjust to it.

On the other hand, you may then face prejudice and risk being stigmatized. Before making this decision, it can help to talk with a psychotherapist or other people in your situation.