Schizophrenia
Introduction
Schizophrenia is chronic mental health condition that causes a range of different psychological symptoms. These include:
- delusions - believing in things that are untrue, and
- hallucinations - hearing or seeing things that do not exist.
Hallucinations and delusions are often referred to as psychotic symptoms, or symptoms of psychosis. Psychosis is when somebody is unable to distinguish between reality and their imagination.
The exact cause of schizophrenia is unknown. However, most experts believe that the condition is caused by a combination of genetic and environmental factors.
How common is schizophrenia?
Schizophrenia is one of the most common serious mental health conditions. One in 100 people will experience at least one episode of acute schizophrenia during their lifetime. Men and women are equally affected by the condition.
In men who are affected by schizophrenia, the condition usually begins between 15-30 years of age. In women, schizophrenia tends to occur later; usually beginning between 25-30 years of age.
Misconceptions about schizophrenia
Schizophrenia is often a poorly understood condition and many people hold a number of misconceptions about it.
One misconception is that people with schizophrenia have a split, or dual personality, acting perfectly normal one minute and then irrationally, or bizarrely, the next. However, this is totally untrue. Schizophrenia is a Greek word that means 'split mind', but the term was first used long before the condition was properly understood.
It would be more accurate to say that people with schizophrenia have a mind that can experience episodes of dysfunction and disorder.
Another misconception about schizophrenia is that people who have the condition are violent. Again, there is little evidence to back this up. Acts of violence committed by people with schizophrenia tend to get a great deal of high-profile media coverage, and this can give the impression that such acts happen frequently when, in fact, they are very rare.
A person with schizophrenia is far more likely to be the victim of violent crime, rather than the instigator. Experts at the Royal College of Psychiatrists have estimated that if schizophrenia could be cured overnight, the rate of violent crime in England would only drop by 1%.
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Symptoms
The symptoms of schizophrenia are usually classified into one of two categories - positive or negative.
- Positive symptoms - symptoms that represent a change in behaviour, or thoughts, such as hallucinations, or delusions.
- Negative symptoms - symptoms that represent the reduction, or total lack of thoughts, or functions, that you would usually expect to see in a healthy person. For example, people with schizophrenia often appear emotionless, flat, and apathetic.
Negative symptoms are not usually as dramatic as positive symptoms, but they can be harder to treat.
People often have episodes of acute schizophrenia, during which their positive symptoms are particularly severe, followed by periods where they experience few, or no, positive symptoms
Positive symptoms of schizophrenia
Hallucinations
A hallucination is when you think that you perceive something that does not exist in reality. Hallucinations can occur in any of the five senses, but the most commonly reported hallucination in schizophrenia is hearing voices.
In some cultures and religions, hearing voices is regarded as being healthy and a sign of spiritual development. In these situations, the voices that people hear are usually friendly and supportive. However, the majority of people with schizophrenia report that the voices that they hear are unfriendly and critical.
The type of voices that are heard by people with schizophrenia usually fall into one of two groups that are listed below.
- Critical voices - the voice provides a kind of critical running commentary on the person and their actions.
- Controlling voices - a person can hear a voice that 'forces' them to commit acts that they would otherwise not do.
Delusions
A delusion is having an unshakable belief in something that is very unlikely, bizarre, or obviously untrue. One of the most common delusions experienced in schizophrenia are paranoid delusions. This is where you believe that something, or someone, is deliberately trying to mislead, manipulate, hurt, or, in some cases, even kill you.
Paranoid delusions can range from believing in everyday, 'normal' delusions, such as being convinced that your partner is being unfaithful, to more unusual delusuions, such as believing that the CIA is plotting to assassinate you.
Another relatively common type of delusion is a delusion of grandeur. This is the belief that you have some imaginary power, or authority, such as thinking you are the King of England, or that you have the power to cure cancer.
Another common delusion in schizophrenia is to start attaching undue and misguided significance to everyday events. For example, you may start to think that songs being played on the radio are actually about you, or that newspaper headlines are being used to send you secret messages.
Behavioural problems
During an acute schizophrenic episode, the combination of hallucinations and delusions can cause a person to act in an unusual and bizarre manner. For example, a person may cover all the windows of their flat in tin-foil because they believe that this will prevent their thoughts from being controlled by the government.
Disordered thoughts
People with schizophrenia often complain that their thinking has become confused, muddled, or disorganised.
You may experience problems with concentration, your performance at work or college may suffer, and even the simplest tasks, such as reading a newspaper article, or sending an email, can become incredibly difficult.
Other thought disorders are described below.
- Thought insertion - this is the feeling that your thoughts are not actually your own, and have been placed in your mind by another person, or organisation.
- Thought withdrawal - this is the feeling that your thoughts are somehow being removed from your mind by another person, or organisation.
- Thought broadcasting - this is the belief that your thoughts can be heard, or read, by others.
- Thought blocking - this is the feeling that your thought processes suddenly halt, leaving your mind blank with no recollection of what you were thinking about.
Negative symptoms of schizophrenia
The negative symptoms of schizophrenia can often begin to manifest themselves several years before somebody experiences their first acute schizophrenic episode. These initial negative symptoms are often referred to as the prodromal period of schizophrenia.
Symptoms during the prodromal period usually begin gradually and then slowly get worse. They include becoming more socially withdrawn and experiencing an increasing lack of care about your appearance and personal hygiene.
After some point, these negative symptoms will become more noticeable. The more noticeable symptoms are briefly outlined below.
- A lack, or 'flattening', of emotions - your voice can become dull and monotonous, and your face takes on a constant blank appearance.
- An inability to enjoy things that you used to enjoy.
- Apathy - you have no motivation to follow through on any plans, and neglect household chores, such as washing the dishes, or cleaning your clothes.
- Becoming increasingly uncommunicative - you may find it hard, or become reluctant, to speak to people.
The negative symptoms of schizophrenia can often lead to relationship problems with friends and family because they can sometimes mistake them for deliberate laziness, or rudeness.
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Causes
The exact cause of schizophrenia is unknown, but most experts support what is known as the stress vulnerability model theory of schizophrenia.
The stress vulnerability model
The stress vulnerability model theory of schizophrenia states that every individual has a certain vulnerability to schizophrenia which is determined by a combination of biological, psychological, and environmental factors. A stressful, or traumatic, incident can sometimes trigger the symptoms of schizophrenia in particularly vulnerable people.
For somebody with a high vulnerability to developing schizophrenia, it may only take a relatively moderately stressful event, such as losing a job, to trigger the condition.
However, it may require a significant stressful, or traumatic, event, such as a bereavement, to trigger schizophrenia in a person who has a lower vulnerability to the condition.
This does not explain what causes the initial vulnerability to schizophrenia, but a number of theories have been suggested, some of which are outlined below.
Schizophrenia and genetics
There is a great deal of scientific evidence that certain people can have an increased vulnerability to schizophrenia as a result of the genes that they inherit from their parents.
However, exactly what genes are involved, and how they are passed down through families, is still unknown, but there is strong evidence to suggest that a vulnerability to schizophrenia can run in families.
For example, if one of your parents has a history of schizophrenia, your chance of developing the condition is one in 10. This risk factor is 10 times higher than that of somebody with no family history of schizophrenia.
If you have an identical twin with schizophrenia, who shares the same genetic code as you, your risk of developing schizophrenia is one in two.
Schizophrenia and dopamine
Researchers believe that dopamine plays an important role in the development of schizophrenia. Dopamine is a neurotransmitter, one of many chemicals that your brain uses to transmit information from one brain cell to another.
Dopamine is associated with feelings of pleasure and reward. For example, when you experience something enjoyable, such as sex, the level of dopamine in your brain increases.
In someone with schizophrenia, it is thought that either the levels of dopamine in their brain become too high, or that their brain is particularly sensitive to the effects of dopamine.
The elevated dopamine levels can interrupt the specific pathways of your brain that are responsible for some of its most important functions, such as memory, emotion, social behaviour, and self-awareness. The disruption to these important brain functions may explain the psychotic symptoms of schizophrenia, such as hearing voices and delusional thinking.
The role of dopamine in schizophrenia is based on the fact that medicines that are known to reduce the effects of dopamine in the brain also reduce some of the symptoms of schizophrenia.
In addition, illegal drugs that are known to increase the levels of dopamine in the brain, such as cannabis, cocaine, and amphetamines, can trigger similar symptoms of psychosis to those that are often experienced by somebody with schizophrenia.
Schizophrenia and early development
The developmental theory of schizophrenia suggests that the condition is the result of an infection that interferes with the early development of the brain. It is believed that infections that occur while a woman is pregnant could have the potential to cause problems with her child's brain development much later on in life.
For example, one study found that children who are born to mothers who experienced a herpes infection during pregnancy, were six times more likely to develop schizophrenia than other children.
Brain imaging studies have also shown physical differences in the structures of the brain in people with schizophrenia compared to those without the condition.
Risk factors
A number of risk factors have been identified for schizophrenia, some of which are outlined below.
Illegal drug use
All illegal drugs carry a risk, but cannabis users are particularly vulnerable to developing schizophrenia. Regular cannabis users are twice as likely to develop the condition compared with people who do not use cannabis.
Heavy users of strong herbal cannabis, known as skunk, are thought to be six times more likely to develop the condition compared with non-users. A heavy user is defined as someone who uses cannabis at least once a day.
Being bought up in an urban environment
Rates of schizophrenia are higher among people who were born in urban environments, such as a city, or a town. This may be due to the fact that urban environments can be more stressful places to live compared to rural environments.
An alternative explanation is that mothers who live in urban environments are more likely to be exposed to an infection during pregnancy.
Being Afro-Caribbean
The rates of schizophrenia in the Afro-Caribbean community are higher than in other ethnic groups. It is not known whether this is due to genetic reasons, or if it could be the result of social pressures that are sometimes caused by being a member of an ethnic minority.
Being an immigrant
Rates of schizophrenia tend to be higher among people who immigrate to the UK. This may be due to the social pressures of trying to adapt to a new and unfamiliar environment.
Previous stressful or traumatic life events
People who have experienced stressful, or traumatic, events, such as the death of a parent, or a car accident, have a higher risk of developing schizophrenia than those who have not.
However, a major life event that most people would consider positive, such as winning the lottery, can also trigger schizophrenia in some vulnerable people.
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Diagnosis
If you are concerned that you may be developing symptoms of schizophrenia, you should see your GP as soon as possible. While many people are reluctant to seek a diagnosis due to the fear that they will be labeled as 'mad', or 'dangerous', the earlier schizophrenia is treated, the more successful the outcome tends to be.
Your GP will ask you about your symptoms, and make sure that they are not the result of other causes, such as recreational drug use.
Community mental health team (CMHT)
If a diagnosis of schizophrenia is suspected, it is likely that your GP will refer you to your local community mental health team (CMHT).
CMHTs are teams that are made up of different mental health professionals who provide support to people with complex mental health conditions.
A member of the CMHT team, usually a psychologist, or psychiatrist, will carry out a more detailed assessment of your symptoms. They will also want to know about your personal history and current circumstances.
There is no single test for schizophrenia. Most mental health care professionals use a 'diagnostic checklist', where the presence of certain symptoms and signs indicate that a person has schizophrenia.
Schizophrenia can usually be diagnosed if:
- you have at least two of the following symptoms: delusions, hallucinations, disordered thoughts, or behaviour, or the presence of negative symptoms, such as a flattening of emotions,
- your symptoms have had a significant impact on your ability to work, study, or perform daily tasks,
- you have experienced symptoms for more than six months, and
- all other possible causes, such as recreational drug use, or depression, have been ruled out.
Getting help for others
Due to their delusional thought patterns, people with schizophrenia may be reluctant to visit their GP if they believe that there is nothing wrong with them.
It is likely that someone who has had acute schizophrenic episodes in the past will have been assigned a social worker. If this is the cases, you should contact the person's social worker to express your concerns.
If someone is having an acute schizophrenic episode for the first time, it may be necessary for a friend, relative, or other loved one, to persuade them to visit their GP. In the case of a rapidly worsening schizophrenic episode, you should contact the duty psychiatrist at the nearest accident and emergency (A&E) department.
If a person who is having an acute schizophrenic episode refuses to seek help, and it is believed that they present a risk to themselves, or others, their nearest relative can request that a psychological assessment is carried out.
The social services department of your local authority will be able to advise you about how you can do this.
In severe cases of schizophrenia, people can be compulsorily detained at hospital for assessment and treatment under the Mental Health Act (1983).
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Treatment
Treatment and outcome
Schizophrenia is treated using a combination of medical treatments, such as anti-psychotic medicines, and psychological interventions, such as cognitive behavioral therapy. Some people respond very well to treatment, while others are more challenging to treat.
Research has shown that out of 100 people with schizophrenia:
- 20 people will never have another acute schizophrenic episode,
- 50 people will experience a relapse of symptoms within two years,
- 30 people will never be free of symptoms, though the severity of symptoms can fluctuate over time, and
- 20 people will remain resistant to treatment and will require constant support and supervision.
Community Mental Health Teams
Most people with schizophrenia are treated by community mental health teams (CMHT). The goal of the CMHT is to provide you with day-to-day support and treatment while trying to ensure that you have as much independence as possible.
A CMHT can be made up of:
- social workers,
- community mental health nurses (a nurse who has had specialist training in mental health conditions),
- pharmacists,
- counsellors and psychotherapists, and
- psychologists and psychiatrists - the psychiatrist is usually the senior clinician in the team.
The Care Plan Approach (CPA)
People with complex mental health conditions, such as schizophrenia, are usually entered into a treatment process, known as a Care Plan Approach (CPA). A CPA is essentially a way of ensuring that you receive the right treatment for your needs.
There are four stages to a CPA.
- Assessment - where your health and social needs are assessed.
- Care plan - a care plan is created in order to meet your health and social needs.
- Appointment of a care coordinator - a care coordinator - sometimes known as a keyworker - is usually a social worker, or nurse, and is your first point of contact with other members of the CMHT.
- Reviews - your treatment will be regularly reviewed and, if needed, changes to the care plan can be agreed.
Treatment for schizophrenia
Treatment for schizophrenia usually involves using a combination of antipsychotic medicines and psychological therapies.
Treating an acute schizophrenic episode
People who are experiencing serious psychotic symptoms, as a result of an acute schizophrenic episode, may require a more intensive level of care than a CMHT can provide.
Crisis resolution teams (CRT)
One treatment option is to contact a crisis resolution team (CRT). Crisis resolution teams treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis. Without the involvement of the CRT, these people would require treatment in hospital.
The CRT will aim to treat a person in the least restrictive environment possible, ideally near the person's home. This can be in your own home, in a dedicated crisis residential home, or hostel, or in a day care centre.
CRTs are also responsible for planning after care once the crisis has passed in order to prevent a further crisis from occurring.
Your care coordinator should be able to provide you, and your friends, or family, with contact information, so that you can contact your CRT in the event of a crisis.
Voluntary and compulsory detention
More serious, acute schizophrenic episodes may require admission to a psychiatric ward at a hospital, or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees that it is necessary.
People can also be compulsorily detained at a hospital under the Mental Health Act (1983). However, it is only possible for someone to be compulsorily detained at a hospital if they are suffering from a severe mental disorder, such as schizophrenia, and if detention is necessary:
- in the interests of the person's own health,
- in the interests of the person's own safety, and/or
- for protecting others.
People with schizophrenia who are compulsorily detained may need to be kept in locked wards.
All people being treated in hospital will stay only as long as absolutely necessary for treatment.
An independent panel will regularly review your case and your progress. Once they feel that you are no longer a danger to yourself, and others, you will be able to leave the hospital. However, your care team may recommend that you remain in hospital on a voluntary basis.
Advance directives
If it is felt that there is a significant risk of future acute schizophrenic episodes occurring, you may want to write an advanced directive.
An advanced directive is a series of written instructions about what you would like your family, or friends, to do in case you do experience another acute schizophrenic episode. You may want to also include the contact details of your care coordinator. See the 'selected links' section for more advice about writing an advanced directive.
Antipsychotics
Antipsychotics are usually recommend as the first-line treatment for treating the symptoms of an acute schizophrenic episode. Antipsychotics work by blocking the effect that dopamine has on the brain.
Antipsychotics can usually reduce feelings of anxiety, or aggression, within a few hours of use, but they may take several days, or weeks, to reduce other symptoms, such as hallucinations, or delusional thoughts.
Antipsychotics can be taken orally (as a pill) or given as an injection. Several 'slow release' antipsychotics are available whereby you only need to have one injection every 2-6 weeks.
You may only need to take antipsychotics until your acute schizophrenic episode has passed. However, their long-term use is usually recommended in order to prevent further acute schizophrenic episodes occurring.
There are two main types of antipsychotics:
- typical antipsychotics - the first generation of antipsychotics that were developed during the 1950s, and
- atypical antipsychotics - a newer generation of antipsychotics that were developed during the 1990s.
Atypical antipsychotics are usually recommended because they are less likely to cause side effects. However, they are not suitable, or effective, for everyone.
Both typical and atypical antipsychotics can cause side effects, although not everyone will experience them, and their severity will differ from person to person.
The side effects of typical antipsychotics can include:
- drowsiness,
- shaking,
- trembling,
- muscle twitches, and
- spasms.
Side effects of both typical and atypical antipsychotics can include:
- weight gain,
- blurred vision,
- constipation,
- lack of sex drive, and
- dry mouth.
You should tell your care coordinator, or GP, if your side effects are becoming severe. There may be an alternative antipsychotic that you can take, or additional medicines that will help you to deal with the side effects.
You should not stop taking your antipsychotics without first consulting your CMHT because if you do, it is possible that you may experience a relapse of symptoms.
Psychological treatment
Psychological treatment, such as counselling, or cognitive behavioural therapy (CBT), can help people with schizophrenia to cope better with the symptoms of hallucinations, or delusions.
Psychological treatments can also help to treat some of the negative symptoms of schizophrenia, such as apathy, or a lack of enjoyment.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is based on the idea that most unwanted thinking patterns, and emotional and behavioural reactions, are learnt over a long period of time.
The aim of CBT is to identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and to learn to replace this thinking with more realistic and useful thoughts.
For example, you may be taught to recognise examples of delusional thinking in yourself. You may then receive help and advice about how you can avoid acting on these thoughts.
Most people will require between 8-20 sessions of CBT over the space of 6-12 months. CBT sessions usually last for about an hour.
Your GP, or CMHT, should be able to arrange a referral to a CBT therapist.
Family therapy
Many people with schizophrenia rely on family members for their care and support. While most family members are happy to help, the stress of caring for somebody with schizophrenia can place a strain on any family.
Family therapy is a way of helping both you, and your family, to cope better with your condition.
Family therapy involves a series of informal meetings that take place over a period of six months. Meetings may include:
- discussing information about schizophrenia,
- exploring ways of supporting somebody with schizophrenia, and
- deciding how to solve practical problems that can be caused by the symptoms of schizophrenia.
If you think that you and your family could benefit from family therapy, you should contact your care coordinator.
Occupational therapy
Many people with schizophrenia find that they benefit from meeting with an occupational therapist. An occupational therapist provides training, support, and advice in order to help people with mental health conditions, such as schizophrenia, to develop the skills that they need for day-to-day living.
Occupational therapists can:
- help you to identify both your weaknesses and strengths,
- help you to improve your social and communication skills, and
- provide practical help and training that will allow you to get back to work.
Most CMHTs will have an occupational therapist working as part of the team.
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Self-help
Spotting the signs of an acute schizophrenic episode
Recognising the initial signs of an acute schizophrenic episode can be very useful. It may be possible to prevent a full-blown schizophrenic episode through the use of antipsychotic medicines and counselling.
The initial symptoms of an acute schizophrenic episode can vary from person to person, but the most commonly reported symptoms include:
- loss of appetite,
- anxiety,
- sleeping problems,
- beginning to neglect your personal hygiene and household chores,
- beginning to feel increasingly suspicious and fearful about other people, and
- beginning to hear voices which make it increasingly difficult to concentrate.
If you are concerned that your schizophrenia symptoms may be getting worse, you should contact your GP, or your care coordinator.
You may also want to ask somebody that you trust about whether they think that your symptoms are getting worse.
Avoiding drugs and alcohol
A large minority of people with schizophrenia are also drug and alcohol abusers. One study estimated that 16% of people with schizophrenia had a drug problem, and 32% had an alcohol problem. The most commonly abused recreational drug was cannabis.
While alcohol and drugs may provide some short-term relief from your symptoms of schizophrenia, it is important to remember that they will make your symptoms worse in the long run. Alcohol can cause depression and psychosis, while most illegal drugs will increase the levels of dopamine in your brain, which will make your schizophrenia worse.
People with schizophrenia who have drug or alcohol problems are more likely to end up homeless, or in prison, compared to people with schizophrenia who do not abuse alcohol or drugs.
Drugs and alcohol can also cause your antipsychotic medicines to react in unpredictable and, possibly dangerous, ways.
If you are currently using drugs or alcohol, and you are finding it hard to stop, you should contact your community mental health team (CMHT), or GP because they will be able to help you.
Dealing with voices
People with a limited understanding of schizophrenia often dismiss how upsetting and frightening it can be to hear voices. Finding ways to control those voices can sometimes be an important part in coping more successfully with schizophrenia.
You may find it helpful to:
- keep as busy as possible,
- spend time with other people,
- listen to a personal stereo, or MP3 player, and
- remember that the voices cannot hurt, or control, you.
You may also wish to join a self-help, or support group, for people who have similar symptoms to you. See the 'selected links' section for more information about this.
Smoking
Rates of smoking among people with schizophrenia are three times higher than in the general population. If you are a smoker, you are placing yourself at significant risk of cancer, heartdisease, and stroke.
The nicotine in cigarettes has also been found to decrease the effectiveness of antipsychotics. This means that smokers often require a higher dose, which increases their risk of experiencing unpleasant side effects.
If you smoke, stopping will give you both short and long-term health benefits, as well as reducing the severity of any side effects that you may be experiencing.
Diet and exercise
If you have schizophrenia, it is important not to neglect your general health. Eating a healthy diet, and taking regular exercise, will not only improve your health, it can also help boost your mood.
For most people, a minimum of 30 minutes of exercise a day, at least five times a week is recommended. The exercise should be strenuous enough to leave your heart beating faster, and you should feel slightly out of breath afterwards. Examples of the intensity of exercise that you should be doing include going for a brisk walk, or walking up a hill.
You should also eat a low-fat, high-fibre diet that includes plenty of fresh fruit and vegetables (at least five portions a day) and whole grains.
Stress
You should make a conscious effort to control the amount of stress in your life because high stress levels are a major risk factor for an acute schizophrenic episode.
Some ways to help relieve stress include:
- relaxation techniques, such as meditation, or breathing, exercises,
- physical activities, such as yoga, or Tai Chi (a Chinese martial art), and
- taking regular, vigorous exercise.
If you are currently undergoing cognitive behavioral therapy (CBT), your therapist should also be able to provide you with advice about ways that you can reduce stress.
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Complications
Unemployment
Due to the complex nature of schizophrenia, many people with the condition have problems finding and keeping a job.
You may also be reluctant to re-enter the job market because you may fear that you would be unable to cope with the responsibility. However, most experts would recommend that you try to return to work as soon as possible because people with schizophrenia, who continue to work, tend to have a better quality of life compared with those who do not work.
If you feel ready and able to return to work, you should ask to speak to an occupational therapist. An occupational therapist can help you to improve both your employment and social skills.
There are also a number of organisations that provide support, training, and advice for people with schizophrenia who wish to continue working.
Your community mental health team is a good first point of contact to find out what services and support are available for you. Mental health charities, such as Mind, or Rethink, are also an excellent source of information relating to training and employment. See the 'selected links' section for more information about this.
While you are looking for work, you may want to consider taking part in voluntary activities. Doing voluntary work is a good way of learning new skills and increasing your self-confidence.
Depression and suicide
Many people with schizophrenia experience periods of depression. You should not ignore these symptoms, as left untreated, depression can worsen and lead to suicidal thoughts.
Research has found that 30% of people with schizophrenia will attempt suicide at least once, and one in 10 people with schizophrenia will commit suicide.
If you find that you have been feeling particularly down over the last month, and you no longer take pleasure in the things that you used to enjoy, you may be depressed. You should see your GP for advice and treatment.
You should immediately report any suicidal thoughts to your community mental health team.
The warning signs of suicide
The warning signs that can indicate that people with depression and schizophrenia are considering suicide are listed below.
- Making final arrangements - such as giving away possessions, making a will, or saying goodbye to friends.
- Talking about death or suicide - this may be a direct statement such as, "I wish I was dead". However, depressed people will often talk about the subject indirectly, using phrases such as, "I think that dead people must be happier than us", or "wouldn't it be nice to go to sleep and never wake up.".
- Self harm - such as cutting their arms, or legs, or burning themselves with cigarettes.
- A sudden lifting of mood - a sudden lift of mood could mean that a person has decided to commit suicide and feels better because of their decision.
Helping a suicidal friend or relative
If you see any of these warning signs you should:
- get professional help for the person, such as a crisis resolution team (CRT), or the duty psychiatrist at your local A&E department,
- let them know that they are not alone, and that you care about them, and
- offer your support in finding other solutions to their problems.
If you feel that there is an immediate danger of the person committing suicide, you should stay with them, or have someone else stay with them, and remove all available means of suicide such as sharp objects and medication.
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