Sometimes hospitalization is required to help a person with schizophrenia get stabilized and recover from a psychotic episode. Hospitalization can save lives. Specifically, a person with schizophrenia might be hospitalized when: they have acute symptoms, such as severe delusions or hallucinations, and they’re experiencing a break from reality, and are unable to care for themselves; they’re a danger to themselves or others (e.g., experiencing suicidal thoughts); they need to change or adjust their medication, because it’s no longer working, or has severe side effects; or they’re struggling with substance abuse, or severe symptoms from another mental illness.
In fact, a 2019 study found that having a co-occurring condition—such as substance use disorder, bipolar disorder, or depression—was associated with an increase in the number of hospital stays, and in the length of stay. Also, the more disorders a person was diagnosed with, the greater the number of hospitalizations they experienced.
Sometimes, the person with schizophrenia will realize they’re unwell and go a psychiatric hospital voluntarily. Other times, family members or mental health professionals need to step in and request involuntary commitment. For instance, this might be necessary when a person is having a psychotic episode and believes everyone wants to harm them, including their loved ones.
Every state has different laws for involuntary commitment, but in general, according to Kim T. Mueser, Ph.D, and Susan Gingerich, MSW, in their book The Complete Family Guide to Schizophrenia, the process might look like:
- Individuals petition to have the person with schizophrenia get evaluated by a mental health professional.
- The petition is granted when there’s evidence of the person being a serious danger to themselves or others, and having severe mental illness.
- The person filing the petition usually goes to a community mental health center or a hospital ER.
- Once they’ve completed the petition, a staff member calls the state office of mental health to receive approval.
- If approval is received, and a warrant is issued, the police are called, and they bring the individual with schizophrenia to an emergency facility for the evaluation.
- If the practitioner administering the evaluation determines the person meets criteria for being involuntarily hospitalized, they are committed to treatment for a certain number of days at the closest psychiatric facility with availability.
- At the end of the person’s stay at the hospital, the petitioner appears in court and testifies about the dangerous behavior they witnessed.
- The person with schizophrenia also can testify and have an attorney.
- After considering all the testimony, a judge rules on whether the person should be discharged or remain in the hospital (typically for 2 to 3 weeks).
Most hospital stays are short term—from several days to several weeks. But it really depends on the severity of symptoms, because some people may stay longer.
During their hospital stay, a person will typically get a medical evaluation and attend individual, group, occupational, and recreational therapy.
This information sheet about hospitalization (PDF) provides more information on why someone might need hospitalization, how they can benefit, and what loved ones can do to make the hospital stay as easy as possible, along with hospital experiences from people with schizophrenia and their loved ones.
Coping Guidelines For The Family
If your loved one has schizophrenia, here are some ways you can help.
- Get educated and informed. Learn everything you can about schizophrenia from a variety of resources—self-help books, memoirs, blogs written by people with schizophrenia, podcasts (such as Psych Central’s A Bipolar, a Schizophrenic, and a Podcast). Talk to your loved one about what having schizophrenia is like for them. Talk to them when they’re well about how they’d like to be supported.
- Help your loved one create a daily routine that includes activities that are meaningful to them. When you can, join them. This might be anything from taking a walk to volunteering together.
- Help your loved one take their medication as prescribed, and set up systems that simplify this process. Have an easy-to-use pillbox. Create reminders and alarms. Help them keep track of their symptoms and/or side effects.
- Listen and be empathetic. Keep the lines of communication open about problems, concerns, or fears your loved one might have.
- Devise a plan to deal with episodes. Collaborate with your loved one and their treatment team on a written plan that includes: their individual triggers and warning signs of an episode; tactics for navigating these triggers and signs; healthy tools to turn to; names and numbers of professionals to call; along with other problem-solving strategies and ways to be supportive.
- Help your loved one advocate for themselves. If your loved one doesn’t want to take medication, talk to them about why. Encourage them to be honest with their providers, to voice their concerns, and to collaborate with them on their treatment.
- Commend your loved one’s hard work — and your own (no matter how small it might seem). Here are several examples from the excellent book The Complete Family Guide to Schizophrenia: A parent found it helpful to note something positive every day, such as, “I’m proud of how persistent my daughter has been in pursuing her art career in spite of the many difficulties she’s encountered. We both have a lot to learn about coping with this illness, but we’ve also come a long way.” When one dad’s daughter shared that she felt like a failure for needing to be hospitalized, he told her, “I’m sorry you had to go through that, but I’m proud of you for getting help when you needed it and for being so strong in dealing with this illness. You’re a survivor.”
- Join a support group for family and friends of individuals with schizophrenia. This is a great way to share common experiences and learn strategies to best deal with your frustrations, feelings of helplessness, and sadness. Start your search for a local support group at the National Alliance on Mental Illness.
If you have schizophrenia, there are many things you can do to help and support yourself. Below, you’ll find a short list of ideas.
- Stick to your treatment. Keep attending therapy and taking your medication — and if side effects become intolerable, talk to your doctor before
- Be honest about your thoughts and symptoms. Talk about how you’re feeling with providers and loved ones you trust. If you’re hearing voices or experiencing other hallucinations, let them know.
- Join an in-person or online support group. Having schizophrenia can feel incredibly isolating—until you realize that you’re not alone, and even though everyone’s specific experiences are different, there are many, many commonalities. In addition to the connection, support groups are an invaluable place to pick up helpful coping tools and strategies.
- Minimize stress. Stress can exacerbate symptoms and trigger an episode. Along with your treatment team, identify what people, places, and situations are stressful for you, and the various ways you can effectively navigate those stressors.
- Have a solid plan for difficult times. As mentioned earlier (in the section on coping tips for family and friends), plan ahead on how to deal with challenging times, episodes, and crises. When you create this plan when you’re well, you make it much easier to help you when you aren’t.
- Find healthy ways to deal with hearing voices (if you do). The key in getting better isn’t to stop hearing the voices; it’s to learn to effectively interpret and interact with them. The British mental health charity Mind has helpful information on managing your voices. This Ted talk from Eleanor Longden, who has schizophrenia, also provides a valuable perspective.
- Set goals. You can absolutely live a meaningful, enjoyable life with schizophrenia. Think about what you want and what you value. Then, together with your treatment team and/or a loved one, brainstorm small steps you can take to make this happen.
- Fill your days with fulfilling activities. What do you love to do? What are your favorite hobbies? Maybe it’s writing or gardening or painting or running outside. Carve out time to engage in these activities on a daily or weekly basis. Again, schizophrenia is a difficult disorder, but it doesn’t have to shatter your life.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Beck, A.T., Rector, N.A., Stolar, N. & Grant, P. (2011). Schizophrenia: Cognitive Theory, Research, and Therapy. New York: Guilford Press.
Campbell, C.E., Caroff, S.N., Mann, S.C. (2018). Pharmacotherapy for co-occurring schizophrenia and substance use disorder. UpToDate. Retrieved from https://www.uptodate.com/contents/pharmacotherapy-for-co-occurring-schizophrenia-and-substance-use-disorder
Healthwise. (2019). Schizophrenia: When Hospital Care is Needed. Retrieved from https://www.healthlinkbc.ca/health-topics/ug5101
Janicak, P.G., Marder, S.R., Tandon, R., Goldman, M. (2014). Schizophrenia Recent Advances in Diagnosis and Treatment. New York: Springer.
Kar, N., Barreto, S., Chandavarkar, R. (2016). Clozapine monitoring in clinical practice: Beyond the mandatory requirement. Clinical Psychopharmacology and Neuroscience, 14, 4, 323-329.
Kessler, T., Lev-Ran S. (2019) The association between comorbid psychiatric diagnoses and hospitalization-related factors among individuals with schizophrenia. Comprehensive Psychiatry, 89, 7-15.
Little, J. (2017). Lived experience tips for managing schizophrenia. SANE Australia. Retrieved from https://www.sane.org/the-sane-blog/managing-symptoms/lived-experience-tips-for-managing-schizophrenia
Louise, S., Fitzpatrick, M., Strauss, C., Rossell, S.L., Thomas, N. (2018). Mindfulness-and acceptance-based interventions for psychosis: Our current understanding and a meta-analysis. Schizophrenia Research, 192, 57-63.
Mueser, K.T. & Gingerich, S. (2006). The Complete Family Guide to Schizophrenia: Helping Your Loved One Get the Most Out of Life. New York: Guilford Press.
National Institute of Mental Health. (2018). Schizophrenia. Retrieved from https://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml.
Olukayode, A. et al. (2014). The 4th Schizophrenia International Research Society Conference, 14-18 April 2014, Florence, Italy: A summary of topics and trends. Schizophrenia Research, 159, e1-22.
Rado, J. & Janicak, P.G. (2016). Living with Schizophrenia: A Family Guide to Making a Difference. Johns Hopkins Press Health Book.
Remington, G., Addington, D., Honer, W., Ismail, Z., Raedler, T., Teehan, M. (2017). Guidelines for the pharmacotherapy of schizophrenia in adults. The Canadian Journal of Psychiatry, 62, 9, 604-616.
Shah, P., Iwata, Y., Plitman, E., Brown, E.E., Caravaggio, F., Kim, J., Nakajima, S., Hahn, M., Remington, G., Gerretsen, P., Graff-Guerrero, A. The impact of delay in clozapine initiation on treatment outcomes in patients with treatment-resistant schizophrenia: A systematic review. Psychiatry Research, 286, 114-122.
John M. Grohol, M. (2020). Schizophrenia Treatment. Psych Central. Retrieved on April 1, 2020, from https://psychcentral.com/schizophrenia/schizophrenia-treatment/