{"id":1703,"date":"2019-05-14T10:14:22","date_gmt":"2019-05-14T10:14:22","guid":{"rendered":"https:\/\/www.lancaster.ac.uk\/reacttoolkit\/?page_id=1703"},"modified":"2019-09-04T14:44:55","modified_gmt":"2019-09-04T14:44:55","slug":"helping-the-pavey-family","status":"publish","type":"page","link":"https:\/\/www.lancaster.ac.uk\/reacttoolkit\/toolkit\/dealing-with-crises-2\/helping-the-pavey-family\/","title":{"rendered":"Helping the Pavey Family"},"content":{"rendered":"<p style=\"text-align: justify;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-1695\" src=\"https:\/\/www.lancaster.ac.uk\/reacttoolkit\/wp-content\/uploads\/2019\/05\/Module-11-1-226x300.png\" alt=\"\" width=\"150\" height=\"199\" \/> <strong>Dr Ashton says \u2013 \u201cUsing the crisis management system I made the following observations\u2026\u201d<\/strong><\/p>\n<h4 style=\"text-align: justify;\">Predicting<\/h4>\n<p style=\"text-align: justify;\"><strong>Relapse is common in psychosis and bipolar disorder. Statistics show that it is more common in those who:<\/strong><\/p>\n<ul>\n<li style=\"text-align: justify;\">Have a poor understanding of their experiences<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">Don\u2019t take medication as prescribed<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">Drink alcohol above recommended limits<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">Take street drugs<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">Have stressful or unstructured lives<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">Have stressful relationships at home or with friends<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-1695\" src=\"https:\/\/www.lancaster.ac.uk\/reacttoolkit\/wp-content\/uploads\/2019\/05\/Module-11-1-226x300.png\" alt=\"\" width=\"150\" height=\"199\" \/> <strong>Dr Ashton says -\u201cIn hindsight it was easy to predict that Jez was at high risk of relapse and engaging in risk taking behaviour. The psychiatrist and CPN need to work more closely with Jez and his family to reduce the risk of relapse. Ideas about how to do this are outlined below.\u201d<\/strong><\/p>\n<h4><\/h4>\n<h4 style=\"text-align: justify;\">Preventing<\/h4>\n<p style=\"text-align: justify;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-1695\" src=\"https:\/\/www.lancaster.ac.uk\/reacttoolkit\/wp-content\/uploads\/2019\/05\/Module-11-1-226x300.png\" alt=\"\" width=\"150\" height=\"199\" \/> <strong>Dr Ashton says \u2013 \u201cOne of my favourite sayings is \u2013 When you\u2019re being chased by a crocodile it\u2019s too late to think about draining the swamp!\u201d<\/strong><br \/>\n<strong>Dr Ashton has made several recommendations on how the Pavey\u2019s swamp might be drained, to try to prevent further relapses.<\/strong><\/p>\n<ul>\n<li style=\"text-align: justify;\">Although it needs to be Jez\u2019s choice whether he takes the medication, he might benefit from spending time discussing any links between his lifestyle and medication use, and his mental health and wellbeing. This will help him make informed decisions about his treatment<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">Jez needs a system that makes it as easy as possible to remember to take his medication and monitor how much he has taken (if he decides to take any)<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">A shared plan is needed about how information will be shared between the family and the mental health team. Specifically, who they can contact if they are worried about changes in Jez\u2019s health or behaviour<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">A Care Plan is needed that has input from everyone involved and which includes help for Jez to find structured, meaningful activity such as work, education or volunteering<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">Support should be offered to the family to understand Jez\u2019s problems and to discuss practical strategies that may help to maintain healthy relationships<\/li>\n<\/ul>\n<h4 style=\"text-align: justify;\">Planning<\/h4>\n<p style=\"text-align: justify;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-1695\" src=\"https:\/\/www.lancaster.ac.uk\/reacttoolkit\/wp-content\/uploads\/2019\/05\/Module-11-1-226x300.png\" alt=\"\" width=\"150\" height=\"199\" \/> <strong>Dr Ashton says \u2013 \u201cEven though we do our best to prevent crisis, sooner or later one will happen. Be a good Scout \u2013 Be Prepared!\u201d<\/strong><\/p>\n<ul>\n<li style=\"text-align: justify;\">Insist on a Care Plan that describes exactly what will happen in a crisis. This is usually developed by a Care Coordinator from a mental health team. Everyone involved in supporting Jez should be aware of the crisis plan and have had input into to it<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">Jez should be given the chance to make an Advance Statement (outlined in Module 9 \u2013 Understanding Mental Health Services) in which he can decide upon important aspects of his treatment should he become unwell again<\/li>\n<\/ul>\n<ul>\n<li style=\"text-align: justify;\">Agree which other services\/people supporting Jez would benefit from knowing that Jez is vulnerable to relapse of illness and that he might be at risk<\/li>\n<\/ul>\n<p><strong>Try to lessen the potential impact of any crisis in advance. Examples to consider might be:<\/strong><\/p>\n<ul>\n<li>Jez to cancel or put a low withdrawal limit on credit cards<\/li>\n<li>Help Jez to choose a bank account that cannot be overdrawn<\/li>\n<li>Keep bank details handy so that cards can be cancelled quickly<\/li>\n<li>Keep a few days supply of medication in a safe place for emergencies<\/li>\n<li>Talk to friends and relatives (as appropriate) and discuss how they might be able to help<\/li>\n<li>Ensure that car keys, credit cards or other vulnerable items are kept safe<br \/>\nManaging<\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-1695\" src=\"https:\/\/www.lancaster.ac.uk\/reacttoolkit\/wp-content\/uploads\/2019\/05\/Module-11-1-226x300.png\" alt=\"\" width=\"150\" height=\"199\" \/><strong>Dr Ashton says \u2013 \u201c999 if you need it, be SMARTY if you don\u2019t\u201d (or even if you do.)<\/strong><\/p>\n<h4 style=\"text-align: center;\">SMARTY? \u2013 a system for managing crises when they do happen<\/h4>\n<p style=\"text-align: justify;\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1704 aligncenter\" src=\"https:\/\/www.lancaster.ac.uk\/reacttoolkit\/wp-content\/uploads\/2019\/05\/smarty-system-300x59.png\" alt=\"\" width=\"300\" height=\"59\" \/><\/p>\n<p style=\"text-align: justify;\"><strong>The Pavey family learned about the SMARTY system and decided to put it into action the next time Jez had a crisis:<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>S<\/strong>imple \u2013 Keep your statements simple and to the point. One person to talk at a time. Due to his symptoms and emotional state Jez will have problems understanding or paying attention to complex statements or arguments.<\/p>\n<p style=\"text-align: justify;\"><strong>M<\/strong>indset \u2013 Try to understand the other person\u2019s mindset. Especially how they are feeling. In the SMARTY system, we encourage people to talk about what makes them feel so angry, upset or desperate. This is partly a delaying tactic, and partly because we need to understand what\u2019s happening. Joan said \u201cI can see that you\u2019re really upset Jez, what happened last night?\u201d<\/p>\n<p style=\"text-align: justify;\"><strong>A<\/strong>void giving orders, blaming or judging. Joan didn\u2019t say \u201cyou\u2019ve got paranoid again because you haven\u2019t taken your medication\u201d. She gave Jez a choice or option. \u201cIs it possible you might be feeling paranoid?\u201d<\/p>\n<p style=\"text-align: justify;\"><strong>R<\/strong>epeat if necessary. Jez was distracted by his racing thoughts and his fear that people were after him. Joan had to tell him several times that she didn\u2019t have another set of car keys before Jez understood.<\/p>\n<p style=\"text-align: justify;\"><strong>T<\/strong>ruce \u2013 This is not a contest of wills or a test of who is wrong or right. Leave your ego behind and be willing to give a little. Avoid the other person having to \u201close face\u201d. Jez was desperate for cigarettes so Joan gave him some money to go to the corner shop. This also gave her additional time to collect her thoughts and think through her strategy.<\/p>\n<p style=\"text-align: justify;\"><strong>Y<\/strong>ou can\u2019t always solve the problem alone, you may need help. Display your own trust in the system but don\u2019t make promises about outcomes. Joan said \u201cThe crisis team are there to help you. We could give them a ring; they\u2019re the experts in this kind of situation.\u201d See below for ideas on \u201cGetting Help in a Crisis\u201d<\/p>\n<h4 style=\"text-align: justify;\">Learning<\/h4>\n<p style=\"text-align: justify;\">After a crisis is over it is very tempting to try and forget about it and move on. However, this can also be a good opportunity to learn a lot about how to prevent future crises or manage them differently.<\/p>\n<p style=\"text-align: justify;\">Joan Pavey sat down with the rest of the family 2 weeks later when Jez was feeling better. They discussed what had happened and whether there was anything they could do to avoid this situation from happening again. Imagine you had been there:<br \/>\nWhat suggestions would you have made?<\/p>\n<p>[arrows]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dr Ashton says \u2013 \u201cUsing the crisis management system I made the following observations\u2026\u201d Predicting Relapse is common in psychosis and bipolar disorder. Statistics show that it is more common in those who: Have a poor understanding of their experiences Don\u2019t take medication as prescribed Drink alcohol above recommended limits Take street drugs Have stressful <\/p>\n<div class=\"btn-more-wrapper\"><a href=\"https:\/\/www.lancaster.ac.uk\/reacttoolkit\/toolkit\/dealing-with-crises-2\/helping-the-pavey-family\/\" class=\"btn btn-sm btn-hover-fill\"><i class=\"icon-right-arrow\"> <\/i>Read More<span class=\"screen-reader-text\"> &#8220;Helping the Pavey Family&#8221;<\/span><i class=\"icon-right-arrow\"> <\/i><\/a><\/div>\n","protected":false},"author":1,"featured_media":1691,"parent":1858,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"page-toolkit.php","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-1703","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Helping the Pavey Family - REACT<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.lancaster.ac.uk\/reacttoolkit\/toolkit\/dealing-with-crises-2\/helping-the-pavey-family\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Helping the Pavey Family - REACT\" \/>\n<meta property=\"og:description\" content=\"Dr Ashton says \u2013 \u201cUsing the crisis management system I made the following observations\u2026\u201d Predicting Relapse is common in psychosis and bipolar disorder. 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