Helping the Pavey Family

Dr Ashton says – “Using the crisis management system I made the following observations…”


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’t take medication as prescribed
  • Drink alcohol above recommended limits
  • Take street drugs
  • Have stressful or unstructured lives
  • Have stressful relationships at home or with friends

Dr Ashton says -“In 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.”


Dr Ashton says – “One of my favourite sayings is – When you’re being chased by a crocodile it’s too late to think about draining the swamp!”
Dr Ashton has made several recommendations on how the Pavey’s swamp might be drained, to try to prevent further relapses.

  • Although it needs to be Jez’s 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
  • 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)
  • 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’s health or behaviour
  • 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
  • Support should be offered to the family to understand Jez’s problems and to discuss practical strategies that may help to maintain healthy relationships


Dr Ashton says – “Even though we do our best to prevent crisis, sooner or later one will happen. Be a good Scout – Be Prepared!”

  • 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
  • Jez should be given the chance to make an Advance Statement (outlined in Module 9 – Understanding Mental Health Services) in which he can decide upon important aspects of his treatment should he become unwell again
  • 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

Try to lessen the potential impact of any crisis in advance. Examples to consider might be:

  • Jez to cancel or put a low withdrawal limit on credit cards
  • Help Jez to choose a bank account that cannot be overdrawn
  • Keep bank details handy so that cards can be cancelled quickly
  • Keep a few days supply of medication in a safe place for emergencies
  • Talk to friends and relatives (as appropriate) and discuss how they might be able to help
  • Ensure that car keys, credit cards or other vulnerable items are kept safe

Dr Ashton says – “999 if you need it, be SMARTY if you don’t” (or even if you do.)

SMARTY? – a system for managing crises when they do happen

The Pavey family learned about the SMARTY system and decided to put it into action the next time Jez had a crisis:

Simple – 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.

Mindset – Try to understand the other person’s 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’s happening. Joan said “I can see that you’re really upset Jez, what happened last night?”

Avoid giving orders, blaming or judging. Joan didn’t say “you’ve got paranoid again because you haven’t taken your medication”. She gave Jez a choice or option. “Is it possible you might be feeling paranoid?”

Repeat 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’t have another set of car keys before Jez understood.

Truce – 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 “lose face”. 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.

You can’t always solve the problem alone, you may need help. Display your own trust in the system but don’t make promises about outcomes. Joan said “The crisis team are there to help you. We could give them a ring; they’re the experts in this kind of situation.” See below for ideas on “Getting Help in a Crisis”


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.

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:
What suggestions would you have made?