When my roommate had a relapse

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I am a 27-year-old woman living in Chicago. For the last two years I lived with a roommate, a 29-year-old man I will call David, who has schizophrenia. We met through a friend of a friend who knew we were both looking for an affordable two-bedroom. David had been stable for three years on his medication when we moved in together. He was open about his diagnosis from the first conversation. We split rent, took turns buying groceries, and watched basketball together on Sunday afternoons. I want to write about what happened the month he relapsed, because before it happened I had no idea what to do, and the resources I found afterward would have made an enormous difference if I had read them earlier.

The first sign

The first sign was that David stopped showering. Not for a day, which is normal. For about ten days. He had always been meticulous — he showered every morning before work, even on weekends. When the daily showering stopped, I noticed. I did not say anything for the first week. I told myself he was tired, or had a cold, or was depressed. By day eight I asked, gently, if everything was okay. He said he was fine.

The second sign was sleep. He had been a nine-to-five person, asleep by 11 p.m. I started hearing him pacing in his room at 2 a.m., 3 a.m., 4 a.m. Some nights he was up for 24 hours. Some days he slept for fourteen.

The third sign was that he stopped taking his medication. I learned this later. At the time, I noticed only that the pill bottle on the kitchen counter, which used to move every morning, was sitting in the same spot for days at a time.

What I should have known

If I had known then what I know now, I would have recognized those three signs as the classic early warning of relapse described in resources like NAMI's overview of warning signs. Sleep disruption, hygiene change, and medication non-adherence are three of the most common precursors to a full episode. By the time I noticed all three together, the relapse was already well underway.

What I tried first

I tried, gently, to talk to David. I asked once if he had been to his last appointment. He said he had. I learned later that he had not. I asked if he wanted to call his sister, who lived in Indianapolis and who was the family member he was closest to. He said no. I asked if I could bring him soup. He said sure. I made soup. He did not eat it.

I felt completely out of my depth. I had no clinical training. I had no relationship with his treatment team. I did not have his sister's number. I did not even know the name of his psychiatrist.

What I should have done sooner

This is the section I wish I had read three years before I needed it. With the benefit of hindsight, the things I should have done — and that I would urge any roommate of a person with serious mental illness to do — are:

• Get an emergency contact in writing, before there is an emergency. When David moved in, I should have asked for the name and number of one family member I could call if I were ever worried. I should have asked him to share that contact in his own words, calmly, on a normal day. We never had that conversation. By the time I needed his sister's number, I was rifling through his desk drawer.
• Know the name of his psychiatrist or clinic. Not the medical details — those are private. Just the name and the main line of the clinic. So that if something happened, I had a number to call.
• Learn the warning signs together, in a calm conversation. "What does it look like for you when you are getting unwell?" That conversation, on a Tuesday afternoon when both of you are well, can save a life later.
• Know the local mobile crisis number. In Chicago that is the 988 line and the local mobile response team. Many cities have CCBHCs or mobile crisis teams that can come to the apartment without involving police. See mobile crisis teams and crisis intervention teams.

The night it broke open

Three weeks after the showers stopped, David started talking out loud in his room. Not to himself, exactly — to someone. The conversations were in fragments. The volume rose over a few nights. By the third night, at 4 a.m., the apartment manager knocked on our door because two neighbors had complained about shouting.

I let her in. David was in the living room, fully dressed, holding a kitchen knife in a way that suggested he did not really know it was in his hand. He was not threatening anyone — he was talking to a presence in the corner of the room and gesturing at it. He looked at me and said, "They are in the walls." He said it the way you would tell someone the time.

I called 988. I asked for a mobile crisis team. The operator stayed on the phone with me. The team arrived in about forty-five minutes — two clinicians, no police. They had been to our building before. They talked to David for almost an hour. He eventually agreed to put down the knife, which he had still been holding the whole time. He agreed to go to the local crisis stabilization unit voluntarily — see crisis stabilization units — for an evaluation. He came back to the apartment three days later.

What changed afterward

He was started back on his medication, with a higher dose than before, and a long-acting injection added so the daily pill compliance was no longer the only thread keeping him well. His treatment team called his sister, with his permission. His sister flew in for a week. The four of us — David, his sister, his case manager, and me — sat down at our kitchen table and made a written plan. The plan said:

• The case manager would call me, with David's written consent, if David missed two appointments in a row.
• I would have his sister's number and could call her if I noticed three or more warning signs in a week.
• David would put a sticky note on his bathroom mirror listing his own warning signs, in his own words.
• If a crisis happened again, the first call would be to mobile crisis at 988, not to 911. The case manager wrote out the script for me on an index card.

We have lived together for another fourteen months since that night. David has had no further crises. The plan has not been activated. The card is still on the inside of our kitchen cabinet.

What I would say to someone whose roommate has a psychiatric illness

• Have one calm conversation, early, about warning signs and emergency contacts.
• Get a written list of who to call and what to say. Tape it inside a kitchen cabinet.
• Learn your city's mobile crisis number. Save it in your phone.
• Trust your noticing. If you sense something is wrong for more than a few days, you are usually right.
• Do not try to be a clinician. Your job is to call the people who are.
• You are allowed to set limits about your own safety. Calling for help is not betrayal. It is care.

For more, see living with a roommate with schizophrenia, early warning signs, and how to talk to someone in psychosis.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.