This post tells you to how to help someone who is experiencing psychosis, based on first aid guidelines that have just been published in the medical journal Schizophrenia Bulletin
Psychosis is a mental state where someone might experience hallucinations, unusual beliefs, paranoia, mixed emotions, muddled thoughts, hyper-awareness or show unusual or puzzling behaviour.
The guidelines have been drawn from an international committee of professionals, patients and carers. The detailed points are in table 1 of the paper which is available online as a pdf file.
If you want additional mental health first aid information, there’s more on a dedicated website.
Recognising and acknowledging psychosis
Psychosis is the mental state where someone might experience hallucinations, unusual beliefs, paranoia, mixed emotions, muddled thoughts, hyper-awareness or show unusual or puzzling behaviour. If someone seems distressed or impaired by their experiences, even if they’re quite subtle at first, it’s best not to ignore them and hope they’ll go away. It’s good to give the person the opportunity to discuss the situation.
Approaching someone who might be experiencing psychosis
People experiencing the early stages of psychosis may be worried, and may be concerned about discussing their experiences because of what others might think. Also, the experiences might be frightening in themselves.
The key is to be caring, gentle and non-judgemental. Find somewhere where they can talk safely and that’s free of distractions. Say why you’re worried about them, but avoid talk of mental illness or diagnoses – you could be wrong and it might just make them more frightened. Don’t force a conversation if it’s not wanted and don’t touch them without permission.
Ask the person what will help them feel safe and in control, and allow them to talk about their experiences at their own pace, even if they seem quite unusual to you. Let them know that help is available, and if they don’t want to talk, they’re welcome to talk at a later time.
Giving support
It’s important to respect the person’s beliefs, even if you don’t agree. Someone who is experiencing psychosis might find it hard to distinguish what’s real from what’s not, so telling people that they’re wrong rarely helps. However, it’s always possible to empathise with whatever emotions are stirred up by the experience and this can be very comforting.
Avoid criticising or blaming the person. They may be talking or behaving differently because of their experiences. Although the person might be having some odd experiences and difficulty focusing, their intelligence is unlikely to be affected, so you can talk to them as any other adult. However, sarcasm might be misunderstood by someone who is very suspicious, so should be avoided. Be honest, and don’t make promises you can’t keep.
Dealing with delusions and hallucinations
Delusions (false beliefs) and hallucinations (false experiences) will probably seem real to the person. Avoid denying, dismissing, laughing at, or arguing about their perceived reality. Try not to be alarmed, horrified or embarrassed about any unusual ideas or paranoia.
Dealing with communication difficulties
People with psychosis are often unable to think clearly. Speaking at your normal pace is fine and usually you will be understood perfectly well, but you may need to give the person extra time to absorb and respond to what you say, and you may need to repeat anything they haven’t been able to focus on. The person may seem to show little emotional reaction – but be aware that they may well be feeling strong emotions inside.
Discussing whether to seek professional help
Ask the person if they’ve felt this way before and, if so, what helped then. Find out what sort of assistance the person thinks will help them this time. If the person has supportive family or friends, encourage the person to contact them. The person might need practical or emotional support when using mental health services, and if the person lacks confidence in the medical advice they’ve received, encourage them to get a second opinion.
What to do if the person doesn’t want help
Some people with psychosis don’t realise there’s anything wrong, even when they’re quite distressed or impaired, and may actively resist encouragement to get help. However, many people understand what’s happening and have a right to refuse help. Threatening the person with hospitalisation or mental health law is likely to make matters worse.
If you’re worried about someone you should encourage them to talk to people they trust or get a medical check-up. You may need to be patient, and remain friendly and open to the possibility that the person will seek help in the future as some people will need some time to feel comfortable with the idea.
What to do in a crisis when the person is very unwell
Try to remain as calm as possible, talking in a normal tone of voice and answer any questions the person might have. Your aim is to make the person feel more comfortable and calm the situation.
Try and evaluate whether the person is at risk of being harmed, harming themselves, or is suicidal. If you think this is the case, call for medical assistance immediately. If the situation seems risky, check how to leave and keep yourself safe.
If you need to call medical assistance, make sure they know the seriousness of the situation by describing specific observations about the person. If new people arrive, explain who they are, that they they’re here to help, and how they’re going to assist.
Find out if there’s anyone the person can contact who they trust and might be able to help. If you can help with any requests that aren’t unsafe or unreasonable, it might help the person feel in control.
What to do if the person becomes aggressive
It is very rare that people with even severe psychosis become aggressive. They are much more likely to be a risk to themselves.
However, people who are extremely suspicious, feel persecuted or are worried about their own safety may be jumpy or feel ‘on edge’. The best response is to make the person feel safe and calm. A good way is to lead the way by acting in a calm, reassuring, non-challenging manner. Try to avoid doing anything that might look ‘shifty’ or suspicious or avoid restricting the person’s movement.
Take any threats or warnings seriously. If you are frightened or worried about your own safety leave and call for help. If you call the police, describe any symptoms and immediate concerns and tell them if the person is armed. If possible, explain that you’ve called help to get medical treatment and because you’re worried about their aggressive behaviour.
25 Comments
Excellent advice.
Have come to the same observation in dealing with people I’ve known to be experiencing psychosis.
My daughter is suffering from severe psychosis. It has been a nightmare to deal with, as she is in complete denial and extremely delusional.
My daughter to is suffering from a phychosis to and like your daughter feels there is nothing wrong is very painful to deal with a big shock and an over whelming feeling of feeling powerless i like you feel there is no where to turn maybe we could keep in touch take care marie
My daughter is in a severe state of psychosis, is very difficult to have any conversation with, is not trusting anyone, but is talking to her therapist almost daily on the telephone. She threatens us daily with her her words, she thinks we bad people, we are not, but she has it in her mind that everyone is sinning and is against her. She is clinging to her bible and corrects our every word and tells us we don’t have God in our hearts, but indeed we do. She wants us to speak and act the way she wants us to speak and act. It is the most difficult situation to deal with. She trusts no one and is very suspicious of everyone. She is paranoid and is having a delusional relationship with a policeman which, even though the policeman is real and is someone she knows through her previous job, there is no relationship. She writes him letters, has called him at work, has emailed the entire police department. He will put a restraining order on her if she tries to contact him again, but she is persisting that he is going to marry her. There many things going on in her mind, so will end here. Need some advice.
I see myself in your daughter`s story. What helped me were medications, going away from city to a mountain, silence, lots of sleep, physical activity. It took about 3 weeks to completely get out of psychosis.Here is the list of medication prescribed to me and I still take them: Seroquel, Lithium, Rivotril, Flormidal, Propranolol. Keep her away from stress and if there is some sort of trauma in her past, that would be the place to start, after she gets out of psychosis. I hope she will get better soon.
My 34 year old brother has severe psychosis, he was first diagnosised 7 years ago and his episodes have gradually become more severe each year. At the moment he is sectioned in a hospital where he has been for 6 months and he is getting worse by the week. The consultants keep changing his medication but with no improvement he is walking around like a zombie and his speech is so slurred we have difficulty working out what he’s saying. My parents and I are considering trying to get the sectioned overturned so that we could care for him at home. As all the hospital do is give him drugs but don’t chat with him so he his left in his room most of the day, which in my opinion would be enough to send anyone of us over the edge. Does anyone know of any alternatives to medication that we could try?
Thanks for any advise you can give.
hi
your brother need love from you he need to find family next to him love him and care for him, this will hellp him alots, you need to get him home and start showing him life and soind lots of time with him and go out alots with him respect him and make him feal he is ok its the best way with medacation
do that and he will be 75% better
good luck
My brother was diagnosed in his early 20s, was able to maintain an almost-normal life for 30+ years with occasional medication changes (they all have side effects) then stopped taking medication on his own and descended into psychosis once again this past year. I visited him at the hospital when he was first put back on medication and seeing him as you describe your brother. Please do not take him home yet. In order to get patients to take the medications they need, hospitals prescribe other medications that act to reduce resistance to treatment. It is very unhappy, but a common delusion is that one is being poisoned and so is resistant. At home there is no way your family can insist your brother take the medication he needs. Of course you want to visit him often as you can–but love is not going to cure this episode anymore than it would cure a heart attack. As with any other hospitalization, your family needs to keep the medical staff aware that someone cares what is happening to your brother. That is all you can do.
My 34 year old brother has severe psychosis, he was first diagnosised 7 years ago and his episodes have gradually become more severe each year. At the moment he is sectioned in a hospital where he has been for 6 months and he is getting worse by the week. The consultants keep changing his medication but with no improvement he is walking around like a zombie and his speech is so slurred we have difficulty working out what he’s saying. My parents and I are considering trying to get the sectioned overturned so that we could care for him at home. As all the hospital do is give him drugs but don’t chat with him so he his left in his room most of the day, which in my opinion would be enough to send anyone of us over the edge. Does anyone know of any alternatives to medication that we could try?
Thanks for any advise you can give.
I hope u can find a better alternative for your son, to treat him that way locked up in a room on drugs doesn’t sound like rehabilitation, he needs calming/normal/pleasant experiences like we all do. I feel for you.
My mum has these symptoms described, and is in denial or unaware. I’ve come to realise that the following is definitely important in how I deal with her: Do not criticize or ridicule, be empathetic, be calm (that’s hard!), don’t take over but offer support make them feel it’s on their terms so you’re not taking control away from them. I hope one day mum will agree to seek mental health help. I agree she’s very suspicious of everyone and everything, scared. It’s upsetting but those caring for them must remain strong.
My daughter is 22 and has had her first “break”. I am devastated. I don’t understand this. She just graduated from college with a BS in Political Science. She had gotten a job that she suddenly quit and was pursuing law school admission then suddenly decided to not pursue it further. When everything go derailed. She was admitted and placed on medications last week. I cannot get her into see a psychiatrist until 6/20. She keeps accusing her brother who is 14 of things he isn’t doing. She is difficult to deal with. She just started another job with a prestigious law firm that I know she cannot keep with her given thought processes disturbed. She says she is confused. I don’t know what to do or how to do it. I want my daughter back. What has happened? She was a kid that always had it together? The medications she is on currently are not helping her. She isn’t getting well at all. She is worse with the psychosis now. Any suggestions of what I should do? The confidentiality of the mentally ill really does not help the family in their support of them.
When in acute psychosis medications help. Such as Zalasta, Seroquel..it all depends on person which one will help. But I recommend to all who have this problems to try Cognitive Behavioral therapy either with a help of professional or alone. I strongly believe that psychosis comes from complete confusion about one`s own emotions and about ways to deal with problems.
I have a son aged 23yrs has been experienced with psychosis. I am really worrying that he is not getting better even though he has been on drugs. he keeps saying that we all are sinning, and everyone is in delusion and everyone is in a dream, this world is a devil world, everyone will go to hell. he keeps reading article about Matrix and read bible.
he does not socialise anyone and talk to anyone either but seeing his pschaitrist. I am really hoping that he will get better soon as he is my only child. any feedback will be excellent thank you
Zen buddhism, taoism, yoga… these things can help a mind regain composure. Exercise, good diet (balanced, lots of vegetables and water), and sleep are crucial. They help restore balance to the brain’s chemicals. Getting out of the city, experiencing nature can help. Avoiding overuse of technology can help. Meditation helps. Don’t worry too much. Don’t project negativity. Guide the inner child. If things get too messed up, you can suggest going to the hospital for a check up, see if neurotransmitters are doing ok and whatnot. They might get checked into the mental health care facility from there.
One point I would add, from my experience as a student nurse in a highly regarded psychiatric hospital, is not to validate their delusions. Like you said, if you try to deny or argue with a psychotic person, you will lose their trust and only damage your communication with them. On the other hand, you should not try to agree with their delusions either– this only sets you up for losing their trust when it becomes obvious that you’ll say anything to pacify them.
When talking with schizophrenic and bipolar patients, I found it was helpful to ask them more details about their delusions, to allow them to talk about their fearful state of mind. It helped to gain their trust by showing that I was interested in what they were experiencing. It will take a while for them to come back to “normal,” so building a foundation of trust is essential.
I have known both a case of schizophrenia and paranoia, and I find that paranoia psychosis is much harder to deal with. The person is in control and lie about everything if they loose your trust. They convince very well the doctor that they are fine, but then live on their mental construction (they have to escape the city, something like that).
The paranoia person I know has been diagnocised Bipolar, but I doubt that’s the problem. She doesn’t have periods of high moods followed by depression. For me, after having read a lot, I feel more that it’s paranoia personality disorder, because even in standard life she is highly aggressive, all the time reproaching others that they’re just talking in their backs, and also ask a lot of help like it was due to her but give little back. Not somebody I would refer to as a “kind” person, yet she has friends because I think people are attracted to how she is pretty much self-empowered and go-getter in her “normal” mode.
I have read that the best cure for paranoia personality disorder is humor, and it is true this person has none whatsoever. This is a person in my family, by the way, which I’ve tried to help for 5 years (funny how all the friends disappear when she’s into psychosis and then come back later). Personally I don’t think I can do much more. It’s flabbergasting how someone can come to realize they have a big problem, get treatment for it, and than later they fall all back into it again, and worse. It’s very discouraging. Maybe she hasn’t reach the bottom enough, I don’t know. I’d think this is a disease scary enough that you’d make everything for it to not come back. I don’t how harsh are the side effects of meds but she’s only focussing on stopping taking them as soon as she’s fine. She “doesn’t really need them” is how she sees it. Ah well, sorry for the rant.
Trouble is, a person never recovers from a psychiatric disorder, it’s built into the physical being…a chronic disease, not one that gets cured. People can only gain some control over it, not do away with it.
You’ll have to do some more reading, actually your description of your friend with bi-polar diagnosis sounds very much like diagnosis is correct. Please continue reading, and choose the more complicated, not quick, material because there is no easy way to understand these things. You can’t really help, except by being calm yourself, and not getting dragged into situations.
my son was recently diagnosed with physicosis, he graduated from high school,and then he went off to finishing his degree becoming a electrician. he needs to still do his internship, but with this sickness he can’t seem to go foward. his brothers and sisters are scared of him and he is always talking to people from the past or past events to the air. his brake down was last year on june i took him immediatly to EMH and he was hospitalized for 2weeks he was sent home on seriquel, but know he doesn’t want to take the medications he was doing good at first until his father and his step mom dropped the ball while he was living with them. he doesn’t want to seek help and he won’t take the medication. i don’t know what else to do but pray to god to make it better.
There really is nothing else you can do–he will probably have to go back into the hospital and get put back on the proper drugs. The ones that work tend to have side effects, but like treatments for diabetes, for instance, it’s kind of a choice between being able to live and not being. My brother has this problem, it generally shows up in young people starting out in life, and never goes away, but the medication does help control it enough for people to have a real life.
Just wondered if anyone could help me. My sister has just recently had her children taken of her due to mental health grounds they seem to have taken the children but put no help in place for her it is very frustrating because when we try to get information they just tell us its confidential. she is constantly making up story’s which are very graffic and hard to repeat regarding sexual abuse ect. She recently visited our mums grave and left two vases with the name Matthew and Bernard engraved when she was questioned about this she told us they were for her children that are buried there but this is not true we don’t know where those names have come from or what to do about it. any suggestion would be greatly appreciated x
my son is 19 years old he is becoming extremely difficult to handle. His thoughts are unreasonable and he is always looking for an arguement. His dad told him to live in a shelter and he does not want to deal with him. I recently had the police take my son to a hospital for treatment. Today i visit him and found him worst making faces and telling me he is so smart and that is why no one understands him. The doctors are treating him with a drug named invega. In the past he has been treated with depakote and seraquil forgive my spelling . I see no improvement in him and i am so sad. When do you know if the medication is the right one?
You know it’s the rigth one when it finally works. When he/she no longer has delusions and they say they feel better and have insight into the disease. When they understand they need medication, not that everyone else is wrong and they are right.
My brother is once again suffering from a psychotic episode. He makes up ridiculous stories about me threatens me and when my mother questions him about it he denies it and says it was someone else. He makes no sense and will not stop messaging me accusing me of very serious things. He is not on medication for it I’m just wondering if he will ever come out of this and if he does if he’ll remember any of the things he has said or done. Mentally Ill or not, he has done a lot of damage to my reputation
I am just here to say i think i have the same problems as you all describe you friends and relitives to ahve. im not sure what to do about it thou , i cant confront my parents , ive been ignoring my “friends” , i have no connection with the outside world other then the birds and bees in my backyard. i have severe tooth decay and fear death is on its way. any ideas wat to handle first? my teeth my brain or a job to help out with the bills ive racked up over the years getting in trouble with the police. i have beeen feeling really bad that my parents have to put up with me and acutally pay for my mistakes. help please..