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.
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.