How to support someone with psychosis

What is psychosis and how can it affect someone's everyday life?

Psychosis isn't a medical diagnosis in itself - it's a symptom. It can be brought on by a mental health disorder such as schizophrenia or bipolar disorder, or sometimes by severe depression. Psychosis affects people's thinking and ways of perceiving the world and other people. Someone with psychosis tends to lose contact with reality by hearing or seeing things, or believing things that are not true.

Mental health charity Mind describes the three types of psychosis as hallucinations, delusions and disorganised thinking and speech.

Hallucinations

Hallucinating means someone sees, hears, feels, smells or tastes things that aren't there. Someone with hallucinations might see faces, animals or religious figures; they might hear voices (saying both positive or negative things); or experience tastes or sensations (such as a feeling of insects crawling on their skin) for no apparent reason.

Delusions

Mind says that many people without psychosis have beliefs that many other people don't share. However, a delusion is usually a belief that nobody else shares and which other experiences or perceptions show cannot be true. A delusion can feel completely real to the person experiencing it.

Examples of delusions

• Delusions of grandeur - thinking you are a very important, rich and powerful person with control over major things like stocks or the weather.

• Finding you can spend a lot of money or take on a lot of debt because your sense of reality has been distorted.

• Paranoid delusions - frightening thoughts that someone is trying to harm or kill you, even if there is no evidence that this is the case.

Disorganised thinking and speech

This is sometimes called formal thought disorder. It includes racing thoughts (when thoughts go through someone's head quickly and feel beyond control); flight of ideas (constantly between ideas and linking them together in ways others wouldn't); and speaking incoherently.

Many people experience racing thoughts and flight of ideas at the same time. A person with disorganised thinking might speak very quickly, stumble over their words, and find it difficult to focus their attention on one thing.

What can you do to support someone with psychosis?

Dr Bhavsar is a consultant psychiatrist, working with people diagnosed with psychosis. He says it's important to spend time with your loved one and talk about how they're feeling. Not only can this help them process what they're experiencing, but it can also help you understand.

He adds: "Many people affected by psychosis experience anxiety, and can feel helpless and with a low mood. So, offering emotional support and just simply being there as a comfort is important. This can really help someone remember that they aren't on their own."

Dr Bhavsar stresses that every person's needs will differ, so it's a good idea to ask them what would be beneficial, rather than assuming.

However, someone might find it helpful if you offer support with their medical appointments.

"Attending, or even just booking, appointments might be a stressful thing. Someone with psychosis might also struggle when coming up with the right questions to ask a health professional. So, accompanying a person to an appointment can boost their confidence in enquiring about their care and relax them when talking openly about what they're going through."

Other things you can do to be supportive of someone with psychosis
These include:

• Speaking slowly to them, especially if they are in the middle of a psychotic episode. They will not necessarily understand humour or sarcasm, so speak clearly and explain things factually, maintaining a calm voice.

• Staying positive and optimistic. Especially as someone with psychosis can struggle with a low mood, it's important you try to offer comfort when they are angry or upset.

• Encouraging them to seek professional treatment: you can gently steer them in the direction of medical support by explaining to them how it can help.

• Treating them still as a valued family member or friend. Just because someone has a mental illness, that doesn't make them any less of a human being. They are still your child, your sibling, your cousin or your friend. Emphasise to them those connections you have, ensuring they know you are by their side.

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What if the person doesn't want help?

Seeking help for a mental health condition can be a really daunting, frightening thing. It can also be difficult for someone to even accept support from their loved ones. If you find yourself in this situation, Dr Bhavsar says it's important not to turn your back on someone, even if they are pushing you away.

"Stay in contact with your person, even if they don't want help. It might be helpful to ease the focus away from their diagnosis, if they're reluctant to seek professional support for the time being. You can do this by showing interest in their hobbies, spending time together as a family, or going out for walks to get some fresh air."

With time, someone might then come around to the idea of professional support if they feel supported and reassured by you. However, Dr Bhavsar stresses that someone's reasons for declining help can be complex.

"It's also important to remember that people are allowed to refuse help, and this doesn't mean they don't deserve support. There might be a number of reasons why someone doesn't want help, and the explanation isn't always simple," he says.

A crucial caveat

It is important to remember that if you are caring for someone with psychosis, they absolutely refuse help and their safety (or that of others) could be at risk as a result, you should speak to a healthcare professional. In certain circumstances, your doctor may recommend assessing the person to see whether they need to be sectioned under the Mental Health Act.

This is only done when all other avenues have been exhausted and when there is a real risk to safety if they do not get help. An example might be if they are at immediate risk of self-harm as a result of their delusions, or are threatening to harm someone about whom they have delusional beliefs.

What can you do while someone is experiencing a psychotic episode?

Psychotic episodes are usually very distressing for the person. In that situation, the person might need to see their GP, or go to A&E for an urgent mental health assessment. In this instance, attending someone's appointment with them can be useful. You can provide a doctor with your own impression of how the person is getting on. As mentioned above, people with psychosis tend to see, hear or believe things that others do not; therefore, having someone else there to explain the reality of the situation can provide a GP with the full picture.

Dr Bhavsar adds: "Unfortunately, people who are having a psychotic episode can experience intense fears about other people. This can cause them to become aggressive. It is important to take this seriously and to try not to take their behaviour personally. In these instances, you should seek help because we know that psychotic episodes worsen unless a person receives effective treatment."

He also suggests educating yourself on the types of medication someone is taking and the treatment recommended to them. If they want, you can offer them reminders to take their medication.

How should you respond to their psychotic thoughts?

Seeing things or hearing voices can be very scary and alarming for the person experiencing them. Dr Bhavsar says each person is different, so while some might find it helpful to have a casual conversation in these moments, others might find that impossible. It depends on the person and the moment - something you will get used to with time as you become better acquainted with their condition.

"Since psychosis also leads people to developing unusual beliefs that are not shared by those around them, it often isn't a good idea to directly confront these beliefs. This is partly because it can increase emotional tension and lead to the person feeling even more isolated. In this case, think about the ways you can practically support someone, rather than entering arguments and overloading them with facts.

It is really important to avoid invalidating someone's beliefs, even if you don't agree with their perspective. One way of doing this might be to accept the reality of the beliefs for them, and to validate the feelings and emotions that are attached to them for the person," he says.

What should you not do?

Even though you might want to help someone, because you care deeply for them, you should be aware of what can be harmful.

• Do not physically force someone to attend appointments or to take medication, even if you are very concerned and you don't feel you have another choice. However, as explained, if you feel their safety or that of others is at risk, do contact a healthcare professional for advice on their behalf.

• Do not use pejorative language to label the person.

• Do not threaten them with a negative repercussion for their behaviour.

• Do not judge them, but rather encourage them to talk about how they're feeling.

• Don't panic or overreact, and try not to get frustrated with someone's beliefs.

How can loved ones practise self-care and look after themselves?

Dr Bhavsar says lots of carers end up experiencing depression and other mental health conditions. It can be very overwhelming and tiring supporting someone with a mental health condition, especially when you just want to do right by them.

"It's important to seek support for yourself too, which you can access via your GP. You should talk about the difficulties you are facing and what you're finding stressful. Sole caring is really challenging, so be sure to make time for your own hobbies and to do things that take you away from that role. Mental health apps and practising mindfulness and meditation can be of benefit, as can respite if it's an option.”

Where can you find support?

If you are struggling with psychosis, your first port of call should be your GP, who can curate treatment plans and prescribe medication. Dr Bhavsar says peer support might also be useful.

"This is where people who live with, or have been affected by, psychosis meet and interact with one another, either one-to-one or in groups. You can offer emotional support and a listening space free from judgement. This helps lots of people with psychosis, as they can access advice from those who understand what they are going through, rather than doctors who may not have lived experience of psychosis."

If you are caring for someone with psychosis and require a helping hand, your GP can also suggest forms of therapy that might help you or, if needed, might prescribe medication, such as antidepressants.