Psychosis: Mental Health First Aid Guidelines

Recognising and responding to psychotic episodes

 

 

What Is Psychosis?

Psychosis is a general term describing a mental health condition in which a person loses touch with reality. There are severe disturbances in thinking, emotion, and behaviour that can disrupt relationships, self-care, work, and other usual activities. Psychosis can be very distressing for both the person experiencing it and those around them.

 

 

Early Recognition: Common Signs and Symptoms

• Changes in emotion and motivation: Depression, anxiety, irritability, suspiciousness, blunted or inappropriate emotion, changes in appetite, and reduced energy and motivation may occur.
• Changes in thinking and perception: Difficulties with concentration, sense of alteration of self or others, odd ideas, and unusual perceptual experiences such as changes in smell, sound, or colour intensity.
• Changes in behaviour: Sleep disturbances, social isolation or withdrawal, and reduced ability to carry out work or social roles become apparent.
• Cultural considerations: Consider the spiritual and cultural context of behaviours, as what may appear as psychotic symptoms in one culture could be normal experiences in another, such as hearing voices of deceased loved ones in some Aboriginal communities.

 

 

 

What Not to Do

Important Things to Avoid

• Don't dismiss warning signs: Even gradual or unclear changes in motivation or interest may be symptoms of psychosis rather than laziness. 
• Don't assume it's a phase: Avoid dismissing symptoms as normal teenage behaviour, typical life challenges, or substance misuse without proper assessment.
•  Don't expect symptoms to resolve independently: Signs and symptoms of psychosis will not go away on their own and require professional intervention.

 

 

 

How to Provide Support

• Approach with care: A person developing psychosis may not reach out for help. Approach them in a caring, non-judgemental manner for a one-on-one conversation in a safe, comfortable environment free of distractions.
•  Remain calm and patient: Try to be calm regardless of the person's emotional state. Avoid confrontational approaches and tailor your interaction to their behaviour, particularly if they appear suspicious.
• Build common ground: Start with general topics and gradually build towards more specific questions about their experiences. Avoid using the term 'psychosis' and instead discuss concerning changes in thoughts, feelings, or behaviour.

 

Communication Guidelines

• Language: Use everyday rather than simplified language. Use normalising language such as 'stress' and avoid stigmatising terms like 'crazy' or 'psycho'.
• Listening: Convey empathy and listen non-judgementally. Acknowledge their feelings with phrases like "That sounds really upsetting" or "It sounds like you don't know what to do".
• Body language: Don't touch without permission. Minimise nervous behaviours like fidgeting. If they're sitting, don't stand over them or hover nearby.

 

Responding to Psychotic Symptoms

• Understanding their reality: Hallucinations (false perceptions) and delusions (false beliefs) are very real to the person experiencing them. Listen to demonstrate empathy without confirming or denying their experiences.
• Appropriate responses: Acknowledge their reality by saying something like "I accept that you hear voices in that way, but it's not like that for me." Use their terminology when referring to their experiences.
• What not to do: Don't pretend to agree with delusions, try to reason with them about their experiences, dismiss or argue with them, or act alarmed or embarrassed by their symptoms.

 

Encouraging Treatment

• Convey hope: Tell them that help is available and things can improve with appropriate professional support. Early treatment is more effective and can prevent symptoms from worsening.
• Address concerns: Reassure them that seeking help doesn't necessarily mean hospitalisation, as early treatment often takes place in the community. Health professionals maintain confidentiality except in limited circumstances.
• Provide options: Let them know their GP can be a good first point of contact. If they're reluctant, explore their reasons and focus on finding something they agree is a problem worth addressing.

 

 

Crisis Situations

• Severe psychotic state: If someone has overwhelming delusions, very disorganised thinking, or bizarre behaviours that may endanger themselves or others, approach with caution and prioritise safety. 
• De-escalation techniques: Speak in short, simple sentences. Stay calm and avoid nervous behaviours. Ask permission before moving close or making physical contact. Try to gather information about whether they feel safe.
• Safety considerations: Stay at a safe distance while maintaining interaction. Ensure clear access to an exit. If the person has a weapon, don't approach and call emergency services immediately.

 

When to Seek Immediate Help

Contact emergency services immediately if you suspect the person may be a risk to themselves or others, or if they're in a severe psychotic state with overwhelming symptoms. If calling emergency services, explain that the person is experiencing psychosis and needs medical help. 

 

Self-Care

Looking After Yourself

• Acknowledge your emotions: It's normal to feel shock, confusion, fear, or frustration when supporting someone experiencing psychosis. These reactions are common and understandable.
•  Seek support: Look after your own mental health and wellbeing. Don't pressure yourself to solve all their problems. Seek support through professional help, support groups, or trusted friends whilst maintaining confidentiality.
•  Practice self-care: Use stress-reduction strategies such as relaxation methods, regular exercise, adequate sleep, and maintaining a healthy diet to manage your own wellbeing.