It is often the people around the individual who notices the onset of varying psychotic symptoms, rather than the individual themself. The symptoms can seem very real to the person and so they will often react as if they are real or become defensive when others try to challenge them. Other times a person can recognize what they are experiencing as ‘not quite right’ and will reach out for help.
During the possible onset of psychosis, it is important to support the person experiencing these changes. Let them know you are concerned and encourage them to “check it out” by making an appointment with a professional who will assess what’s going on in a supportive, safe and comfortable environment. A friend, family or loved one is also welcome to attend.
Even though this step is often the most difficult, it is also the first step where anxiety and fears of the unknown begin to be addressed and provide a sense of empowerment and hope for the individual and their family and loved ones.
It can be very distressing to realize that someone close to you may be experiencing psychosis. You may feel shocked, confused, bewildered and guilty. There is no right or wrong way to feel.
At this first stage, it’s important to support your friend or loved one and reach out for help. Once they are connected to professional services, you will also have the opportunity to have your questions and concerns about the condition answered, and to receive support for yourself and your family.
Being supportive
Families, partners or friends find it hard to take the first step to obtain help for many reasons. They may be unsure what the problem is. The person experiencing a psychotic episode may not wish to get help or even realize that they are unwell. It can be difficult to cope with a person who is in a psychotic state.
Family, partners and friends are very important in the process of assessment, treatment and recovery. When a person is recovering from their psychotic episode you can provide love, stability, understanding and reassurance. You can also help the recovery of your loved one by increasing your knowledge about this condition, learning how to help support management of the symptoms, and how to regain a sense of stability in your own life.
It is not uncommon for the person experiencing the symptoms to feel very alone or isolated. It is important to recognize that reactions such as fear, anxiety, anger, loss, sadness, blame and confusion are common for both your loved one and their friends and family. Being hopeful is realistic and helpful. Providing support for simple day to day challenges, helping cope with stressful situations, listening to what the person wants to talk about and remaining non-judgemental are all beneficial. Another way to help is to act as a support person if the person wished to learn more self-management skills by working on the Dealing With Psychosis Toolkit.
Getting agreement for help
Sometimes people with symptoms of psychosis are reluctant to seek treatment. Similar to some other major medical conditions, fear of the unknown along with hope the symptoms will go away without help, can result in a ‘denial’ phase for the young person. The symptoms of psychosis can include a lack of awareness that these are symptoms as opposed to reality, hence; a belief there is nothing wrong. This young adult age group is also in an important developmental stage were achieving independence is often a priority. The realities that they will need significant support and help from parents, family and medical professionals may be very frustrating and unwanted. They may be concerned about the treatment processes or worried about what people may think if they find out. Unfortunately, stigma and lack of correct information about psychosis is still strong in our communities, our selves and the mental health system.
Find a time when you can talk with them in private – it’s important to approach them in a caring and non-judgmental manner.
Specifically state why you are concerned. It is often best to frame your concerns in behavioural terms. For example, “I have been concerned because you don’t seem to be spending any time with your friends anymore.” Tell them in clear and calm terms, what you have noticed that makes you concerned.
Ask them if they’ve been experiencing anything unusual or troubling to them. Focus on the specific problems that the person acknowledges, e.g. difficulties with sleep, concentration, appetite, taking the bus etc.
Do not speculate on what their diagnosis might be. For example, do NOT state, “I am concerned that you might be getting psychotic.” – focus on what’s troubling them and what would help them.
If conversation seems to agitate the person, don’t try to force them to talk; just sitting together quietly may be helpful as a first step.
Experiencing distressing thoughts, feelings and sensations can be very frightening for the person. If they disclose they are experiencing these, offer comfort and reassurance, provide hope, and offer information that you know is accurate.
Invite them to look at this website or to take the foundrybc.ca reality self-check quiz.
Tell them what you know about help that is available and reassure them that you really are convinced that seeking help is the right thing to do.
Often the person will feel relieved that help is available but still may be anxious or worried about what will happen. Prepare the person for what they might expect. See this section on EPI services.
Reassure them that you will support them and that psychosis is treatable. Be patient and persistent.