Psychosis is not an illness but a symptom characterized by a disassociation from reality based on perception and thoughts. A person with acute psychosis may see and hear things that are not there. The behavior and emotions of someone with psychosis may seem strange or disconnected from reality because they often find it challenging to know what is real and what isn’t. Psychosis can cause a person to harm themselves or those around them. Acute psychosis is a medical emergency that requires urgent treatment. What do you do if someone you know is showing signs of acute psychosis? What can you do to help?
Mental Health First Aid was established to aid and train people for such a situation. It can help an individual assess someone showing signs of psychosis and provide appropriate support. With 1 in 5 adults living with a mental illness, being prepared ahead of time can be invaluable. Anyone can become trained to provide Mental Health First Aid. This article will discuss practical ways you can provide mental health first aid for psychosis. Training courses for mental health first aid for psychosis are available through Mental Health First Aid USA.
Acute Psychosis Symptoms
Acute psychosis typically exhibits early warning signs and changes in behavior before acute symptoms set in.
Early Signs of Psychosis
Acute psychosis can affect people of all ages; approximately 100,000 episodes of psychosis are reported among young people every year. While psychosis can come on suddenly, there are often early warning signs that precede a psychotic episode.
Some early warning signs of psychosis to be aware of include:
- Steep decline in performance at work or school
- Lack of hygiene or concern for personal appearance
- Extremes in emotion or lack of emotion
- Suspicious attitude toward others
- Difficulty with concentration and thought processes
- Difficulty sleeping
- Feelings of anxiety or depression
If you see any of these symptoms, do something. Early treatment of psychosis can alter the course of the person’s life and improve their chances of recovery. Most people experiencing psychosis do not seek medical care on their own unless their symptoms become intolerable. It is usually family members who initiate mental health first aid for psychosis and further medical treatment.
Tell-tale symptoms of acute psychosis include hallucinations and delusions. Not every person will have the same symptoms, but at least one of these symptoms will be present in acute cases.
Hallucinations involve the senses and can include seeing, hearing, feeling, tasting or even smelling things that are not there. Some examples of hallucinations include:
- Seeing things or people not there
- Hearing sounds or voices that aren’t there
- Perceiving unexplainable sensations, smells and tastes
- Hearing thoughts spoken aloud
- Hearing a running commentary on their actions
- Hearing a voice telling them commands or berating them
Delusions are false or irrational beliefs that a person clings to despite not having grounds or evidence to do so. The beliefs must be out of the ordinary for that person or their culture. Examples of delusions include:
- Thoughts of grandeur, or falsely believing that they have special powers or missions
- Paranoid delusions that they are being watched or someone is trying to control them
- Delusional beliefs that others can control their body or mind
- Out of the norm or extreme behavior
Causes of Acute Psychosis
Because psychosis is not an illness, but rather a symptom, the causes are varied. For this reason, it is crucial to seek treatment with an experienced medical professional who will look for what is causing the psychosis. Listed below are some conditions that can bring on psychosis. These conditions do not all guarantee the occurrence of psychosis, and there may be other conditions not listed here that can trigger psychosis:
- Mental health disorders, including depression, schizophrenia, bipolar, paranoid personality disorder and postpartum depression
- Traumatic events
- Physical illness or neurological disorders, including Parkinson’s disease, Alzheimer’s, dementia, epilepsy, traumatic brain injury, brain tumors and HIV
- Substance use
- Sleep or hormonal problems
How to Provide Mental Health First Aid for Acute Psychosis
It can be scary to witness someone you know and love experiencing acute psychosis, but there is a 5-step action plan that can help you provide mental health first aid for psychosis. It can be remembered with the mnemonic device “ALGEE.”
- Assess for risk of suicide or harm
- Listen non-judgmentally
- Give reassurance and information
- Encourage appropriate professional help
- Encourage self-help and other support strategies
Remembering these steps can help you diffuse the situation, help the person get needed treatment and keep them calm while help is on the way.
Assess for Risk of Suicide or Harm
A person with acute psychosis may have hallucinations that encourage them to harm themselves or others. Delusional thoughts could make them believe that others are trying to persecute or harm them, and they could become aggressive. If this occurs, it is known as a crisis situation.
To assess the situation and the risks involved, you must remain calm. Here are some guidelines to follow:
- Stay calm and speak with a quiet voice in a clear, concise manner
- Do not raise your voice, as this could be seen as aggression
- Do not restrict their movement if it is not harmful, i.e., pacing the room
- Comply with any safe or reasonable requests
If the person has a weapon or the means to harm themselves and voices the intent to do so, do not attempt first aid. Retreat to safety immediately and dial 911. Wait on emergency personnel to de-escalate the situation.
If no weapons are present, the individual does not voice or show aggression, and you have access to an exit, you may decide to begin a conversation and continue providing mental health first aid for psychosis.
This step is especially important if the individual is experiencing active hallucinations or delusional thoughts. If they have agreed to talk with you, let them set the pace of the conversation. Choose a place to speak to them that is private and free of distractions. Be sensitive to their behavior. For instance, if they are avoiding eye contact or appear suspicious, give them space. If this is the first time they are experiencing acute psychosis, they are likely afraid and confused. Do not try to diagnose the person, but state clearly what symptoms or behaviors are concerning you.
It may be difficult to convince the individual to open up to you, as they may not trust you or fear criticism. Here are some ways you can help put them at ease:
- Be attentive and don’t fidget with your phone or other things
- Avoid touching the person without their permission
- Let them know your purpose is to help and support them
- Speak in a calm, quiet tone
- Listen with empathy to what they are saying and avoid reacting harshly
- Do not dismiss, laugh at, minimize or act horrified if they share their hallucinations or delusions with you
- Be honest
- Do not make promises you can’t keep
This second step of listening is critical, as it can open the way for them accepting help. Be empathetic and convey your concern for the person. Ask open-ended questions to begin with, such as “How have you been feeling lately?” You can progress to more closed questions as you gain their trust, such as “Have you heard unusual voices or noises?” Do not try to force them to talk with you. If they don’t respond well to the questions, stop asking. Be patient and allow the conversation to happen naturally.
Give Reassurance and Information
The break from reality experienced by those with acute psychosis can be exhausting and distressing, often causing intense fear. By being present and showing genuine concern, you may be able to reach them during the acute psychosis process and convince them to seek professional treatment. Be aware that they may be suspicious of you, but you can calmly reiterate your concern. Consider these suggestions:
- Ask them what would help them feel safe or in control
- Offer the person choices of how you can help them
- Find out if they’ve experienced this before, and if so, what helped them in the past
- Let them know there is hope and treatment available
The thought processes of those experiencing acute psychosis are altered, and you may have to repeat yourself often. Be patient and listen to their responses. The confusion and fear they are experiencing may make it difficult for them to accept that something is wrong with their behavior. The lack of knowledge about their symptoms may cause them to deny the problem. If they refuse help, encourage them to turn to someone they trust. Remember, if they are not presenting a risk to themselves or others, they can refuse treatment, no matter how strongly you may feel they need it.
Mental health first aid for psychosis may take time, so be patient and take the time to discuss insight on their symptoms. Here are some links to information about acute psychosis you can share with them:
- Early psychosis and treatment options
- Psychosis and psychotic disorders
- Do I have a psychotic disorder?
- Commonly asked questions about psychosis and psychotic disorders
Encourage Appropriate Professional Help
In the case of acute psychosis, professional medical help is necessary. Many times, patients with acute psychosis go to the emergency room. A thorough examination follows to determine the possible cause of the psychosis. Research indicates that Coordinated Specialty Care (CSC), a team-based approach that involves the patient and family members in an individualized care plan, has had noted success in treating illnesses causing acute psychosis.
CSC is made up of 6 components:
- Case management
- Family support and education
- Medication management
- Supported education and employment
- Peer support
Initiating mental health first aid for psychosis is often the first step in helping someone seek medical treatment. Mental health first aid can shorten the length of negative symptoms and provide the support needed to help individuals recover.
Encourage Self-Help and Other Support Strategies
Psychosis is often first experienced during the teenage years and young adulthood. Support from families and friends during this time is invaluable. Having a clear plan of how to manage symptoms and knowing what to do when they don’t feel right is also crucial for individuals experiencing psychosis.
The following self-help strategies can help improve the symptoms of psychosis and reduce instances of psychosis:
- Locate reliable medical help early on
- Stay connected to supportive and understanding friends
- Reduce stress
- Continue learning about psychosis
- Avoid drugs and alcohol
- Take time to exercise and do things you enjoy
Other people can support family members or friends while providing mental health first aid for psychosis by:
- Being positive
- Increasing knowledge of psychosis
- Being aware of possible triggers
- Encouraging healthy behavior
- Devising a game plan if a crisis should occur
Overcoming acute psychosis is a team effort. There are many avenues of support available to those living with psychosis and their family members.
A list of places to call to receive support and resources concerning psychosis include:
- NAMI HelpLine: 800-950-NAMI(6264)
- NAMI Peer-to-Peer
- NAMI Connection Support Groups
- NAMI Family Support Groups
Being aware of the symptoms of acute psychosis and how to provide mental health first aid for psychosis can be life-changing. However, reaching out to help as a mental health first aider can be stressful. These hotlines can provide additional support and information on how to deal with acute psychosis:
- National Suicide Helpline: 1-800-273-8255
- Substance Abuse and Mental Health Services Administration’s National Helpline: 1-800-662-4357
- American Psychiatric Association Answer Center: 1-888-357-7924
- American Psychological Association Public Education Line: 1-800-964-2000
- The National Mental Health Association: 800-969-6642
- The National Poison Control Center: 800-222-1222
- Alcohol and Drug Abuse Helpline: 1-800-821-4357
- National Institute on Drug Abuse Hotline: 1-800-729-6686
If you believe someone with a substance use disorder is displaying signs of acute psychosis, you can reach out to The Recovery Village. Our toll-free line is staffed with representatives who can discuss treatment options for those experiencing acute psychosis related to substance abuse.
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Mentalhealthfirstaid.org. “Take a course.” Accessed April 8, 2019.
NAMI.org. “Early Psychosis and Psychosis.” Accessed April 8, 2019.
NAMI.org. “What To Do In A Crisis.” Accessed April 8, 2019.
Byrne, Peter. “Managing the Acute Psychotic Episode.” BMJ, March 31, 2007. Accessed April 8, 2019.
Parolaro, D. “[Adolescent cannabis consumption and schizophrenia: epidemiological and experimental evidences].” Medline, 2010. Accessed April 8, 2019.
Sit, D., Rothschild, A.J., Wisner, K.L. “A Review of Postpartum Psychosis.” J Womens Health, May 2006. Accessed April 8, 2019.
Trotman, H.D. et al. “The Development of Psychotic Disorders in Adolescence: A Potential Role for Hormones.” Horm Behav, July 2013. Accessed April 8, 2019.