Would You Know What to Do If Your Friend or Family Member is Experiencing a Psychosis?

I have been trained in CPR to help someone having a heart attack, and I’ve learned how to administer Naloxone (a.k.a. Narcan) to people who are experiencing an opioid overdose. But I had not been taught what to do with someone who is having a psychotic episode. I recently attended a Mental Health First Aid workshop in which we were taught how to identify, understand and respond to signs of mental illnesses and substance abuse disorders. One problem that is most commonly misunderstood is psychosis.

Psychosis is a general term used to describe a mental health problem in which a person has lost some contact with reality. The NIMH (National Institute of Mental Health) defines an episode of psychoses as one in which a person’s thoughts and perceptions are disturbed and the individual may have difficulty understanding what is real and what is not. Symptoms of psychoses include delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). Other symptoms include incoherent or nonsense speech, and behavior that is inappropriate for the situation. Psychoses may involve delusional beliefs, some of which are paranoid in nature. Signs and symptoms of psychoses vary from person to person and can change over time. People in early stages of a psychosis often go undiagnosed for a year or more before receiving treatment.

Psychoses can occur with a number of mental health disorder such as schizophrenia, bipolar disorder, intense depression or it can be brought on by prescription drugs or illegal substances. It is caused by a combination of factors such as genetics, biochemistry, and stress. Stress and drug abuse may trigger an episode. Early intervention is important. The longer the delay between the onset of psychosis and start of treatment, the less likely the person is to recover.

So, how do you help someone who is in a psychotic episode? Your task is to de-escalate the situation. Mental Health First Aid’s Action Plan utilizes an acronym ALGEE.

Action A: Assess for risk of suicide or harm. There is a very small percentage of people experiencing psychoses who will threaten violence. They are not usually aggressive and are more likely to harm themselves than others. But if it occurs, don’t put yourself in a position of potential harm. Draw them outside or to a place of easy escape.

Action L: Listen nonjudgmentally. Approach them in a caring manner to discuss your concerns and let them know that you are interested in what they are going through. It is best not to try to reason with people having delusions. Don’t confront or criticize. Don’t act alarmed by the person’s delusions or hallucinations, and don’t encourage or inflame their paranoia if they have them.

Action G: Give reassurance and information. Offer support and understanding while conveying a message of hope that there is help available and things can get better. Provide practical help by asking what they need to feel safe and in control. Offer them choices of how you can help. Provide resources that are appropriate to their situation.

Action E: Encourage appropriate professional help. Ask them what they have done in the past that has been helpful. Support them in accessing services.

Action E: Encourage self-help and other support strategies. Friends and family are important resources. A person is less likely to relapse if they have good relationships.

Let’s make Mental Health First Aid as common as CPR. Find a class or become a trainer at https://www.mentalhealthfirstaid.org.