How to Stay Safe Around Someone Experiencing Psychosis

The symptoms of psychosis, such as hallucinations and delusions, sound scary. Because of this, there’s been a significant amount of stigma towards people having these symptoms.

But stigma is often the result of a lack of knowledge. For example, it’s often assumed that people with psychosis can be dangerous. But the reality is that most people experiencing psychosis are not violent. In fact, they’re more likely to be the victims of violence themselves. 

Understanding what psychosis is can help you better support someone with psychosis. You can learn to show compassion while keeping you both safe.

In this article, we’ll go over the signs and symptoms of psychosis. We’ll also provide safety, communication, and self-care tips to help you better support a loved one with psychosis. 

Understanding Psychotic Episodes

Psychosis isn’t a mental health condition in and of itself. Instead, it’s a collection of symptoms. Psychosis can be caused by mental health conditions, like schizophrenia. It can also be caused by medical conditions, like dementia or lupus, or the use of certain medications. 

Common Symptoms and Presentations

Common symptoms of psychosis include:

• Hallucinations (seeing, hearing, or feeling things that aren’t there).
• Delusions and false beliefs. For example, believing that someone is controlling their thoughts or watching them. Or, thinking an imposter is replacing a loved one.
• Disorganized thinking and behavior. For example, fragmented or incoherent speech.
• Negative symptoms, such as a lack of emotion, flat speech, and withdrawal from friends and family members.
• Cognitive symptoms, such as difficulty focusing and remembering things.

It’s also important to note that symptoms can vary from person to person and change over time. Psychosis symptoms can also differ based on cultural norms. For instance, a behavior seen as a symptom in some cultures might not be viewed the same way in others.

Myths vs. Reality About Psychosis

Myth: People with psychosis are violent. Reality: Most people with psychosis aren’t violent. Only about 10% of people with psychosis have violent tendencies.

Myth: People with psychosis have split personalities. Reality: People with psychosis don’t have split personalities. People with a different mental health condition, dissociative identity disorder (DID), have multiple personalities.

Myth: People with psychosis can’t live normal lives. Reality: Many people with psychosis live healthy, productive lives.

Myth: People with psychosis are psychopaths. Reality: Psychosis and psychopathy are not the same. Psychopathy is a different mental health condition. 

Myth: Psychosis can’t be treated. Reality: Psychosis can be treated, often with a combination of medication and therapy.

Myth: Psychosis is really rare. Reality: About 3 out of 100 people experience an episode of psychosis in their lifetime. Psychosis is more common than people think. 

Duration and Variability

Psychosis has many causes. This means the length of episodes and the number of episodes can vary for each person. Acute psychosis is a temporary episode of psychosis. It’s often caused by extreme stress, a lack of sleep, or certain substances. Acute psychosis fully resolves with treatment or time. 

Chronic psychosis is more long-term. People with chronic psychosis usually have a mental health issue. This can include schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features. They may also have a chronic medical condition that is causing the psychosis, such as dementia, lupus, or a neurological disorder. People with chronic psychosis often need ongoing treatment to help manage symptoms.

Recognizing the Signs

Knowing what signs to watch for can help you identify small behavioral changes and monitor for worsening symptoms.

Early Warning Indicators

Initial symptoms of psychosis are often mild. However, when symptoms are mild, it’s often easier for the person themselves to recognize that something might be going on. This can make it easier to seek early treatment, which can make treatment more effective. Early warning indicators can include sudden changes in the person’s behavior or the way they communicate, such as:

• Withdrawing socially.
• Changes in sleep or appetite.
• Difficulty keeping up with daily responsibilities or personal hygiene.
• Changes in speech.
• Lack of interest in things previously enjoyed.
• Changes in the way that they see themselves or others (for example, believing that others are acting differently).
• Difficulty with focusing or thinking.
• Irritability, anxiety, or restlessness.
• Reduced energy and motivation.
• Showing a lack of emotion.
• Expressions of hopelessness or worthlessness.
• Rapid changes in mood.
• Speaking about distress or harm.

Escalation Signs

Early warning signs that can get worse can indicate that a psychotic episode is progressing. People may pull away from their support networks. They might also feel more agitation, aggression, or paranoia. Their speech might become quicker, and they might have difficulty completing tasks or making decisions. They can also appear confused or disoriented.

Certain environmental triggers can also raise the risk of psychotic episodes and make symptoms worse. These include:

• Major life changes, such as moving, losing a loved one, or losing a job.
• Relationship stress.
• Overwhelming workload.
• Exposure to trauma reminders.
• Chronic illness or pain.
• Substance use (including drugs, alcohol, and medications).
• Lack of sleep.
• Sensory overstimulation, such as loud, crowded places.

Safety Strategies

Being aware of safety strategies can help both you and someone who is experiencing a psychotic episode stay safe.

Environmental Awareness

It’s important to be aware of the environment that you are in. This means that you know where the exits are in case you need to leave for your safety.

Ensure that you have a path to the exit, but don’t block the doorway. This allows the other person space to move and leave if they need to. If it’s safe to do so, remove any weapons or potentially dangerous objects. This might include sharp objects, heavy objects that could be thrown, or breakable items. 

Being aware of the environment also means being aware of any triggers. If there are certain items in the room that seem to be triggering the person, such as images or certain objects, you can remove or cover them if it is safe to do so. Also, be aware of the number of people in the room. While multiple people might want to help, a room full of people can be stressful and overwhelming to someone who is having a psychotic episode. 

De-escalation Techniques

Your body language can go a long way to help ease a situation. Calm, unthreatening body language includes a relaxed posture with open arms.

Avoid any sudden movements and keep a distance so that the other person doesn’t feel blocked in or threatened. Intense, direct eye contact can also feel threatening. Instead, stay on their side or get on their level so that you can make occasional eye contact without looming over them, which can feel intimidating.

Staying calm yourself can help the other person stay calm and help to keep your body language relaxed. Take time to check in with how you’re feeling and use calming techniques, such as taking deep breaths. It’s also important to recognize your own limits. If you’re feeling overwhelmed, then you’re not able to help the other person, so take a step back. If necessary, call for help.

When to Maintain Distance

When someone is having a psychotic episode, they can act in unexpected ways. It’s important to give them space and avoid touching them so that they don’t feel threatened.

Keep an eye on any signs of increasing agitation, as a person may become more agitated if they don’t have enough space. Signs of increasing agitation include:

• Clenched fists, restlessness, or sudden movements.
• Lack of communication or “shutting down”.
• Speaking quickly or raising their voice.
• Intense eye contact.
• Threats or aggressive language.

If you’re giving the person more space, make sure to communicate this so that they understand what you’re doing. For example, you might say, “I’ll move over here so that you feel more comfortable.” If the agitation continues to increase despite more space, remove yourself from the situation and call for help. 

Creating Safe Spaces

Along with offering space and removing any dangerous or triggering objects, there are several things that you can do to help the person feel safe. First of all, provide them with things that they might need, such as water or tissues. Set these nearby instead of giving them directly to the person, allowing easy access if they want. 

Environmental stimuli can also be overwhelming for a person who has psychosis. Try to keep the room as quiet as possible, turning off the television or any music. If possible, turn off or dim any harsh lights. 

The symptoms of psychosis can make it difficult to trust people. If you know that there is someone whom the person trusts, call them so that they can be there for the person who is having the psychotic episode.

Know that psychosis can also make a person feel out of control, and offering them choices is a way for them to regain this control. For example, you might ask them if they prefer to sit or stand, or if they’d prefer to have their jacket on or off.

Effective Communication 

It can be difficult to communicate with someone with psychosis. They may be speaking in ways that you can’t understand, change topics quickly, or be distracted by things you can’t see or hear.

In this section, we’ll go over effective communication techniques that you can use to help support someone with psychosis. Remember, just because someone in a psychotic episode doesn’t respond appropriately, it doesn’t mean they don’t understand you. This is why it’s important to continue to use these techniques for effective communication.

Speaking Techniques

Symptoms of psychosis can be very overwhelming, so it’s important to use clear and simple language when communicating. You’ll also want to keep your tone and volume neutral and your pace even to avoid overwhelming the person. 

Keep in mind that someone who is having a psychotic episode might have trouble thinking clearly. Give them time to think and respond to what you’ve said, and repeat things if necessary. You can even ask the person if they’d like you to clarify or repeat what you’ve said. 

Addressing Delusions

When someone is having delusions, it can be tempting to try to talk them out of it. However, doing this isn’t the best idea, as it can lead to tension and defensiveness.

For someone with delusions, their beliefs feel very real. Trying to convince them otherwise can be very upsetting. Instead, try to remain neutral, neither agreeing nor disagreeing about the beliefs. For example, saying, “That sounds really frightening” can show support for someone’s feelings about a delusion. It does this without agreeing or disagreeing with the delusion itself. 

Validating Emotions

Rather than focusing on the reality of symptoms, try to focus on validating the emotions toward the symptoms. For example, if someone is experiencing distress about a hallucination that they are having, agree with them that it would be very scary. Show empathy and concern to help ground them in the moment. 

Reflective listening can also be helpful. This involves repeating the person’s feelings back to them. For example, if someone says that they are being watched and need to hide, reflect their feelings back to them by saying, “I hear that you are feeling anxious and worried about someone watching you”.

What Not to Say or Do

Even if you have good intentions, certain things can escalate the situation. While you may want to provide a soft touch to help calm the person, this can be too overwhelming and crowding. It can also be harmful to try to convince someone to calm down quickly by threatening consequences if they don’t. Phrases to avoid include:

• “You need to calm down.” - While well-intentioned, this can seem dismissive of what a person is feeling. 
• “Everything will be fine.” - While meant to be reassuring, this oversimplifies things.
• “You’re imagining things.” - Although intended to calm, this can lead to distrust or agitation.
• “If you don’t stop, I’ll call the police.” - This ultimatum can increase the amount of fear that a person feels.

When to Seek Help

Knowing when to seek help is important for keeping a situation from escalating.

Emergency Situations

If someone is an immediate threat to themselves or others, call 911. NAMI suggests telling the operator it's a mental health emergency and you need help. Inform the operator about any mental health diagnoses the person might have.

It’s also recommended to meet the emergency responder outside to let them know what’s going on and provide them with any helpful information. Let them know about any weapons or potentially dangerous objects for everyone’s safety.

Professional Support

While it’s important to call 911 if someone is an immediate risk to themselves or others, there might be situations where the person is having a mental health crisis and needs help but isn’t a risk to themselves or others.  In these situations, you can call the Suicide & Crisis Lifeline at 988.

A mobile crisis team is also an option. These are teams of mental health professionals who can help assess an individual, de-escalate a situation, and refer them to inpatient or outpatient treatment. Mobile crisis teams are best in situations where there isn’t an immediate safety risk, but the person isn’t able to call or text the Suicide & Crisis Lifeline. You can request a mobile crisis team by calling 988.

In some situations, community resources may also be used to help manage situations. These might include outpatient treatment and peer support groups. In outpatient treatment, providers might create a safety plan to help prevent the situation from escalating.

Supporting Long-Term Recovery

In this section, we’ll go over how to support long-term recovery.

Building Trust and Rapport

Someone with psychosis may feel frightened by the changes they experience or worry about feeling “different.” They might also find it difficult to trust others due to the symptoms that they are experiencing. This is why consistent, respectful interactions are important. 

It’s also important to respect a person’s autonomy and dignity. While symptoms of psychosis can seem scary, people need to make their own decisions to start treatment. Emergency treatment isn’t required unless they are a risk to themselves or others. Instead, focus on developing trust so that you’re there to support them when they do decide to seek treatment. 

Encouraging Treatment

It can be difficult for someone who has psychosis to seek treatment. Because someone with psychosis may have trouble differentiating between what is real and what isn’t, they might not recognize that they’re having symptoms that can benefit from treatment. In fact, it’s common for people with psychosis to have symptoms for more than a year before seeking treatment.

One way to encourage someone with psychosis to seek treatment is to practice active listening. This shows that you care about a person without showing any judgment. Validating how they are feeling and the courage that it takes to seek help is also important. 

If a person decides to start treatment, a doctor might recommend medication. Medication management can be difficult, especially when a person is undergoing a crisis. You might offer to help set them up with practical reminders, such as a pill case. Highlighting the benefits that you see when a person regularly takes their medication can also be helpful. 

Friend and Family Involvement

Loved ones can provide great support to help people who are living with psychosis. Learning about the condition can help a lot; the more understanding that you have, the more that you’re able to talk to your loved one from a place of understanding. Attending support groups for friends and family members can support this learning process while also introducing you to coping skills. Offering practical support, such as driving someone to their appointment or dropping off a meal, can also be helpful.

However, it’s important to set boundaries around your help so that you’re able to prioritize your own needs. Let your loved one know when you are available. Ensure that you are taking the time to focus on your own self-care so that you are able to take care of yourself and your responsibilities.

Self-Care for Supporters

Practicing self-care is important. It protects your own well-being so that you’re able to support the ones you love.

Managing Your Own Response

It’s normal to feel confused and fearful when your loved one is going through psychosis. As a support person, your role is to validate how they’re feeling rather than to try to fix it. It’s important to recognize your limits and encourage them to get help from a trained professional. 

Keep in mind that supporting a loved one with psychosis can bring up emotions for you. It’s normal to feel worried, angry, or upset about what’s happening. If these emotions impact your daily life, consider counseling. It provides a safe space to process your feelings and learn new coping skills. 

Finding Support

There are a number of support groups and education programs designed for friends and family members of people living with psychosis. These resources can help you better understand psychosis, learn supportive strategies, and support you with what you might be feeling.

‍Caregiver Toolkit - Schizophrenia & Psychosis Action Alliance

Hearing Voices Network USA Groups 

How Can I Help My Loved One During a Psychotic Episode? - NAMI Helpline

NAMI (National Alliance on Mental Illness) Family Support Group

NAMI (National Alliance on Mental Illness) Helpline

Schizophrenia & Psychosis Action Alliance Family & Caregiver Support Groups

Schizophrenia: Guidance for Patients, Families, and Friends - American Psychiatric Association

Tips for Communicating with Someone Experiencing Psychosis - Step Clinic

Understanding and Addressing the Stigma Experienced by People with First Episode Psychosis - SAMHSA (Substance Abuse and Mental Health Services Administration)

Understanding Psychosis in Youth: Resources and Recovery - NAMI Minnesota (National Alliance on Mental Illness)

Sources

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National Alliance on Mental Illness. (n.d.). Psychosis. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Psychosis/

National Institute of Mental Health. (n.d.). Understanding psychosis. U.S. Department of Health and Human Services. https://www.nimh.nihgov/health/publications/understanding-psychosis

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