How to Support Someone With Psychosis

Watching someone you love go through psychosis can be frightening, confusing, and often lonely. Wanting to learn how to support someone with psychosis in the right way is a sign of how much you care. 

While there's no one playbook that works for every person, or in every moment, there are compassionate, practical ways to show up for your loved one that can make a real difference. This compassionate guide on how to support someone with psychosis walks you through what psychosis is, how to talk with your loved one if they are experiencing psychosis, what to do in a crisis, and how to take care of yourself along the way. 

What is Psychosis, and What is Your Loved One Experiencing?

Psychosis is a set of symptoms that changes how a person may perceive or interpret reality. Your loved one could experience a range of symptoms of psychosis, including hallucinations, such as seeing, hearing, or sensing things that aren't there, delusions, which are strongly held beliefs that don't match reality, and disorganized thinking that may make it hard to communicate clearly. Experiencing and witnessing psychosis symptoms can be scary. However, it’s important to know it’s rare for people experiencing psychosis to be violent. 

Psychosis can be a symptom of a mental health condition, such as schizophrenia, bipolar disorder, or severe depression. It can also be a result of substance use, sleep deprivation, or, in rarer cases, some medications. 

People with psychosis can also experience feelings of anxiety, intense emotions, lack of motivation, and difficulty functioning in their everyday life. How long psychosis lasts and whether someone experiences more episodes depends on the cause of the symptoms, if treatment was received, and other factors.

How Do You Talk to Someone Experiencing Psychosis? 

How to talk with someone experiencing psychosis can make a big difference in being able to support them. Many people with psychosis experience anosognosia, which is the inability to recognize they may not be well. Because of this, your approach to talking to someone experiencing psychosis should be to help them feel heard and safe, and find support, not to debate what they’re experiencing.

What to Say

• Speak simply and directly. If someone is experiencing psychosis, ask them one question at a time, and avoid presenting multiple options, to reduce confusion.
• Validate the feeling, not the belief. Instead of confirming or denying what they’re experiencing, respond to them with phrases like, "That sounds really scary. I'm here with you,” so they do not feel alone or not believed.
• Stay calm and steady. A relaxed tone can help de-escalate any fear or agitation that can accompany hallucinations or delusions.
• Offer clear, simple options, if appropriate. Yes-or-no questions or options can be easier to process. For example, if your loved one is experiencing something that is making them nervous, you can ask them, "Would you like to sit down?" to help them begin to regulate. This also gives your loved one a sense of control back, which can help de-escalate symptoms.

What Not to Say to Someone With Psychosis 

• Don't argue about what's real. When someone is experiencing psychosis, challenging or dismissing symptoms can make it harder for them to calm down. Arguing about what’s real can also make it more challenging to communicate and lead them to shut down communication completely.  
• Don't whisper, joke, or laugh nearby. Making light of what your loved one is experiencing can further increase paranoia or agitation, even if that isn't your intent.
• Don't give multi-step instructions. Complex directions are harder to follow and can raise stress in the moment. Yes-or-no questions or options help keep things less stressful.
• Don't take it personally. Fear, suspicion, or anger directed at you is a symptom of psychosis and not a reflection of your relationship or how your loved one feels about you. Getting defensive can further escalate the situation.

How Can You Support Someone With Psychosis Day to Day?

There are many ways to support someone with psychosis day to day. Support isn’t only needed during a crisis and should be built into every moment and interaction.

Build Predictable Routines

Helping your loved one build predictable routines around sleep, meals, and activities can help limit any unknowns and build trust with their surroundings. You can support them by helping to schedule their days and plan activities to provide the stability that keeps things predictable and fosters trust, which can help manage symptoms. 

Encourage Treatment Without Pressure

As a loved one, it’s not your role to force your loved one into treatment unless they are a danger to themself or others. Instead, offer to research options on their behalf, make calls on their behalf, or accompany them to any appointments.  

By framing care around what your loved one wants, whether it’s more sleep or less nervousness, rather than care for a diagnosis, you may also make more inroads on them following through with care. 

If you're exploring what treatment can look like, this overview of psychosis treatment options is a good place to start together.

Many families find NAMI's LEAP approach (Listen, Empathize, Agree, Partner) to be helpful. The approach focuses on listening to your loved one, finding common ground, and partnering with them around how to make sure they are safe, healthy, and taking care of themselves. 

Know When to Keep Your Distance

It’s important to know how to stay safe if your loved one is experiencing psychosis. 

During a psychotic episode, your loved one may act in unexpected ways and could feel threatened if they don’t have enough space. You can communicate that you are giving your loved one space to see if that helps them feel more comfortable.

However, if you feel the situation is becoming dangerous, it’s important to remove yourself and seek emergency help. 

Educate Yourself

You’re already educating yourself by reading this compassionate guide on how to support someone experiencing psychosis. Understanding of your loved one’s condition can help you support them day to day. Other ways to support them are joining support groups for family and friends, which can help you take better care of yourself and learn coping skills from others who “get it.” 

How Do You Help Someone With Psychosis During a Crisis? 

Helping someone with psychosis during a crisis in the right way can make all the difference.

How to Recognize a Crisis

Knowing how to recognize a crisis before it escalates is helpful for both you and your loved one. 

Signs someone experiencing psychosis may be reaching a crisis may include:

• rapidly increasing agitation or fear
• disorganized or erratic speech 
• erratic and unsafe behavior
• statements about harming themselves or others

None of this means your loved one is "dangerous”. It often means they may need urgent crisis support. 

When and How to Get Urgent Help

If your loved one is in emotional distress or a behavioral health crisis but isn't in immediate physical danger, you can call or text a crisis line such as 988, the Suicide & Crisis Lifeline, for free, confidential support. Fewer than 2% of 988 calls require escalation to emergency services. 

You can also help your loved one to schedule an urgent virtual behavioral health visit with a provider from Willow Health.

If your loved one is a danger to themselves or to others, or if you feel like there is an emergency, dial 911. If you're weighing whether a visit is necessary, this article on what is a psychiatric emergency can help you decide together.

How Do You Cope While Supporting Someone With Psychosis? 

It can be hard to cope while supporting someone with psychosis. Caring for a loved one through psychosis is demanding, and it’s important to remember your wellbeing matters, too. Taking care of yourself helps you be a better support person.

Ways to cope while supporting someone with psychosis include:

• follow your typical routines, including sleep schedule, meals, and exercise
• give yourself permission to feel all the ways you’re feeling, even if it may feel contradictory, such as hope and fear
• ask for and accept help from others 
• let your own care team know you're a caregiver
• connect with others who understand, through a support group like NAMI Family Support Group or Family-to-Family class 

You don’t need to care for a loved one experiencing psychosis alone. There are many ways to share and lessen whatever burden you may feel. 

How Willow Health Can Help

Willow Health can help someone experiencing psychosis or a crisis by getting them virtual crisis stabilization care within 48 hours or less. 

Oftentimes someone experiencing psychosis needs support beyond what a single ER visit can offer. Willow Health offers evidence-based, intensive support right from home, without waiting for a traditional outpatient program to have an opening or the cost of an inpatient stay.  

Supporting someone with psychosis does not have to be managed alone. If you're not sure what your loved one needs right now, the multidisciplinary care team at Willow Health, which includes psychiatric medication providers, therapists, care managers, and peer coaches, can help you figure out the next right step.

Frequently Asked Questions  

What should you not say to someone with psychosis?

There are multiple types of things not to say to someone with psychosis. Avoid arguing about or dismissing what they're experiencing, even if it isn't factually true or happening, as it can feel invalidating, break down trust, or further escalate the situation. Also avoid whispering, joking, or laughing nearby, which can be misread and increase fear or paranoia, and steer clear of complex, multi-step instructions that are hard to follow under stress.

Can you force someone into treatment?

Yes, you can force someone into treatment if they are a danger to themselves or others. In most situations, though, treatment generally requires a person's consent. However, the exception is involuntary commitment, which is a legal process in which laws can vary in every state. Forcing someone into treatment through involuntary commitment is usually a last resort. 

How do you help someone who doesn't think they're unwell?

You can help someone who doesn’t think they’re unwell by focusing on connecting with them instead of trying to convince them they are unwell. You can focus on shared goals they may already want, such as better sleep, less fear, or feeling more calm, and then gently refer to those goals as you recommend different approaches of support and treatment. Consistency, patience, and avoiding power struggles tend to open more doors than insisting they accept a label they aren't ready for.

References

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

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

Substance Abuse and Mental Health Services Administration. (n.d.). 988 Suicide & Crisis Lifeline. https://www.samhsa.gov/mental-health/988

Medication-induced psychotic disorder. A review of selected drugs side effects.