How to help people in psychosis
Managing such a crisis isn’t one-size-fits-all. One expert says it’s best just to be there and to listen.
It was an April spring morning in Birmingham, England, and I had been experiencing severe symptoms of psychosis for two weeks. My only contact had been a kind flatmate making me dinner and leaving it outside my bedroom door. • I was convinced I was Britain’s most wanted criminal and that I was under surveillance by police. Holding this false belief, a symptom of a psychotic illness like paranoid schizophrenia, I felt overwhelmed and like the only way out was to kill myself. • I was lucky enough that, after my attempt, the sun started shining, and that offered me hope. I called emergency services for help — because a psychotic crisis needs to be treated in a hospital, by doctors and professionals, not by police officers, or in a jail.
I’m far from alone. About 3 in 100 people will experience psychosis at some point in their lives, according to the National Alliance on Mental Illness, and when they do, they’re at a marked increase of suicide attempts, self-harm and death. It’s often missed that psychosis and psychotic illnesses like schizophrenia can be treated effectively. What’s crucial is getting support early. That’s where people like you are so important.
I want you to understand that you can help someone in a psychotic crisis — like the unhoused people you might see on the streets of Los Angeles who are exhibiting various symptoms of psychosis. It might feel daunting, but it’s worth trying.
It helped me during my crisis for other people to build on small glimmers of hope that are always around — the sunshine, a cool breeze, some good news on the TV or a nearby pet.
However, psychosis crisis management isn’t one-size-fits-all. Friends and acquaintances with psychosis have told me that this wouldn’t work for them, and instead they would prefer to be listened to or guided by a trusted person with access to their personal safety plan (a plan devised by the patient and a professional while the patient is stable to mitigate future crises).
That said, there are still ways to help, regardless of someone’s preferred approach. Consider taking a Mental Health First Aid course, which trains you how to navigate a mental health or substance use-related crisis. It’s taught across the United States, including some free offerings. You can learn more at mentalhealthfirstaid.org.
Sophie Eggleton, who teaches similar courses, told me that the key thing in helping and comforting someone in a psychotic crisis is to not concentrate on fighting them on what they believe to be true at the time. “It’s good to share that you are concerned for them, but try not to show judgment even if what they’re saying is out of character or unusual. Try to stay calm and caring and if possible find out if they’ve experienced this before. If they have treatment in place they might be able to tell you what helps, or they might have a crisis team in place you can contact.”
Feeling compassion and practicing empathy are also key to helping those in distress with psychosis.
“Probably the best thing you can do for someone in extreme distress is to empathize with the fear that is often associated with these experiences and obviously seek medical support when you can,” psychologist Paul Gilbert, who founded compassion-focused therapy, told me. “And you should contact a doctor urgently if the voices are indicating harm to self or others.”
Psychologist Charlie Heriot-Maitland offers similar advice in his recent book “Relating To Voices Using Compassion Focused Therapy.” To help someone in psychosis, he says, it’s best to first just be there and listen.
“If she is very distressed, then her mind is likely to be organized in such a way that it will be difficult for her to process and utilize my suggestions,” Heriot-Maitland wrote. “So instead, I’d get alongside her, listen, allow, hold, wait, until she feels safe enough to start generating her own wisdom, ideas, and plans … Caring mental health workers will have the potential to help her feel calm, safe, validated, and understood.”
This was my experience in 2009 after my suicide attempt. Along with my kind roommate helping me stay fed, I was met with kindness from the medical team who arrived at my home when I called for them, including a nurse who encouraged me that I was going to be OK.
I was hospitalized and diagnosed with paranoid schizophrenia, a disorder where psychosis is the predominant feature. I stayed in a psychiatric hospital for only a week and responded well to an antipsychotic medication. So much good has happened since.
I earned my master’s degree in creative writing and rekindled love with my childhood sweetheart, Paul. If you’d told me in 2009 that I’d be sitting in my own office, my partner making breakfast, while I wrote for the Los Angeles Times, I would not have believed it. But recovery is possible.
I’ve since been diagnosed with schizoaffective disorder, which is slightly less troublesome than schizophrenia. I learned to live with my paranoid thoughts, and as I did, they took a back seat to the real drivers of my life: love, family, and good food and drink. I’ve even started to drive my own hatchback around the country lanes I live by.
As you drive down the streets of Los Angeles, I implore you: Please don’t give up on people with psychosis, especially if they are in a crisis. There’s hope — and treatment — for them. And sometimes, the first step is a kind soul noticing that they need help.