What can I do if a friend is having a psychotic episode?
Psychosis blurs the line between what’s real and what’s not. This can cause hallucinations (seeing, hearing or feeling things that aren’t there) and delusions (believing something that is unlikely to be true and that isn’t believed by others). Thoughts and speech can get disorganised and the person experiencing it may not recognise that their behaviour is unusual or out of character.
Not a diagnosable condition itself, psychosis is often triggered by another mental health condition like schizophrenia, bipolar disorder or severe depression. Some mothers will also experience postpartum psychosis after they’ve had their baby.
If you suspect a friend is experiencing psychosis, it’s understandable to feel confused and worried for them. You may struggle to know how to help them or whether or not you can but, as counsellor Nicola Strudley explains, ignoring the warning signs could do more harm than good.
“If you have never experienced a person in the midst of a psychotic episode it would be natural to feel frightened, scared and confused. You might even want to ignore the signs that your friend is not quite themselves. It might be that they have started seeing or hearing things that aren’t there, they might hold strange beliefs that you know not to be true. Ignoring early warning signs is never a good idea.”
Listen to the person
The good news is that you can help them, it’s just a case of how. Talking about what’s happening is usually a helpful tactic, but asking someone who’s experiencing psychosis to explain what they feel is happening can be difficult, Nicola says.
“My advice would be not to ask them what’s going on, as they are in a confused state, probably struggling to understand themselves. Trying to articulate what you are thinking, feeling and doing, in the midst of a psychotic episode, is like trying to find your way out of a maze in the dark of night – it only adds to the confusion and isolation.”
Instead, Nicola suggests you support them by listening in a non-judgemental way and providing a sense of safety.
“Let them know you are there to support them and will help them get the professional support they need to get better. This might mean calling NHS 111 for advice, taking them to a walk-in centre or getting them to see a GP. They may need you to attend with them in order to promote the trust and reassurance that they need.”
Try to focus on what they’re feeling rather than the details of what they’re experiencing. For example, instead of asking them to describe in detail a hallucination they’re seeing, ask them how it’s making them feel. Their hallucination could be a comfort to them, or it could be frightening. When talking to them, try to speak in a slow, calm and simple way. Psychosis can make thoughts and speech very confused so being clear can help your friend understand what you’re asking.
Remember your friend is still your friend. Avoid talking about them as if they’re not there and try not to discount their experiences. Even if you can’t understand what they’re thinking, seeing or hearing, it doesn’t make it any less real to them.
Supporting them in the future
Being there to listen to how they’re feeling without judgement, reassuring them that they’re safe and offering practical help to get professional support is key according to Nicola.
“Taking the first step to get help is the hardest and most difficult to make. So being there for your friend at this most difficult, traumatic time can make all the difference.”
If there’s a chance your friend could struggle with psychotic episodes again in the future, it can help to plan for it. When your friend is feeling better, you may want to ask them how you can support them if something similar happens in the future. Having a list of numbers to call for example can be very helpful.
Try to learn more about what they’re going through. You may never see or believe the same things they do during a psychotic episode, but taking the time to understand psychosis and how it affects them goes a long way.
Finally, make sure you’re taking care of yourself too. It can be easy for us to let our own self-care practices fall through the cracks when others are struggling with their mental health, but it’s important for you to rest and get support yourself when you need it. Far from being selfish, looking after yourself will ensure you stay well and capable of supporting others.
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Written by Nicola from Counselling Directory, an online mental health resource hub dedicated to connecting people to the help they need.
