Assessing a Psychotic Episode
Recognize the beginning of a psychotic episode. Psychosis is a symptom of various serious mental illnesses, and is defined as a psychological break with reality. If the person seems to drift mentally, if their speech becomes slurred and incoherent, or if they respond to auditory or visual hallucinations, they might be experiencing a psychotic episode. If you know a person around you has a history of psychotic episodes, seek hints. Common behaviors in the days before a psychotic episode include: depression or irritability, alternating between inactivity and hyperactivity, and preoccupation with certain ideas, or social withdrawal. Pay attention to what the person's triggers are—if they're especially stressed, for instance, or if they aren't eating well, it might increase their chances of having a psychotic episode.
Call the person’s name. Talk to the individual, and try to get them to respond and communicate as much as possible. Make sure to keep calm as you do so and avoid making them feel judged. Just be there for them and try to keep yourself and the environment as calm as possible. If the psychosis is not too severe, gently ask the individual what they’re seeing or experiencing. Keep them calm and make the conversation as normal as possible. If you respond to the psychotic episode with fear and anxiety, it could further trigger the psychotic individual and worsen their experience. Ask if there’s something wrong, and if they respond, try to get them to describe what they’re experiencing. Say something like, “I’m not sure what you’re experiencing, can you try to describe it to me?”
Ask the person if they have any medications for emergencies. If the individual answers coherently and affirmatively, get them to take the medication. Also contact the individual’s mental healthcare provider as soon as possible. Ask the individual going through this psychotic episode if they’ve had episodes like this before. Find out what helped previously, and repeat that treatment as much as possible. You may also want to ask if the person has taken any non-prescription drugs. For example, if the person has taken a hallucinogen such as LSD, then this would help to explain their behavior.
Get rid of spectators. Nobody likes to be stared at when they're struggling. Usher away anyone who doesn't need to be here, such as children or curious strangers. Try sitting somewhere quiet, but make sure you are not isolated and both have plenty of space and clear paths to exits. A rule of thumb is to give someone experiencing active psychosis five times the amount of space as a normal conversation to help them de-stimulate. Children may be scared, curious, or needy, and could upset the person who is having the episode.You can give them a job to do, like "call Dad and tell him to come help Mom" or "take your sister to the park, and wait for me to call or come get you." If the person is severely distressed and could become aggressive, take special care to get vulnerable people (such as children, elderly people, and disabled people) away. If possible, try offering to take the person somewhere nearby where they feel calm. For example, if your aunt loves the outdoors, you could take her to the yard, or if your little brother feels safe in his room, you could ask if he'd like to go there with you. However if you are not positive that the person is able to maintain safety for others and themselves, it is not safe for either of you to be alone together and it is time to call for help.
Err on the side of caution. Psychotic episodes are serious occurrences, and you need to treat them as such. If you’re around someone who may be having a psychotic episode (especially if it’s someone you don’t know), or if you’re not sure if they may become violent, it is important to call for help. An actively psychotic person may not realize that they need help in the moment, but if the tables were turned, they would not hesitate to get help for you. If you don’t know the person having the episode or don’t know them well, then call for help right away. They may have a friend or family member nearby who is better equipped to assist them.
Handling a Violent Psychotic Episode
Assess the situation for danger. It is rare for an individual undergoing a psychotic episode to become violent, although it can happen. Psychotic individuals are at a greater risk of harming themselves. Any threats of violence, self-harm, or suicide should be taken seriously. A history of drug and alcohol abuse increases the likelihood of the person becoming violent.
Stay away if the situation becomes threatening or violent. If at any point you suspect the person might be dangerous, either to themselves or to others, call for help immediately. Consider calling an ambulance or other medical experts specifically—if there’s no time to look up phone numbers, just call emergency services. If you’re in a room with an aggressive person, leave the room immediately. If police arrive on the scene, try to explain the situation before they interact directly with the person experiencing the psychotic episode. Without interfering and endangering yourself or others, encourage officers to remain calm and resolve the situation without the use of force.
Protect the psychotic individual from themselves. If the person is dangerous to themselves, remove any sharp objects and dangerous materials from the person and from the room, and lock any un-barred windows and balconies. Try to keep the person calm. Call the police or an ambulance if there’s a chance the person will attempt suicide or cause themselves serious physical damage. If they ask why you are holding something dangerous (e.g. a knife), say "I'm putting it away." If someone is prone to psychotic episodes, it may be appropriate to keep sharps/potentially dangerous items locked. Speak to the individual calmly, and try to de-escalate the situation. If the psychotic individual is asking for things or making demands, comply with those that are safe and reasonable.
Avoid trying to restrain them, or put yourself in harm's way. If the psychotic individual is acting violent or threatening violence, don’t take it on yourself to solve the problem. You could risk personal harm, especially if you try to engage in a physical struggle with the psychotic individual. Your main priority should be keeping yourself and others safe. If you can do things to protect the psychotic individual (e.g. removing a knife from a nearby table top), make sure to keep yourself safe while doing so.
Handling a Non-Violent Psychotic Episode
Hold a calm conversation. If the psychotic individual is not violent, talk to them in a normal voice. It is best to give 5 times the amount of space, maintain an open posture, and avoid facing the person squarely, which could appear threatening. Try to comfort them, if they experience or hallucinate something unpleasant. The conversation should be simple; individuals going through a psychotic episode may find communication or speech difficult. Ask them questions, and if their mind seem to be drifting, try to grab their attention. Make sure to reassure them and let them know that you are there for them.
Make sure you do not play into the person’s hallucinations. Although you want to avoid blaming or criticizing the psychotic individual, you should also avoid playing into their psychoses. This will only worsen the situation and make the individual’s break with reality more difficult to come back from. However, try not to argue with them or engage in too much discussion with them. Instead of, “I hear the same voices too,” try saying “I don't hear those voices, but I can tell they are bothering you.” It's best not to directly contradict the person and tell them whatever they're believing is untrue. That might make them feel angry and unsafe, which will cause them to retreat further into whatever they're experiencing.
Show understanding. Empathize and validate their feelings. Psychosis can be a frightening and confusing thing to experience. The person may not understand how to handle it. Keep in mind that they can't “snap out of it,” nor is it their fault that this is happening to them. Let the person know that you take them seriously and support them. Here are some examples of helpful things to say: “I can’t imagine what you are going through, but I’m happy to listen.” “I don’t fully understand what you’re going through, but I understand it must be really difficult.” "Is there someone you trust that I can call for you?" "What can I do to help you feel safe right now?"
Get them to a doctor. A psychiatrist or psychologist can help figure out what caused the episode, and help prevent future psychotic episodes. If the individual is not already undergoing therapy and medical treatment, strongly encourage them to do so after the psychotic episode has passed. Seeing a doctor is important. Psychosis may be a sign of temporary stress (such as grief or sleep deprivation), but it could also be a sign of a mental health disorder, or a physical health problem that causes psychosis. Mental-health professionals will be able to help the person take steps to decrease the frequency and severity of their episodes. Make sure that the person has somewhere to go to get help after the episode. If they do not, then help them to find help. Things like self-care, stress management, and counseling can make a large difference to the person’s mental health.
Seek help yourself if you need it. Dealing with someone else’s psychotic episode can be very stressful, especially if the person is a loved one or you don't know what's wrong. It may help you to talk to a therapist or counselor. If the person is a loved one, follow up with them as well. Make sure they’re safe and healthy. As long as you don’t downplay the importance of their own experience, you can tell them about your experience of their psychotic episode and why it was difficult for you as well. Make sure not to criticize them or pass judgment about their experience. It is important to avoid making them feel bad about their behavior or to make them worry that they might have scared you away. They need to know that you don't blame them for their illness, and that you still care.
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