How can I help my loved one during a psychotic episode?
Note: NAMI volunteers are not medical or mental health professionals, and we cannot offer medical or mental health advice. The material outlined below is informational and we hope that it helps provide guidance toward getting support.
Seeing someone you care about experiencing symptoms of psychosis can be difficult. Psychosis is a symptom of a group of serious conditions that affect the mind, where there has been some loss of contact with reality. People living with psychosis experience disruptions to their thoughts and perceptions that make it difficult to recognize what is real and what isn’t. They may see, hear, feel, taste or smell things that aren’t there or have strange, persistent thoughts, behaviors, and emotions. While everyone’s experience is different, most people say psychosis is frightening and confusing.
If you are concerned about a loved one who is experiencing psychosis, NAMI can help. NAMI and NAMI Affiliates provide support and information about programs and community resources for you and your family.You can prepare yourself by learning more about serious mental illness. NAMI’s Psychosis page provides information on related mental health conditions, current treatments, ways to support recovery, and links to fact sheets that discuss What is Early and First Episode Psychosis, Early Psychosis: What's Going On, What Can You Do, Encouraging People to Seek Help for Early Psychosis, and Early Intervention Tips for School Staff and Coaches.
You may want to reach out to your local NAMI Affiliate to look into participation in a NAMI Family-To-Family class where you can find information and strategies for taking care of the person you love, or a NAMI Family Support Group where you can gain insight from the challenges and successes of others facing similar experiences. Also, NAMI Peer-to Peer is a free educational program where your loved one can get help better understanding themselves and their recovery, while NAMI Connection is a support group for individuals who experience mental illness. Additionally, you may find the NAMI Ask the Expert Webinar: Supporting a Loved One with Psychosis to be helpful.
Helping During a Psychotic Episode
It can be distressing to see a loved one experiencing psychosis, but there are some ways you can try to help.
- Stay calm. Respond calmly and gently; avoid arguing with or confronting your loved one about their beliefs or behaviors.
- Listen. People living with psychosis can feel isolated by their symptoms. Use active listening to build trust with your loved one: “I hear you saying that people are following you and they seem scary. Do I have that right?”
- Be an ally. Your loved one’s thoughts and experiences feel real to them. You can help them manage their anxiety and confusion by offering empathy for their feelings: “That must be frightening for you. I would feel scared, too, if that was happening to me.”
- Strengthen the relationship. Listening and offering empathy can build the kind of positive, trusting relationship with your loved one that may eventually help them agree to partner in their recovery.
- Focus on the person, not the delusion.Being helpful to your loved one doesn’t mean confirming that their thoughts and experiences are real. Instead, try simple, supportive statements like,“I don’t know what to make of what you’re saying. It’s distressing to hear this, but I’m glad you’re telling me. How are you handling it?”
- Offer assistance. Ask if you can help in practical ways. “I know you’ve been anxious about going out lately. Do you need groceries? Would you like a ride to the store?”
- Reach out for help.If your loved one’s symptoms reach a point where they area risk to themselves or others, or they’re not meeting their basic needs (e.g., not eating, not drinking, putting themselves in danger), seek urgent help.
How Can I Get My Loved One to Realize They Need Help?
Often an individual living with a mental health diagnosis – particularly one that involves a serious mental health condition (or one complicated by substance use disorder) – may not actively participate in their own recovery. This is known as Anosognosia [Ah-no-zog-nosha], a symptom that can accompany a serious mental health condition and render the individual unable to recognize that they have a mental health condition and/or that they need to seek help. Anosognosia can be especially troubling for families and friends who are often responsible for providing care for their loved one.
To learn techniques for communicating with your loved one, and to help them agree to partner in their recovery, we would recommend reading I’m Not Sick, I Don’t Need Help!, a book by Dr. Xavier Amador - a psychologist whose experiences with his own family demonstrated how challenging this phenomenon could be. In his book, Dr. Amador discusses the condition of anosognosia and outlines strategies for communicating with a loved one to help them work toward recovery. Portions of the book are accessible to the public on our website here; the book is available in English and Spanish for purchase at online booksellers.
A broader discussion of the strategies of Dr. Amador’s LEAP method, including videos on how to apply the LEAP method, are available for public access here.
Coordinated Specialty Care
If your loved one’s symptoms have presented within the past two years and they are between 16 and 30 years of age, they may qualify for the Coordinated Specialty Care services of a First Episode Psychosis program.
Coordinated Specialty Care (CSC) refers to treatment programs designed for people between the ages of 16-30 who have been experiencing symptoms of psychosis for two years or less. Clinical research shows CSC to be more effective at the long-term reduction of symptoms and improvement of quality of life. A CSC program will involve a team of behavioral specialists that work with the client and their caregivers to create a treatment plan involving:
- Coordination with primary care physician
- Recovery-oriented psychotherapy
- Medication management
- Individual and family education and support
- Case management
- Work and/or education support
To find a CSC program in your area, you may wish to consult:
- Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) maintains an Early Serious Mental Illness Treatment Locator as a source of information for family members who are seeking CSC programs across the United States.
If your loved one does not qualify for a CSC program, we suggest building your own team of behavioral health providers who specialize in the areas listed above.The following link includes sites offering resources for families and individuals, examples of which include (but are not limited to) the Early Assessment & Support Alliance, RAISE, and Specialized Treatment Early in Psychosis (STEP).
Cognitive Behavioral Therapy for Psychosis
Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based treatment approach shown to improve symptoms and functioning in patients with psychotic disorders. CBTp was developed as an individual treatment, and later as a group-based intervention to reduce the distress associated with the symptoms of psychosis and improve functioning. More information can be found in this CBTp Fact Sheet.
Being Prepared for a Crisis
Being prepared for a crisis by learning about resources and support services allows you to act fast and make good decisions. You may find the information contained in the section of NAMI’s website on Getting Treatment During a Crisis to be particularly helpful. You may also find our NAMI Guide, Navigating a Mental Health Crisis to be extremely informative. Practical tips for what to do and how to react when a loved one is experiencing psychosis and in or near a crisis may be found here. Additionally, the My Mental Health Crisis Plan App lets individuals clearly state treatment preferences, decide who can make decisions on their behalf, and share a crisis plan with doctors and other members of their care team.