A psychotic episode can involve hallucinations, strongly held beliefs, confused thinking or changes in communication. The person may seem frightened, suspicious, overwhelmed or distracted by things that other people cannot perceive.
That can make approaching them feel uncertain.
There is no perfect opening sentence, and people experiencing psychosis do not all need the same response. A useful approach is usually calm, simple and unhurried. Start with the person in front of you rather than with assumptions about what psychosis should look like.
Before you approach
Take a moment to notice what is happening around the person.
If several people are gathered nearby, there is a lot of noise or the person already seems overwhelmed, adding more voices and attention may make the situation harder. Where practical, reduce distractions and avoid turning the interaction into a group confrontation.
Think about your own safety as well as theirs. Psychosis does not automatically make somebody dangerous, but any immediate risk should be judged from what is actually happening rather than from the label itself.
If the situation allows a calm conversation, approach in a way that gives the person space and does not make them feel surrounded.
A calm first approach
1Make your presence clear
Approach so the person can see or hear you rather than appearing suddenly. If they do not know you well, say who you are. Use their name if you know it.
Begin simply
A straightforward observation or offer of help is often enough. You might say that they seem upset or that you wanted to check whether they are all right. Avoid opening with a diagnosis or telling them that they are having a psychotic episode.
Speak calmly and clearly
Use an ordinary tone of voice and short, clear sentences. If the person is finding it difficult to organise their thoughts, several questions or long explanations may be difficult to follow.
4Give them time
Ask one thing at a time and allow time for an answer. Silence does not have to be filled immediately. If they seem distracted by voices or other experiences, they may need longer to process what you have said.
Ask what would help
Rather than assuming what the person needs, ask. They may want somewhere quieter, somebody they trust, help contacting an existing mental health service, or simply some space.
Respond to the distress without debating the experience
You do not need to agree that something the person sees, hears or believes is true. You also do not need to prove that it is false.
If somebody says they are being watched, for example, you can acknowledge that they seem frightened and ask what would help them feel safer without confirming that somebody is watching them or arguing that they are wrong.
If the conversation is difficult to follow
Psychosis can sometimes affect the way thoughts are organised and expressed. The person may move quickly between ideas, stop halfway through a thought or say things that are difficult for you to understand.
Try not to pretend you have understood when you have not.
You can say so calmly and ask about one part at a time. Repeatedly demanding an explanation, correcting every inconsistency or asking a rapid series of questions can add pressure to a conversation that is already difficult for the person to manage.
The aim is not to make their account fit neatly together. It is to understand enough about how they are feeling and what they may need next.
What is best avoided
- Do not crowd the person or turn the conversation into a group intervention.
- Do not laugh at, ridicule or dismiss what they are describing.
- Do not repeatedly tell them that what they believe is impossible or ridiculous.
- Do not pretend that you can see, hear or confirm something that you cannot.
- Do not bombard them with questions or insist that they explain themselves.
- Do not assume that unusual behaviour automatically means aggression or danger.
- Do not make promises that everything will be fine when you cannot know that.
If they do not want to talk
Approaching somebody does not guarantee that they will want to engage with you.
If there is no immediate safety concern, giving them time and space may be more helpful than pushing the conversation. You can make it clear that you are available, or ask whether there is somebody else they would prefer to speak to.
A person experiencing psychosis may also be suspicious of your intentions. Trying harder to persuade them that you are trustworthy may not help. Being calm, predictable and respectful can matter more than finding the right argument.
If they already have a mental health worker, crisis plan or another agreed source of support, ask whether they would like help making contact.
When the situation needs more than a conversation
An episode of psychosis does not automatically mean there is an emergency, but some situations need professional or urgent help.
If the person is experiencing psychosis for the first time, appropriate medical assessment is important. If they already receive mental health care, their usual mental health team or crisis service may be the most useful first contact.
In Scotland, during GP opening hours the person's GP practice can advise on urgent mental health needs. If their usual services are closed, or help cannot wait, NHS 24 can be contacted on 111 using the mental health option.
Phone 999 or go to A&E if somebody's life is at immediate risk or there is another life-threatening emergency.
The approach does not have to be perfect
It is easy to become so worried about saying the wrong thing that you avoid approaching somebody at all.
A useful first approach can be quite simple: make your presence known, speak calmly, give the person enough space and time, listen to what they are trying to communicate and avoid turning their experience into an argument.
From there, you can work out what the next useful step is.
You are not trying to diagnose the person or bring the episode to an end yourself. You are creating the best chance you can for a calm, respectful first contact and helping them towards further support when it is needed.
