Psychosis can affect perception, thinking, communication and the way somebody makes sense of what is happening around them. At work, that might sometimes become noticeable. But many of the changes a manager or colleague could observe have numerous possible explanations.
Becoming quieter, struggling to concentrate, arriving late, appearing unusually anxious or finding communication difficult does not mean somebody is experiencing psychosis.
The task at work is not to identify a condition. It is to notice when something appears to have changed, respond to any effect on work or wellbeing, and create an opportunity for the person to say what they need.
Notice the change without deciding what it means
There is an important difference between saying, "I've noticed you've seemed distracted and are finding it harder to finish some tasks" and deciding, "I think you're experiencing psychosis."
The first describes what has been observed. The second makes a clinical assumption that a manager or colleague is not in a position to make.
Changes at work can have many explanations
A manager might become concerned because somebody's concentration, attendance, communication, behaviour or standard of work has changed.
Those changes can matter without being diagnostic.
They might relate to mental health, physical health, medication, difficulties outside work, pressure within the workplace or something else entirely. The person may already know what is happening, may be seeking professional support, or may not want to discuss their health with their employer.
Starting with an assumption about psychosis can close down the conversation before it has properly begun.
Starting a workplace conversation
1Choose an appropriate setting
Speak privately and, where possible, at a time and place that reduces interruptions. If the person seems particularly overwhelmed, a quieter environment may make the conversation easier.
Describe what you have noticed
Use specific observations rather than labels. You might refer to a change in work, communication or behaviour and ask how things are going.
Give the person room to respond
Listen without pressing for a diagnosis or an explanation they do not want to give. If their thoughts or speech are difficult to follow, use clear language, ask one question at a time and allow more time for an answer.
Focus on what would help
If something is affecting their work, ask what support might make a difference. Agree any practical next steps rather than assuming what the person needs.
If somebody tells you they are experiencing psychosis
Disclosure changes what you know, but it does not make you responsible for assessing or treating the person's mental health.
Listen to what they tell you about how their experiences affect them and their work. Two people with the same diagnosis or similar experiences may need very different things.
There may also be information the person does not want or need to discuss with you. A manager generally needs enough information to understand any effect on work, safety or support, not a detailed account of somebody's symptoms, treatment or personal history.
If the person is already receiving professional support, they may know what helps when things become more difficult. Occupational health, HR or another appropriate workplace service may also be useful where available.
Workplace adjustments should be individual
- Depending on the person, the job and what is reasonable for the organisation, useful adjustments might include:
- a quieter working area or fewer unnecessary distractions
- more regular check-ins or clearer structure around priorities
- temporary changes to workload, tasks or deadlines
- flexibility around working hours or time for health appointments
- an agreed communication method that is easier for the person to manage
- a planned or phased return following a period away from work
- There is no standard set of adjustments for psychosis. What helps should be discussed with the individual and reviewed as circumstances change.
Mental health and reasonable adjustments
Some mental health conditions can meet the definition of disability under the Equality Act 2010. Where an employee is disabled, an employer may have a legal duty to make reasonable adjustments.
Even where that legal duty does not apply, workplace changes may still be worth discussing if they help somebody manage their health and continue working safely and effectively.
The useful question is not, "What adjustments do people with psychosis need?" It is, "What is making work difficult for this person, and is there a reasonable change that could help?"
If somebody talks about their mental health at work, that information should not become general workplace knowledge.
A manager should be clear about confidentiality and avoid sharing what the person has said without permission unless there is a good reason to do so. Where information does need to be shared, for example to arrange appropriate support or because of a significant safety concern, explain what needs to be shared, with whom and why.
The same principle applies to colleagues. Concern for somebody does not make it appropriate to speculate about their mental health with other people at work.
Safety needs the same proportionate thinking
Psychosis should not automatically be treated as a sign that somebody is dangerous. The Green Ribbons Psychosis module specifically challenges that misconception.
At the same time, an employer still needs to respond if there is an actual safety concern. Focus on what the person is saying and doing, the work they are undertaking and the circumstances in front of you rather than treating a diagnosis or suspected diagnosis as a risk in itself.
If there is an immediate danger to the person or somebody else, follow the organisation's emergency procedures and seek urgent professional help. If there is no immediate danger but the person appears to need additional support, help them consider appropriate professional or workplace routes.
A workplace role has boundaries
Managers and colleagues can notice changes, start conversations, listen and help make work more manageable.
They are not expected to diagnose psychosis, test whether somebody's beliefs are true, provide treatment or become the person's only source of support.
Keeping those boundaries clear is not a way of withdrawing support. It helps keep the response focused on what a workplace can genuinely do: treat the person with respect, respond to their individual circumstances, deal fairly with work-related concerns and help them access further support where that is needed.
