Psychosis can affect the way somebody perceives, interprets or makes sense of what is happening around them. They may hear or see things other people do not, hold beliefs that feel completely real to them, or find their thoughts and communication harder to organise.
That can make a conversation feel unfamiliar, particularly if you are unsure whether to challenge what somebody is saying, agree with it or avoid the subject altogether.
You do not need to resolve their experience. A more useful starting point is to listen, communicate clearly and pay attention to the person’s distress, immediate needs and safety.
Start with the person, not the explanation
Somebody experiencing psychosis may be frightened, confused, suspicious, overwhelmed or simply finding it difficult to put their thoughts into words. Others may not appear distressed by what they are experiencing.
Try not to decide in advance how the person must be feeling or what their behaviour means.
If they want to talk, give them time. Listen to what they are actually saying and respond to the concern in front of you rather than trying to work out a diagnosis.
A simple question such as “What would help just now?” may be more useful than a series of questions about why they believe something or whether they know it is real.
What can help during the conversation
- Speak calmly and use clear, straightforward language.
- Give the person time to answer rather than filling every pause.
- Reduce noise, interruptions or other distractions where that is practical.
- Give them physical space if they seem uncomfortable or overwhelmed.
- Listen for how the experience is affecting them, not only for the details of the experience itself.
- Ask what support would feel useful rather than assuming what they need.
You do not have to agree or argue
If somebody describes something you do not believe is happening, you do not need to confirm it as true. But trying to argue them out of it may increase fear, frustration or mistrust.
You can acknowledge the feeling without agreeing with the belief. For example, you might recognise that something sounds frightening or upsetting and ask what would help the person feel safer.
When thoughts or speech are difficult to follow
Psychosis can sometimes make thoughts move quickly or become harder to organise. A person’s speech may be difficult to follow, or they may lose track of what they were saying.
This is not a reason to stop listening.
Short sentences and one question at a time can make a conversation easier. Avoid turning the exchange into an interrogation or repeatedly asking somebody to explain themselves when they are already struggling to do so.
If you have not understood, it is fine to say that gently. You can check one part of what you heard rather than pretending the whole conversation made sense.
Supporting somebody towards further help
Psychosis can have different causes and may need professional assessment and treatment. If somebody is experiencing psychosis for the first time, is becoming increasingly distressed or is finding everyday life difficult to manage, appropriate professional support matters.
If they are already supported by a mental health service, they may have a named worker, crisis plan or agreed way of getting help when things become more difficult. Where possible, ask what is already in place and how you can support them to use it.
For somebody who is not already receiving support, encouraging contact with their GP practice can be a useful next step. In Scotland, NHS 24’s Mental Health Hub can also be reached by phoning 111 for urgent mental health support.
Supporting somebody towards help is different from taking responsibility for their treatment. You can listen, offer practical help and help make contact with services without becoming the person who has to manage the situation alone.
Hearing that somebody is experiencing psychosis can trigger assumptions about violence, unpredictability or crisis. Those assumptions can affect the way people respond before they have considered what is actually happening.
Pay attention to the situation in front of you.
Somebody may need calm conversation and support towards professional help without there being an immediate emergency. At other times, their level of distress, behaviour or circumstances may make urgent help necessary.
If somebody’s life is at immediate risk, phone 999 or go to A&E. If urgent mental health support is needed in Scotland and the situation is not a life-threatening emergency, phone NHS 24 on 111 and choose the mental health option. If the person already has support from a mental health service, contact that service directly where possible.
Your role has limits
Supporting somebody does not require you to diagnose what is happening, persuade them to see things differently or become their only source of help.
It also does not require you to stay in a situation where you feel unsafe.
A useful first response can be quite modest: stay calm, listen, avoid unnecessary confrontation, consider what the person needs and help connect them with appropriate support when that is needed.
The aim is not to take control of somebody else’s experience. It is to respond to the person with as much clarity and respect as the situation allows.
