- Talking to other people
- Getting information
- Be involved in planning your relative’s care (if they agree)
- Looking after yourself
- Understanding withdrawn behaviour
- If your relative is depressed
- Restlessness, over activity or anxiety
- Food and exercise
- Dealing with delusions
- Embarrassing behaviour
- Sex, promiscuity and relationships
- Alcohol, drugs and medication
- Violent behaviour
- Suicide threats
- Money problems
When supporting someone, a friend, relative or colleague, with psychosis, you can face your own challenges. People with psychosis will say and do some alarming or strange things. The most important thing is to educate yourself and keep calm. Those who suffer from psychosis are really susceptible to absorbing others’ emotions so it’s vital not to overreact or panic.
Talk to other people and get some support for yourself too. You can talk to doctors or mental health nurses as well as organisations like Mind that are familiar with what you are experiencing.
It is important to get as much information as you can about your loved one’s condition. This could be by talking to your loved one themselves or by talking to a doctor. The internet has a wide range of information available too but do make sure you stick to official sites.
If you are talking to your loved one about their condition, they might struggle to explain themselves or understand what you’re asking. It is best to use short sentences in simple language as confusion is likely. As well as thinking carefully about your wording, think about how you are expressing yourself physically. Keeping on the same eye level is a good idea as is keeping a relaxed pose.
When your loved one experiences psychosis, it is a very real experience for them. It is important that your loved one thinks of you as someone on ‘their side’. You need to make sure that you don’t come across as an enemy who is forcing them to take medication. Mental health diagnosis, treatment and medication shouldn’t be your focus as their carer.
Your role should be one of positivity and comfort. Psychosis does make people think the world is a dark, dangerous and threatening place so you need to try and be someone who is encouraging and positive. As your relative how they would like you to help them. Trust is vital.
Often, people with psychosis won’t want to seek help. For you, this can be incredibly frustrating. If you are concerned that your loved one is experiencing psychosis, speak to a qualified mental health professional.
When you are supporting a loved one, you might be considered to be their carer. Carers also need to make sure they are looking after themselves as dealing with someone with psychosis is a draining experience both physically and mentally.
The UK does have a Carers Allowance available to carers who meet certain criteria. Even if you don’t meet the criteria, you could still be considered as a carer who has needs for extra support by the local authority.
Supporting a loved one can have effects on your health too. It can affect your mental health because it is a very upsetting and difficult thing to do. You might find yourself having less time for yourself or suffering from one or more of the following:
- Money problems
- Lack of sleep
- Low self-esteem
Wherever possible, you should try and get some downtime where you can truly relax and let go of your worries. Don’t underestimate the benefits of a brisk ten-minute walk or a five-minute relaxation podcast.
Sometimes people with mental health conditions withdraw from social situations and contact with others. Withdrawn behaviour means either avoiding or not seeking social contact. Someone who is withdrawn might:
- Prefer to work by themselves
- Spend a lot of time alone
- Turn down invitations
- Talk less in a social setting
- Stay at home
- Not be willing to try new things or meet new people
Many people with psychosis might become withdrawn. It is important not to force people do things that they are uncomfortable with all while being mindful that a change in behaviour is something to keep an eye on.
Self-neglect defines itself as a lack of self-care to the extreme. It may even present itself as hoarding or other addictions. Self-neglect is threatening to the person’s safety and health. They might not keep on top of their personal hygiene or manage their personal affairs properly.
The problem with self-neglect
People who neglect themselves to the extreme will often decline any help and support. Often, they don’t realise that they need it. There are limitations as to what agencies and relatives can do to help people with self-neglecting behaviours, especially if the individual has the mental capacity to make their own decisions.
It can be hard seeing your loved one depressed. The hard thing is that you can’t force someone to have help if they don’t want it. It can be hard for people to be open about how they’re feeling. Let your loved one know that it’s ok to talk about depression.
One of the best things that family members can do for their relatives with depression is to listen. You might not need to say anything at all, just being there as someone to listen could be exactly what your relative needs to feel less alone and isolated.
People with depression often become withdrawn so you need to take on the role of keeping in touch with them. It might be as simple as a text message or email just to say you’re thinking of them.
If you have never had an experience of depression, it can be difficult to understand how your loved one can’t just snap out of their feelings. It is important no to put too much pressure on your relative. Getting over depression is a long journey.
It can be easy to try and take care of everything for your relative. However, you need to find a balance. It is important that they are encouraged to do some things for themselves.
Often people with psychosis experience psychomotor agitation. This is a feeling of restlessness or anxiousness that causes the suffer to make involuntary movements. It is a physical expression of mental tension and anxiety. People who experience this might feel like they have something (an emotion or movement) that just won’t come out. You might seem them pacing, tapping their feet or fingers, or they might not be able to finish their sentences. Your loved one may also complain of their head being full of thoughts or bursting with emotions.
You might see your relative have unintentional, purposeless, repetitive behaviours and movements. These are exhibited in response to increased feelings of restlessness that is caused by anxiety.
Physical heath was, in the past, not a focus when dealing with psychiatric problems. However, as time goes on, we are becoming more aware that people who have mental health problems like psychosis, will have more physical health problems than those who do not.
Research shows that people with schizophrenia die around ten years younger than people without this diagnosis. Suicide is a contributing factor but there are also other physical reasons why the mortality rate is higher.
People with psychosis tend to have diets that are not as healthy; they tend to contain less dietary fibre and more fat. What’s more, people with psychosis don’t exercise as much and aren’t as likely to visit their GP when something is wrong physically.
It is important for those with psychosis to have a well-balanced diet. Making it more difficult is the fact that a lot of antipsychotic medication causes weight gain, in particular, zotepine and olanzapine. Aripiprazole, on the other hand, causes fewer problems.
The problem with excess weight in those with psychosis existed long before the use of antipsychotics that cause weight gain and so we must draw conclusions that the condition itself leads to excessive eating.
It is believed that smoking could actually worsen depressive symptoms. People with psychosis don’t relieve their symptoms or have improved cognitive function – they actually suffer more.
Studies have found links between smoking both marijuana and tobacco with regards to psychosis from schizophrenia. The reasons why psychosis sufferers have a higher tendency to smoke, however, aren’t clear.
Some researchers believe that smoking acts as a ‘self-medication’ of sorts. This means that people who experience psychosis find that they can relieve their symptoms through smoking. This could be due to a neurological mechanism that hasn’t yet been identified. It could also be due to the fact that the person isn’t stressed or bored.
In recent times, it has been discovered that when people experience psychosis for the first time, they are more likely to be a smoker – three times more likely in fact.
If you can encourage your loved one to quit smoking, it would be beneficial to their mental and physical health.
It can be really frightening to witness a loved one who is experiencing delusions. It is important to not take things personally and keep in mind that your relative is not behaving rationally.
Try to avoid having long debates and don’t try to convince them that their delusions are not real. This will only make them withdraw from you and they won’t feel as though they can talk to you about what they’re experiencing. Instead, talk about neutral topics. Even if it is tempting to talk about their delusions, don’t go along with them. Instead, sympathise and listen. Try as far as possible to minimise their stress.
As difficult as it may be if you can ignore embarrassing or strange behaviour, do so – as long it is not serious.
There are two ways of dealing with embarrassing behaviour. Firstly, try to come up with an agreement with your loved one about what behaviour you will and won’t tolerate. Secondly, look at your attitude and think about why you become embarrassed.
It might actually be easier to have agreements regarding behaviour than you imagine. Often being direct with an explanation might be enough to end the behaviour. However, there will be times when interventions and agreements simply don’t work. During these times, it is important to remember that your loved one is being affected by a disease that affects how their brain functions. If you allow yourself to be embarrassed by someone else’s behaviour, you will only let your self-esteem take a knock and you won’t be able to deal with the behaviour as effectively.
Here are some ideas that might help you deal with your relative’s embarrassing behaviour:
- Take steps to change or stop the behaviour immediately.
- Don’t be afraid to be firm or angry but make sure you are not abusive.
- Be polite to other people and bystanders. Assume that they’re tolerant and understanding.
- If it is necessary, you can explain and apologise to others involved
- If necessary or warranted, you could offer to pay for any damages, explain or clean up any mess.
- Don’t forget to try and maintain a sense of humour.
- Share the experience with someone else – it will help you to see there is a funny side.
When an individual has psychosis, sex and promiscuity might develop into a problem. Antipsychotics and antidepressants do tend to lower sex drives.
If your loved one is young, they might be particularly vulnerable and an easy target. This is because they have a willingness to trust people too readily and they also have peer pressure to contend with.
Often with psychosis, people are not aware of risks, especially if they are young. Since people with psychosis are often starved of friendships, they might crave relationships and so might put themselves at risk or sexually transmitted infections and diseases. Women are also at risk of becoming pregnant.
People with psychosis are very vulnerable when it comes to temptations. Alcohol and drugs can impair how effective antipsychotic medication is and, if taken excessively, they might also create more problems. It will be difficult for doctors to understand which symptoms are caused by psychosis and which symptoms are caused by drugs or alcohol. When caring for someone with psychosis, don’t encourage them to drink socially.
When people aren’t familiar with psychosis, they often worry about violence. There is often a lot of confusion between multiple or split personality disorders and psychosis. People wrongly believe that everyone who experiences psychosis is dangerous and violent. There are, of course, some who are, but this is a very limited number. This misconception has developed because of TV and the media. In particular, news coverage of violent acts committed by someone with psychosis only heightens the issue. The belief that people experiencing psychosis are violent only adds to the stigma of this condition. The truth is that the vast majority of people with psychosis are not violent.
Sometimes, though, a psychotic episode can have violence. In these situations, there simply won’t be time to talk to your loved one to calm them down. There probably won’t be time to call a psychiatrist or doctor for advice. Since your loved one is not in the same reality as you, they might begin acting out their hallucinations. They might, for example, slam doors or shatter windows. Additionally, your loved one could threaten to harm you or themselves. In situations such as these, it is important to do whatever you can to protect them, you and others from physical harm. You might have to decide to leave them or secure them in a room while searching for help. This, obviously, only applies to extreme situations. When situations like this arise, often the only choice is to call the police. It might be tempting to drive your loved one to the hospital yourself, however, it is wise to get someone else to be with you in this sort of situation.
Unfortunately, suicide and threats of suicide are more common in people with psychosis. If your loved one becomes depressed, disorientated or begins talking about suicide, it is important to be aware of any dangers and remove them. For example, take away anything like matches, lighters, sharp objects and things that could be used for overdose or poisoning. With psychosis, the occurrence of suicide is a fear that is always present since the illness will often occur alongside depression, delusions and hallucinations. There may even be command hallucinations in which the hallucination compels the person to try to kill themselves. Those with psychosis often act on impulse too, which is an added risk. It has been estimated that around 10% of people with schizophrenia kill themselves but suicide is more likely to occur during the first five years of the person being ill. While women attempt suicide more often than men, it is men who complete suicide more.
People with the highest risk of suicide are those who have good knowledge about their illness, are isolated socially, lack hope for their future, respond poorly to medication and have a large change in what they have previously achieved in comparison to where they are now.
Not all suicides are the same. Often times, a person will plan their suicide methodically. Other times, a person will attempt suicide accidentally. By this, we mean that the person acts out a delusion or hallucination whie they are experiencing psychosis. In both types of situation, there are things you can to prevent suicide, however, it is never possible to protect someone completely against suicide.
Behaviours indicating a risk of suicide
There are some signs to look out for in your loved one:
- Your loved one may talk about suicide. They might discuss what death would be like, how you could do it or say things like “When I’m not here…” etc.
- Your loved one might be worried about having a will or distributing their possessions. They might even start to give away their most treasured things.
- You might hear your loved one express their perceived worthlessness. For example, by saying things like “I’m no good”.
- Your loved one might seem hopeless about their future.
- Your loved one might show signs of seeing visions or hearing voices that instruct them to act dangerously.
It is important to take all self-harm and suicide talk seriously. It is often said that people who talk about carrying out suicide don’t do it – this is not true. So, if your loved one begins to self-harm or talks about suicide, even superficially, you must reach out to their therapist quickly. If you can’t do this, you should accompany them to a hospital or call a suicide helpline like Samaritans.
Many people experiencing psychosis will have difficulty handling money. This can make for some difficult situations which won’t have an immediate solution.
Usually, when there is an entitlement, a patient will get some help at hospital to help them arrange welfare benefits. Where this is the case, your loved one will get a monthly income that they control completely. Most patients need a lot of help in order to learn how to manage their money and balance their accounts so that they can pay for rent, transport and food etc.
For many people, this is a challenge, particularly at the beginning. Many people with psychosis will ‘blow’ a lot of money as soon as it is available. There is a tendancy for impulse spending with families having to pick up the short fall. Loved ones need to exercise a lot of patience in these situations.
For the patient, being able to manage money is one of the most important steps towards having more independence. Families have a role to play in teaching their loved ones about better money management. It may even be necessary for a family member to have some guardianship role over their ill relative’s accounts so that they do not get in such severe financial trouble that they are dealing with debt collectors and bailiffs.