Supporting someone who has psychosis can be difficult. Your relativeÂ or friend may appear to be different either as a direct result of theirÂ symptoms, or because of the side effects of their medication. TheirÂ behaviour may be unusual, irritating and hard to cope with, or at timesÂ unreasonable and perhaps frightening.
As a â€˜carerâ€™ you may need to give emotional support and offer practical helpÂ on a day-to-day basis. Your supporting role may consume your time and beÂ emotionally exhausting. When the person you are supporting first becomesÂ unwell, it may feel as if your world has been turned upside down.
Everyone needs to find their own coping strategies, but it sometimes helpsÂ if you talk to other people who have been in the same situation as you. TheyÂ can understand how you feel and share ideas for dealing with difficulties.
It may help you to find out information about psychosis and the diagnosisÂ your relative or friend has been given. This will help you understand moreÂ about the way he or she is behaving. This in turn may help you be moreÂ tolerant and less likely to feel irritated, angry or stressed.
The word psychosis describes a set of symptoms that includes delusions,Â hallucinations â€“ hearing voices, for example â€“ and confused or disturbedÂ thoughts. When people experience these symptoms, mental healthÂ professionals say they are having a psychotic episode. Psychotic episodesÂ can vary in length: they can last for a few days, for much longer, especiallyÂ if untreated and they can also come and go.
When people have a psychotic episode, they are often unaware that theyÂ are unwell. They believe what they are experiencing is actually happening toÂ them â€“ that they really are being followed, they really are at risk, or really areÂ being threatened, for instance. Mental health professionals call this â€˜lack ofÂ insightâ€™.
Psychosis is a symptom of schizophrenia, bipolar disorder and schizoaffectiveÂ disorder. It can also be a symptom of dementia, some forms of personalityÂ disorder, epilepsy, Parkinsonâ€™s disease and other illnesses. People who abuseÂ drugs and alcohol sometimes experience symptoms of psychosis, andÂ psychosis can occur as a side effect of some types of medication. PsychoticÂ experiences can be triggered by severe stress or anxiety, severe depression orÂ sleep deprivation.
It is best to get advice and treatment for the symptoms of psychosis as soonÂ as people start experiencing them. Talk to your GP who can refer you toÂ specialist services. Most mental health NHS Trusts now run Early InterventionÂ services for young people who have experiences that may be the first signs ofÂ a psychotic episode.
Delusions are strong beliefs that are unlikely to be true. However, a personÂ who has psychosis firmly believes them to be true, and as a result may sayÂ things that are strange, or behave in an odd way.
Often, someone with psychosis will believe that other people orÂ organisations are out to get them, are spying on them or watching them, areÂ trying to trick them, hurt them or even kill them. These paranoid delusionsÂ can be very frightening for the person who is unwell.
Sometimes people believe they have a special power or authority â€“ that theyÂ are able to control other peopleâ€™s thoughts, for example. Sometimes peopleÂ have religious delusions â€“ they may believe they are the mother or son ofÂ God for example.
During a psychotic episode, people have disturbed and confused thoughts.Â Their thinking may speed up or slow down, and their mind may be full ofÂ different and random ideas. Their jumbled thinking may be reflected in theÂ way they speak.
They may talk very quickly, without stopping, and without listening, or theyÂ may suddenly stop talking mid-sentence, or refuse to talk at all. They may sayÂ things that donâ€™t make sense, or randomly switch from one subject matterÂ to another. If they stop speaking suddenly, it may be that they have beenÂ distracted by hearing voices, causing them to lose their train of thought,Â rather than that their mind has just gone blank.
Because of this muddled thinking, it may be difficult to follow what a personÂ is saying, and hard to have an ordinary conversation with them.
People with psychosis may see, hear, smell, taste or feel things that are notÂ there. They may see people or objects that no one else can see or feel insectsÂ crawling on their skin.
Auditory hallucinations â€“ hearing voices â€“ are very common. These voices areÂ entirely real to the person who is hearing them, so he or she may talk backÂ and hold a conversation with them. Voices may say upsetting, critical, cruelÂ and frightening things to or about the individual.Â Some voices tell people what to do â€“ and can sometimes dictate harmful orÂ dangerous actions. Most people try to resist these aggressive commands, butÂ often feel they must obey because they believe the voices are powerful andÂ fear what will happen if they do not.
Imaging techniques have allowed researchers to see what happens inside theÂ brain when people are hearing voices. The reason people who hear voicesÂ think they are real is because they hear them through the same system thatÂ everyone uses to hear external speech, in a part of the brain called Brocaâ€™sÂ area. They therefore experience their thoughts as spoken words coming fromÂ the outside world.
The experiences of psychosis may overwhelm peopleâ€™s feelings andÂ emotions. Delusions and hallucinations take over the way they see the worldÂ and become their reality. As a result, people who are unwell may appear toÂ be different â€“ not the same person as they were before they started havingÂ the symptoms of psychosis. They may become very excited or agitated andÂ suspicious of other people. Or they may become miserable and withdrawn,Â refuse to see people and lose interest in everything they previously did. TheyÂ may neglect their self care.
It is important to remember psychosis can be very frightening for the personÂ who is experiencing the symptoms. If the symptoms are severe, people canÂ find it impossible to tell the difference between their own experiences andÂ outside reality, to think logically or talk about how they are feeling, or toÂ put their strange thoughts, emotions and fears in context. They may loseÂ concentration and become distraught at not being able to deal with, or stop,Â what is happening to them.
The mental health team involved in supporting your relative should alsoÂ include you in discussions about treatment and care, unless your relativeÂ asks them not to. If you are in close (daily) contact with and offer supportÂ to someone with schizophrenia, you could ask for family intervention to beÂ offered to you, as recommended in the NICE (National Institute for HealthÂ and Clinical Excellence) guidelines, and as part of the package of careÂ given to your relative.
Living with someone with psychosis can be demanding and difficult. PeopleÂ can feel incredibly worried and anxious, sometimes frustrated, or angry, orÂ resentful.
Relatives may feel guilty, feeling somehow responsible for the illness. BecauseÂ of the stigma still associated with mental health problems, you might feelÂ ashamed that this has happened to someone in your family.
Your caring and supporting role may begin to dominate your life. However, itÂ is important to try to have some perspective on these problems: your caringÂ role should not be the only focus of your interests and concerns.
It is likely that you will need some support to help you deal with the range ofÂ emotions you may feel, and with the day-to-day practicalities of living withÂ someone with psychosis. Maintaining your own interests, keeping a job, orÂ having time away will also help you to cope more effectively and tolerantlyÂ with the difficult symptoms and problems that may arise.
This means there will be less tension in the house and fewer arguments.Â Research has shown the importance of a calm and supportive atmosphereÂ which will help your relative or friend recover more quickly and stay well forÂ longer.
Rethink runs a training programme for carers, offering information and support,Â and giving them skills to help them in their caring role.
The NHS runs primary care and secondary care services. Primary care servicesÂ are your first point of contact with the NHS: your GP, your dentist, yourÂ optician, for example. NHS walk-in centres, and the NHS Direct phone service,Â are also primary care services.
Secondary care services are specialist services. These include specialist mentalÂ health services, provided at hospitals, outpatient clinics, or by community basedÂ teams of health professionals. Most mental health services are run byÂ NHS mental health Trusts, and many of them are â€˜integrated servicesâ€™. ThisÂ means they include social workers employed by the local authority.
Secondary care services, including mental health services, are currentlyÂ â€˜commissionedâ€™ and â€˜purchasedâ€™ byÂ Clinical Commissioning Groups.Â These CCGs spend about 80 per cent of the total NHS budget: they eachÂ cover a specific area and decide what specialist health services the peopleÂ living within their boundaries need. â€˜Commissionâ€™ means they ask (and thenÂ pay) other CCGs as well as voluntary and private sector organisationsÂ to provide those services. CCGs work together with local authorities as â€˜jointÂ commissionersâ€™ to plan and provide some services, particularly community basedÂ mental health services.
The sort of mental health services available vary according to the way aÂ CCGÂ decides to spend its money, so some types of services and community basedÂ teams may not be available in your neighbourhood. Services and community basedÂ teams may also be called different names by different NHS mentalÂ health Trusts.
These are teams of mental health professionals who work with people withÂ mental health problems and support them in their home. You may seeÂ community mental health teams referred to as CMHTs.
The professionals working for these teams include psychiatrists, mentalÂ health social workers, community psychiatric nurses, psychologists andÂ occupational therapists â€“ all the main professions involved in mental healthÂ care. Some teams include a vocational specialist or advisor who can helpÂ people prepare or look for work. Each team member often has their ownÂ individual case load. Community mental health teams have been around forÂ a long time and have become the mainstay of community-based (as opposedÂ to hospital-based) mental health care.
Community mental health teams operate differently in different parts ofÂ the country, depending on the policies of the local NHS mental health Trust.
Sometimes they are divided into teams of staff who each focus on specificÂ areas such as â€˜recoveryâ€™. Other community mental health teams are â€˜genericâ€™,Â offering services for a wide range of problems. This tool provides a guide to the correct support for you.
A GP is usually the first point of contact for people experiencing mentalÂ health problems and their carers. They can refer patients on to specialistÂ services provided by the appropriate Community Mental Health Team,Â comprising health professionals and social workers. For emergency treatmentÂ you should go to the Accident and Emergency department.
The type of service provided will vary depending on the nature of theÂ personâ€™s illness, but broadly falls into two categories:
Some form of occupational therapy is also often used.
If you need advice on any health issue you can call NHS 111Â (24-hours).
They can deal with urgent and non-urgent queries and give free, confidentialÂ advice on medical conditions and issues relating to the health service.
If the person you care for agrees to hospital treatment, they are a voluntaryÂ patient. If it is thought that hospital care is the most appropriate treatment,Â but the person you care for refuses to go, a compulsory admission is possibleÂ as outlined in the Mental Health Act. In such cases the person is sometimesÂ said to be sectioned. This usually only happens after an assessment by twoÂ doctors and a social worker, who must consult with the personâ€™s nearestÂ relative (as specified in the Mental Health Act).
Southwark Carers works in conjunction with the Mental Health carers projectÂ worker. This project provides support, advice and information to people whoÂ care for a friend or relative with mental health problems. There are severalÂ mental health carers support groups in the Borough, that can be accessed viaÂ Southwark Carers or a local CMHT.
Nearest tube: Elephant & Castle underground station (Northern and Bakerloo lines).
Nearest Railway Station: Elephant & Castle
Buses from Elephant and Castle: ask bus driver for Burgess Park. Bus numbers: 12, 171, 148, 176, 68, 484, 42, 40, 45