HOW SHOULDIAPPROACH SOMEONE? HOW DOIKNOWIFTHISISPSYCHOSIS? that you they willbeavailable if would like totalkinthefuture. experiences.Rather,their about talk knowto them them forcelet to try not you,do with talk to unwilling is person the If is available andthingscanget better. person of howchoices you can the help offer possible,them so that If theysafe. them keepare in to wantyoucontrol. that Conveyand them, a messagesupport of hope and byhelp to assuring there them are that youhelp that them Reassure control. in and safe feel to them help will what about person the Ask feelings. and thoughts bytheir frightened be may they interaction.Youthe wantif of style and possible,to.pace as they the far that set As recognize person should the let experiencesbeliefs their and about talk to allowperson to the person’simportant the is about It diagnosis.speculate not Do You the person without their permission. need). not theytouch should state the space specific behaviors about and should you are concerned the them give and this to sensitive be eyecontact, avoiding is and suspicious is person the if (e.g. interacting withtheperson. It is important that you are honest when statements. patronizing using avoid and sarcasm not to take them personally. Do not use the symptoms for what they are and try not criticize or blame them. do Understand and person the confronting Avoid and beliefs about those of experiences. judgments content the stating respect. without experiences, with and beliefs their about person feels person the how with Empathize the Treat Try to tailor your approach and interaction to the way the person is behaving is person waythe the to interaction and approach your tailor Tryto their experiences distractions. inaplacethatisfreeof privatelypossible,person about the you. with youopen If approach be should not may therefore and “different”, as perceived being of afraid be might or you trust not might help to trying are you person The concerns. your discuss to as manner such judgmental non and caring a in person changes the approach someone, about frightening concerned help. are you and If secret. fora them keep profoundto try often out will symptoms psychotic experiencing reach is not often who will Someone disorder psychotic a developing People drugs, orthatsymptomswillgoaway ontheirown. throughgoing just is person the that other assume or alcohol misusing or phase a or ignore to not important is It dismiss such right. warning signs, quite even if they not appear graduallyis and are something unclear. that Do not suggest may together,theythem consider you when own, their on dramatic very be not may you that so psychosis of can recognize when someone may signs be developing psychosis. Although these warningsigns early the about learn to important is It MENTAL HEALTH FIRST AID a symptom of psychosis inanotherculture. psychosis a symptomof what is considered in to one be culture ‘normal’ may be interpreted as as behaviors, persons the contextof cultural and spiritual the consider vary from person to person and can overchange described time. You should also the may psychosis of of symptoms and/or signs however, some signs,the warning exhibit may psychosis experiencing People LovedFirst AidGuidelinesfor Ones PSYCHOSIS SUPPORT r syn, vn f hi rsos is limited. response their if even saying, you are what understand cannot the person anything. assume not feeling should not you Likewise, is person the that mean not does it that aware be a limited range feelings, of you should showing is person the If respond. and information the process to person the for time Be of necessary. plenty allow an and if patient things in repeat manner, and succinct communicating and disorganized uncomplicated by to speech Respond think to clearly. unable of often are symptoms psychosis experiencing People COMMUNICATION f h pro dcds o seek practically inaccessingservices. to they and emotionally sure both decides supported are help,make person professional the If these supports. utilize to them encourage if so, network, social supportive a has person the whether determine Also, assistance they believe will help them. of type what out find to Try helpful. they what been has so, that past the in done have if and before way this felt have they if person the Ask Changes inbehavior: smell, sound,orcolor). reduction orgreater intensityof perceptual experiences (e.g. a some way); oddideas; unusual or are actingdifferently in orothers havethat self changed or outsideworld (e.g. feeling self, other alteration of sense of concentration orattention; 4 perception: Changes inthinkingand motivation in appetite;reduced energy and inappropriate emotion;change irritability; blunted;flator 4 motivation: Changes inemotionand social roles ability tocarryoutwork or isolation orwithdrawal; reduced 4 ENCOURAGEMENT Depression;anxiety; WARNING SIGNS Difficulties with Sleep disturbance;social

WHAT IF THE PERSON DOESN’T WANT HELP? The person may refuse to seek help even if they realize they are unwell. Their confusion and fear about what is happening to them may lead them to deny that anything is wrong. In this case, encourage them to talk to someone they trust. It is also possible that a person may refuse to seek help because they lack insight that they are unwell. They might actively resist your attempts to encourage them to seek help. It is important to recognize that unless a person with psychosis meets the criteria for involuntary committal procedures, they cannot be forced into treatment. If they are not at risk of harming themselves or others, you should remain patient, as people experiencing psychosis often need time to develop insight regarding their illness. Do not threaten the person with hospitalization. Instead remain friendly and open to the possibility that they may

want your help in the future. HEALTH MENTAL FIRST AID WHAT TO DO... AGGRESSION In a crisis situation, try to remain as calm as possible. Evaluate the situation by People with psychosis are not usually assessing the risks involved. It is important to assess whether the person is at risk aggressive and are at a much higher of suicide (please see the warning signs at http://www.suicidepreventionlifeline. risk of harming themselves than others. However, certain symptoms org/Get Help/SuicideWarningSigns.aspx). If the person has an advance directive of psychosis (e.g. delusions or or relapse prevention plan, follow those instructions. Try to find out if the person hallucinations) can cause people to has anyone s/he trusts and try to enlist become aggressive. You should know their help. Try to also assess whether it how to de-escalate the situation if It is important to recognize that is safe for the person to be alone and, the person you are trying to help delusions and hallucinations if not, should ensure someone stays with become aggressive. are very real to the person. You them. should not dismiss, minimize, DE-ESCALATION or argue with the person about It is important to communicate to the person in a clear and concise manner their delusions or hallucinations. and use short, simple sentences. Speak 4Do not respond in a hostile, Similarly, do not act alarmed, quietly in a nonthreatening ton of voice disciplinary, or challenging manner horrified, or embarrassed by at a moderate pace. If the person asks to the person; such delusions or hallucinations. you questions, answer them calmly. You 4Do not threaten them as this may You should not laugh at the should comply with requests unless they increase fear or prompt aggressive person’s symptoms of psychosis. are unsafe or unreasonable. This gives the behavior; If the person exhibits paranoid person the opportunity to feel somewhat 4 Avoid raising your voice or behavior, do not encourage or in control. talking too fast; inflame the person’s paranoia. 4Stay calm and avoid nervous Be aware that the person might act upon behavior (e.g. shuffling your a delusion or hallucination. Remember feet, fidgeting, making abrupt that your primary task is to de-escalate movements); the situation and therefore you should not do anything to further agitate the 4 person. Try to maintain safety and protect the person, yourself, and others around Do not restrict the person’s you from harm. Make sure that you have access to an exit. movement (e.g. if he or she wants to pace up and down the room); Realize that you may not be able to de-escalate the situation and if this is the 4Remain aware that the person’s case, be prepared to call for assistance. If the person is at risk of harming symptoms or fear causing their themselves or others, make sure they are evaluated by a medial or mental health aggression might be exacerbated if professional immediately. If crisis staff arrive, you should convey specific, concise you take certain steps (e.g. involve observations about the severity of the person’s behavior and symptoms to the the police). crisis staff. Explain to the person you are helping who any unfamiliar people are, that they are there to help and how they are going to help. However, if your The PREP Program is an academic- concerns about the person are dismissed by the services you contact, you should community partnership between preserve in trying to seek support. The University of California, Family Take any threats or warnings seriously. If you are frightened, seek outside help Service Agency (FSASF) of San immediately. Never put yourself at risk. Similarly, if the person’s aggression Francisco, and The Mental Health escalates out of control at any time, you should remove yourself from the Association of San Francisco (MHASF). situation and call 211 or 911 for help. When contacting the appropriate mental health service, outline any symptoms and immediate concerns. Our goal is to provide comprehensive, evidence-based services to people If the situation becomes unsafe, it may be necessary to involve the police. suffering from signs and symptoms To assist the police in their response, tell them that you suspect the person is of serious experiencing a psychotic episode and that you need their help to obtain mental medical treatment. Tell the police whether or not the person is armed. illness.

These guidelines were adapted with permission from ORYGEN research center. They are a general set of recommendations about how you can help someone who may be experiencing psychosis. Each individual is unique and it’s important to tailor your support to the individual. Call us. 415.476.7278 Visit us. www.prepwellness.org