Psychosis

Someone experiencing psychosis loses the ability to tell what is real from what is not.

Psychotic symptoms vary from person to person and even between one episode and another. If you are concerned that you may be experiencing or have experienced psychosis, talk to your doctor.

The five main types of psychotic symptom are delusions, hallucinations, disordered thinking, disordered behaviour, and negative symptoms.

Delusions

Delusions are false beliefs that are fixed even when faced with conflicting evidence. These beliefs are not shared by people from the same cultural background. 

I thought I was under constant surveillance and everyone was out to harm me. Television, radio and newspapers were talking directly to me

Carlo

Kinds of delusion

There are many different kinds of delusion, but most fall under the following categories:

Delusions of persecution

The most common delusions experienced by people living with psychosis are paranoid delusions — believing that you’re being watched, followed or persecuted by forces that mean you harm.

Delusions of reference

People experiencing psychosis sometimes believe they have special abilities, are unusually important, or are famous and powerful figures. 

Delusions of grandeur

People living with psychosis may believe that their thoughts are being controlled or influenced by outside forces such as aliens, some real or invented group or agency, or an individual.

Delusions of control

People with psychosis may believe that their thoughts are being controlled or influenced by outside forces such as aliens, some real or invented group, or an individual.

Somatic (body) delusions

A person with psychosis may believe something has happened to their body: something is wrong with it, some part of it is missing or dead, or that they are infested with disease or parasites.

How delusions affect you

Having delusions can be confusing and very frightening. The world stops making sense, or seems to make a different, weird kind of sense that no one else sees or understands.

For some people, delusions can be very isolating. It can be hard to make connections and feel close to people around you when you believe things they don’t. Keeping up with work or study can be harder, too. At their worst, delusions can make everyday life much harder to cope with.

Hallucinations

Hallucinations are when you see, hear, feel, smell or taste something that is not actually there.

It’s normal for human senses to be deceived, like seeing faces in things or being tricked by optical illusions.

But the hallucinations involved in psychosis are different. Neurological tests have shown that the voices, visions, smells and other sensations experienced by people with psychosis are indistinguishable from real sensory input.

Psychotic hallucinations aren’t imaginary and they also aren’t real: they’re the product of a mind that perceives something without an external stimulus being present. For example, hearing a voice when no one else is in the room.

Kinds of hallucination

One of the most common hallucinations associated with psychosis is hearing voices that no one else can hear.

Although some people hear them only occasionally, others hear them every day, and they can be very distressing. Sometimes the voices are abusive, threatening, or tell the person what to do. People sometimes shout back at their voices, or have conversations with them.

Some people may also experience hallucinations of taste, touch, smell or sight.

I don’t hear them during the day, but every night when I go to bed they persecute and denigrate me and now I wake up to them as well which is a real pain in the arse

Sandy

How hallucinations affect you

Hallucinations, like delusions, seem very real to the person who has them — so people experiencing them can feel confused and distressed. Some people describe the experience of psychosis as having a dream or a nightmare while you’re awake.

Hallucinations and delusions can reinforce each other — having a taste hallucination, for instance, can convince someone that their food is poisoned, building on a delusion that others want to harm them.

Disordered thinking and speech

Disordered thinking is when everyday thoughts become confused and don’t join up properly. Words and ideas lose their meanings or take on meanings that make no sense. This is usually recognisable to others through changes in your speech, which can include:

• speaking very quickly or slowly
• changing topics frequently
• speaking in muddled-up sentences
• using the wrong words to describe things
• making up words.

Disordered behaviour

Psychosis can disrupt the way a person behaves. They might become easily agitated or act in a childlike way. They might mutter, talk or swear inappropriately, or act in some other socially inappropriate way. They might find it difficult to manage the tasks of day-to-day life, like looking after their personal hygiene, shopping or cleaning up at home.

This behaviour isn’t a choice or laziness, but a real physical symptom of psychosis.

In rare cases, people experiencing psychosis might become catatonic — much less responsive to the world around them. This can include not responding when they’re spoken to or asked to do something, having a rigid or unusual posture or a complete lack of speech or movement.

Negative symptoms

These symptoms are more common for people with a diagnosis of schizophrenia than people who experience psychosis as part of another health or mental health issue. They involve:

• Reduced emotional expression (making less eye contact, less facial expression, less varied intonation when speaking)
• Less motivation and difficulty initiating or participating in activities
• Reduced feelings of enjoyment or pleasure
• Speaking much less.  

Psychosis doesn’t have a simple cause, like a virus or bacteria. The influences and factors that can contribute to an episode of psychosis are complex and not fully understood, but research is advancing fast, and the picture is becoming a little clearer.

How common is psychosis?

According to the 2010 National Psychosis Survey 64,000 Australians aged 18-64 experienced a psychotic illness. This comes to roughly 0.5% of the population. The figures are slightly higher for men and slightly lower for women.

Psychosis often appears first in late adolescence and early adulthood, when young people are at important stages in their development — getting an education, starting work or exploring relationships. Early onset is especially the case for men.

Your chances of having a first episode of psychosis decrease as you age: for every year after you turn 40, your likelihood of experiencing your first episode of psychosis declines steadily.

Genetics: inheriting a likelihood

Your genes can influence how susceptible you are to psychosis during your life. They don’t cause psychosis or guarantee that you’ll experience it — many people with a genetic susceptibility never have an episode. They just make it more possible.

Some of the genes that influence your susceptibility to psychosis have been identified, but the picture isn’t complete yet.

Like other genetic features, susceptibility to psychosis can be inherited. If one or both of your biological parents, your grandparents or siblings has experienced a psychotic illness, your likelihood of experiencing a psychotic illness is raised.

However, most people with a family history of psychosis will not have an episode themselves. Your chances are raised, but it isn’t inevitable.

Environment: a world of influences

So why do some people with genetically raised chances of psychosis have an episode, while others don’t?

Everything that happens to you from the moment you’re conceived affects the person you will become, including your health.

There are a number of environmental factors that could increase the likelihood of psychosis: your mother’s health during pregnancy, complications with your birth, child abuse, some kinds of head injury and infection, drug abuse, living in urban areas and experiencing high stress and social disadvantage.

Research is continuing on the factors that influence a person’s susceptibility to psychosis. We’re understanding more all the time, but there’s some way to go.

For now, it’s important to know that a complex mix of influences can raise your chances of experiencing psychosis, but no one thing alone causes it.

In some cases, psychosis is experienced as an ‘episode’: a period of acute symptoms during which a person will need expert help.

But those intense symptoms don’t usually appear out of nowhere. In fact, there are typically three stages to psychosis: prodrome, acute and recovery.

Stage 1: prodrome

Psychosis frequently begins with general, hard-to-pin-down changes to a person’s thinking, feeling and behaviour, like:

• trouble with attention and concentration
• trouble screening out distractions
• irritability, depression, anxiety or suspiciousness
• trouble keeping track of thoughts and conversations
• insomnia
• Changes in perceptual experiences (sounds or visual stimuli feeling too overwhelming)
• feeling disconnected from other people, wanting to be alone
• decreased performance at work or school.

These signs are common features of many mental health issues, and some of them are normal parts of human experience, especially during adolescence when many first episodes of psychosis occur. They don’t necessarily mean a person is developing psychosis, but they can indicate that something might not be right.

During prodrome, which can last for months or longer, signs like these can come and go, but they tend to worsen over time.

These changes are much stronger indicators of psychosis:

• preoccupation with a particular person or subject (particularly religion or spirituality)
• speech or writing that is very fast, muddled, irrational or hard to understand
• talking much less
• loss of concentration, memory and/or attention
• increased sensitivity to light, noise and/or other sensory inputs
• withdrawing from relationships, social life and/or hobbies
• increased anger, aggression or suspiciousness
• decreased or disturbed sleep
• inactivity and/or hyperactivity
• behaving in a way that’s reckless, strange or out of character
• laughing or crying inappropriately, or being unable to laugh or cry
• inattention to personal hygiene
• depression and anxiety
• being unable to feel or express happiness.

I started to giggle and laugh a lot and did not want to interact with people socially

— Evan

Prodrome is the best possible time to seek help — the sooner someone with these symptoms can be assessed, the sooner effective treatment can begin and the better the outlook for recovery.

If you think you or someone you know might be experiencing these changes in their thinking or behaviour now, don’t wait for an episode. See a doctor immediately.

Stage 2: acute

This is the episode itself, when intense symptoms of delusions, hallucinations, disordered thinking and behaviour occur. A person experiencing a psychotic episode may not be able to make decisions about their health and need professional help as soon as possible.

Stage 3: recovery

There is growing evidence to suggest early, evidence-based treatment creates better outcomes for people recovering from a psychotic illness. The recovery is generally gradual, and symptoms from the acute stage can persist for some time.

There are many ways to measure recovery: reduction of symptoms, ability to cope with everyday life, return to school or work. Whatever the measure, people who receive timely treatment for their first episode of psychosis can recover well.

It was about getting my life back … rediscovering who I was and developing techniques to help me get well and stay well. It was also about early identification of the triggers that would make me unwell again

— Cameron

The possibility of relapse

A relapse is when, some time after recovering from an episode of psychosis, symptoms return and the person has another episode.

Relapse rates for psychosis are high: 55-70% of people who have a first episode of psychosis will have a second episode within two years.

There are a few things that are known to reduce your risk of relapse, or lessen its impact if it happens:

• taking medication for as long as your health professionals advise
• staying away from drugs and alcohol
• positive support from carers, family and friends
• learning as much as you can about psychosis and your own early warning signs
• developing a relapse plan (see below) and getting help as soon as you or the people around you notice any symptoms, no matter how minor.

Symptoms you experience during the early stages of psychosis can seem vague or not worth a trip to the doctor, but this is the best possible time to ask for help.

The best place to start in getting a diagnosis, especially early on when symptoms are less severe, is your GP. Your doctor can make an initial assessment, monitor your symptoms over time and, if you need it, refer you to the right kind of health professional — usually a psychiatrist — for specialist treatment.

If your health is deteriorating in the direction of a psychotic episode, accurate diagnosis and getting treatment early gives you the best possible chance of minimising its effects and avoiding relapse.

Catching psychosis early is ideal, but someone having an acute episode still needs to be diagnosed and treated as soon as possible. Whatever the stage of the illness, professional care helps people experiencing psychosis and their family, friends and carers.

Conditions associated with psychosis

Psychosis is more often experienced as one part of a complex mental health issue, rather than as mental health issue on its own, so when you seek help you may be diagnosed with one of these conditions:

Schizophrenia

If you’ve experienced at least one month of psychotic symptoms, plus at least six months of a suite of other symptoms including low motivation, reduced speech, diminished emotional expression, social withdrawal and more, you might receive a diagnosis of schizophrenia.

Related: Schizophrenia guide

Schizophreniform disorder

A diagnosis of schizophreniform disorder may be given by a doctor if psychotic symptoms last at least one month and symptoms associated with schizophrenia last less than six months.

Bipolar disorder

Bipolar disorder (which used to be called manic depression) causes extreme mood swings from extreme agitation to deep depression, usually with periods of milder moods in between. Some people with bipolar may also experience psychosis.

Related: Bipolar disorder factsheet

Schizoaffective disorder

This is a less common diagnosis which has symptoms similar to both bipolar disorder and schizophrenia.

The symptoms may change over time — a person may start off with symptoms of bipolar disorder, for instance, then develop symptoms of schizophrenia a year or so later. Because of this, it’s sometimes difficult to diagnose schizoaffective disorder accurately.

Drug-induced psychosis

Psychosis can be induced by the use of drugs like cannabis, cocaine, LSD, magic mushrooms, amphetamines (speed, ecstasy and ice) and even, in rare cases, alcohol.

Most people who experience drug-induced psychosis recover with treatment and by ending their drug use. Not everyone who takes drugs develops psychosis, but it’s difficult to know who’s vulnerable and who isn’t.

Related: Cannabis & psychosis

Postpartum psychosis

In rare cases, women may experience psychosis in the days or weeks following childbirth. For more, see beyondblue’s postpartum psychosis page

Brief reactive psychosis

This is usually a short-term reaction to severe stress. It lasts for less than a month.

Borderline personality disorder (BPD)

People living with BPD experience very intense, hard-to-control emotions, particularly around relationships. They can also struggle to have a strong sense of identity and self-worth. In severe cases, it is possible for people living with BPD to experience psychosis.

Major depressive disorder

Psychosis is not a common feature of depression, but may be present in some severe cases.

Related: Depression

Organic psychosis

In rare cases, psychosis may result from a brain injury or other neurological disorder.

Why your diagnosis can change over time

Understanding a psychotic illness takes time, because the illness itself unfolds over time. Schizophrenia, for example, is only diagnosed after at least six months of symptoms, including at least one month of active psychotic symptoms.

So it’s very likely that your diagnosis will change over time. That’s normal. As the illness takes its course, your health professionals will learn more about it — how best to describe it and how best to treat it.

Related: What use is a diagnosis?

The cornerstone treatment for symptoms psychosis experienced as part of a mental health issue is antipsychotic medication. The Royal Australian and New Zealand College of Psychiatrists emphasise the importance of a recovery-oriented context including peer relationships, social networks, and person-centred support. There is also growing evidence for the role of psychological and neurological therapies in supporting people with a schizophrenia-spectrum disorder.

Treatment should start as soon as possible, and may continue for as long as two to five years.

Antipsychotic medication

Antipsychotic medications work by affecting brain chemicals called neurotransmitters to reduce psychotic symptoms such as hallucinations, delusions and disordered thinking, and to prevent them from returning.

Several different options are available, and it’s not unusual to need to change medication. Antipsychotic medications can cause side-effects that will need to be managed — experiences can vary a lot from one person to another.

Related: Antipsychotic medication factsheet

Other medication you might need to take

People with psychosis often experience other mental health issues, like depression, anxiety or mania. So you may be prescribed anti-anxiety medications, anti-depressants or mood stabilisers along with your antipsychotics. This is relatively common — the medications are often used together.

Psychological therapies

Psychological therapies are becoming an increasingly useful part of treatment for psychosis. Here are some of the most common therapies available.

Cognitive behavioural therapy for psychosis (CBTp)

Cognitive behavioural therapy (CBT) is a therapy that explores the beliefs that influence the way we react to events. It challenges those beliefs and works with the thoughts and behaviours that reinforce them.

For example, if you’re hearing voices, it can be your beliefs about those voices that determine how distressing they are and how you react. Believing the voices are sinister and powerful might mean a more distressing experience, leading you to withdraw from the world or become anxious and afraid.

Cognitive behavioural therapy for psychosis (CBTp) is an effective treatment for psychosis, in combination with medication. The goal of CBTp is to reduce the amount of distress your symptoms cause you, and to help you improve your quality of life.

Family interventions

Family interventions involve family members in formal treatment. This includes programs where families learn about psychosis and how they can be involved in recovery, and family group therapy which involves both the person with psychosis and their family in therapy sessions.

Supporting and educating families makes it easier for them to cope with their loved one’s illness, helps improve family life and may reduce the chances of the person you care about having another psychotic episode or being re-admitted to hospital.

Open Dialogue

Open Dialogue emphasises conversation between the person who is unwell and their support network, which might include friends, family, neighbours, teachers or colleagues. The idea is to use listening and talking to find new and useful perspectives to aid treatment and recovery.

Open Dialogue may help people experiencing psychosis to better engage in their treatment and reduce use of medication.

Open Dialogue is increasingly being recognised and used around the world, but its availability in Australia remains limited.

Cognitive remediation

Cognitive remediation addresses the problems a psychotic illness can cause with thinking, memory, attention, problem-solving and social skills. Repetitive exercises are used to improve skills in these areas.

Cognitive remediation can be undertaken with a therapist qualified in cognitive remediation therapy. There are also online programs which can be completed independently.

Other psychological therapies

Given the wide ranging symptoms and impacts of psychosis, there are many different therapeutic approaches that may be useful. Other possibilities include art therapy, music therapy, solution-focused therapy and narrative therapy. Talk to your doctors or case worker about the options available to you.

Related: Psychological therapies factsheet

Neurostimulation therapies

Electroconvulsive therapy (ECT) can provide short-term improvements for psychosis, especially when it is resistant to medication.

Another, newer therapy is repetitive transcranial magnetic stimulation (rTMS). During rTMS treatments, the patient is exposed to a controlled and localised electromagnetic current for periods of 20-40 minutes at a time. The field can be used to stimulate or reduce activity in brain cells.

rTMS is often used to treat severe depression, but there’s growing evidence that it can help reduce auditory hallucinations in psychosis, including hearing voices.

Finding mental health services

There are a few different options available for clinical treatment. The best choice for you will depend on cost, severity of your symptoms and convenience, but not all services are available everywhere. For people in rural and remote areas, treatment options can be reduced or involve long travel or alternatively can be delivered through telehealth services. Ask your GP for more information about appropriate support options.

Early intervention programs for young people

Psychosis most often develops for the first time during youth. Identifying young people in the early stages of a psychotic illness and providing them with specialised support and treatment can make a huge difference to their future health.

The largest early intervention organisation in Australia is headspace, including their online service eheadspace. Specialist Child and Adolescent Mental Health Services (CAMHS) are also available across Australia — talk to your GP about finding a service near you.

Your public hospital

The treatment available through a public community mental health team ranges from acute inpatient care, where you are admitted and stay in hospital, to outpatient treatment in the community. The type of service provided can differ a lot from state to state and hospital to hospital.

Your state or territory Department of Health can help you identify your local community mental health services, or you can use the National Health Services Directory.

Treatment in a private hospital

With private health insurance, it’s also possible to get treatment in a private hospital. To ensure your money is well spent, research the different types of cover available and the treatment programs offered by hospitals in your area.

Private therapists

Another option for treatment is a private psychologist or psychiatrist, or both. Your GP can refer you, or the Find A Psychologist and Find A Psychiatrist services can help you find a therapist who has experience working with psychosis.

Other services

Many community organisations. offer peer mentor programs, outreach through case workers, support groups and recreational programs. Talk to your doctor about options or call the SANE counselling services on 1800 18 72 63.

Involuntary treatment

In Australia, there are circumstances where you can be legally hospitalised for a mental illness without your consent. You can also be legally compelled to receive treatment — medication and/or therapy — without your consent.

Involuntary treatment is a possibility. Understanding it helps you know your rights if it happens to you or someone you know.

Related: Involuntary treatment factsheet

Living with psychosis can add a layer of challenges to your life. Those challenges vary from person to person. However, there are many things you can do to stay well and live a life that is meaningful. 

The best ways to get well, stay well and flourish are to seek help early from a supportive team of health professionals and your trusted family, friends and social networks.

Doctors can provide medication. They can give you recreational activities and advice. But the desire to get better has to come from you

— Evan

Sticking with treatment

Psychotic illnesses take time to develop, so they also take time to diagnose. Your diagnosis and treatment could change as you and your treating mental health professionals learn more about the form your mental health issues are taking.

While this can be leave you feeling insecure, it’s important that you commit to treatment with a supportive team of health professionals, even if you’re frustrated. Consistent, long-term treatment with a support team you trust is so important for schizophrenia recovery.

Sometimes, people who start taking their medication and feel their symptoms reduce can believe they’re well enough to stop treatment. Stopping medication too soon can make symptoms return. To avoid this, always check in with your GP or psychiatrist before making changes to your medications.

Related: Thinking about stopping your medication?

Functional recovery

Psychosis can interrupt your work or study life, your relationships and your ability to engage with life in general. If you experience psychosis for the first time when you’re young, it can stop you getting started with those things.

So an important part of managing life with psychosis is to seek help with getting those things going again — work or study, relationships, your capacity to do things that are meaningful to you. This is called functional recovery.

Studies have shown that an early functional recovery gives you a better chance of long-term recovery than just treating symptoms alone. So getting on track with work, study, housing, relationships and health is just as important, perhaps even more so, than eliminating positive symptoms such as delusions or hallucinations.

Related: Getting back to work

For years I found it difficult to communicate. But working with customers means my confidence has really soared

— Jock

Looking after your physical health

Psychosis can take a toll on your physical health as well as your mental health. Psychosis can sap your energy, confidence and motivation — you can feel less capable of keeping up your physical health or lose the desire to try.

Another major influence on your physical health is the side-effects of antipsychotic medication. Newer antipsychotic medications have fewer side-effects, but weight gain is still common.

People being treated for psychosis are much more likely than the general population to be overweight, have high blood pressure and develop diabetes.

They’re also more likely to smoke, drink too much and use recreational drugs, which can have a negative effect on your mental and physical health.

If you’re struggling with these problems, you may hear your doctor use the term metabolic syndrome. It means you have some combination of:

• weight gain around the abdomen
• high blood pressure
• low levels of the good cholesterol
• high blood glucose levels.

Metabolic syndrome is common in people with a sedentary lifestyle and unhealthy diet, but it’s especially common in people with psychosis.

There is support to help you get healthy and stay healthy.

Related: Healthy living guide • Diabetes & mental health • Cannabis & psychosis

I was sick of being unfit and unwell and sitting on the couch. I decided to have a go, and if it didn’t work, the worst that could happen was being back on the couch

— Cameron

Finding support

Community support

There are many government and community-run support providers available in Australia. These include:

• training programs to help with social skills and day-to-day living
• outreach programs that can link you with a caseworker, supported employment, study or housing
• recreation or social programs.

These types of programs often employ peer support workers – people with a lived experience of mental health issues who have undertaken training in mental health.

Organisations that can connect you with community support services include:

• Asking a local and trusted GP.
• SANE Counselling Support: 1800 18 72 63
• Mind Australia
• Mental health and suicide prevention contacts (Department of Health)
• Mental health services by state and territory

I used to exist, but now I have a life

— Jock

Coping with stigma

You have a right to be treated with the same dignity, respect and care as everyone else.

Sadly, for people living with mental health issues, that doesn’t always happen. There’s a lot of ignorance about mental health issues in our society. Words like ‘psychotic’ and ‘schizophrenia’ are often used wrongly to refer to violence or danger. Some people react fearfully or judgmentally when they learn a person has a psychotic illness.

The situation is improving, but it’s still very common for people with mental illness to encounter stigma, which can cause problems with relationships, employment and your own self-esteem. For that reason, some people choose carefully who they tell about their mental health issues.

Related: Disclosure & dating • Legal rights & responsibilities • Who should I trust to tell about my mental illness?

How do you cope? You can’t single-handedly fix the problem of mental health stigma, but there are two ways you can strengthen yourself against its effects:

Get informed

Knowledge is power. Trustworthy, evidence-based sources of information about psychosis can give you a strong sense of what it really is, and what it isn’t. When you’re informed, you can spot stigma and wrong information and call it out for what it is.

Related: Guide to reducing stigma • Fact vs myth: mental illness basics

Get involved

Your mental health doesn’t have to isolate you. There are a lot of people out there going through something very similar, and places exist for you to meet them, tell your story and hear theirs. The SANE Forums provide a safe, anonymous, respectful place for people to share their experiences and make connections. It’s available 24/7 and moderated by mental health professionals.

There’s no better protection against stigma than feeling like you belong to a community, and that’s what the Forums are for.

Planning for the future

Relapse prevention plan

A relapse is when, after you recover from an episode of psychosis, your symptoms return and you experience another episode.

• A relapse prevention plan is a powerful tool for staying well and avoiding a worsening of your mental health issue. Making a plan involves:

  identifying your triggers: what events or situations could set your symptoms off?
• identifying your warning signs: what changes in your thinking, emotions and behaviour signal the early signs of psychosis?
• planning responses: what will you do to cope or seek help when you experience triggers & warning signs?
• listing support people: who will you call when you experience triggers & warning signs?

Having a relapse prevention plan can make you and the people who care for you feel more secure, even if you never have to use it.

You can read more about relapse prevention plans at Orygen and Here to Help.

Advance care directives

Because of the way psychosis affects thinking, feeling and behaviour, if your symptoms worsen at some time in the future, you may not be able to make good decisions about your care. It can also be hard for the people around you to know what’s best for you when the situation is intense and confusing.

An advance care directive is your instructions for what you want to happen if you can’t make your own choices, and who you authorise to make decisions for you.

If you make an advance care directive, keep a copy somewhere obvious and make sure the people close to you know about it, including any health professionals you are working with. Ask them to carry with them a simple summary of what to do and where to call for help if needed — in their phones, for example.

Having an advance care directive makes it much easier on you and the people who care for you if you ever need serious help.

For more information, see Advance Care Planning Australia.

I often feel like I’m taking one step forward, ten steps back, but when I take a step back at look at the big picture, I can see how far I’ve come

— Hannah

Seeing someone you care for experience the symptoms of psychosis can be confusing, frightening, hurtful, frustrating and terribly upsetting. The health system can be hard to understand and navigate. Recovery can be slow and uneven. The possibility of relapse can linger.

For all these reasons and more, the people around a person experiencing psychosis — their family, friends, supporters and carers — need their own support.

Caring for yourself

Carers tend to put the needs of the person they’re caring for first. But carers have needs too, and they need to be met, not just because it makes them better carers, but because everyone deserves care.

Physical health

Care, worry and effort can leave anyone physically run down and stressed, so the physical wellbeing of carers is a high priority. The basics of good physical health include:

• Sleep: 7-9 hours of sleep per night during regular hours is hugely beneficial to your health.
• Exercise: you don’t need to run marathons, but anything that raises your heart rate for 20 minutes per day helps. A long walk is a good example.
• Diet: regular, balanced, nutritious meals play a big role in feeding your mind and body.
• Alcohol: keep your alcohol consumption moderate at most, especially if you’re taking medication or might need to drive.
• Smoking and other drugs: the best thing for your health is to quit smoking and avoid illicit drug use altogether.

For more information, see Carer Gateway’s Health & wellbeing page.

That’s all easy to say, but changing habits takes time. Be kind to yourself and try making small and achievable changes. 

As a carer, it is very important to try to look after yourself and stay connected. I know this from personal experience

— Jo

Your boundaries

One of the most important things to do in relationships is to recognise your own boundaries. Decide for yourself how much time and energy you can give in a caring relationship, what you’re willing to do and what you’re not willing to do.

It’s okay to say no. In fact, sometimes it’s vital to say no, so that you can continue to provide support in the months and years to come.

Ask yourself:

• How much can I afford to give?
• How am I going to continue looking after myself?

Related: CBT & mindfulness for carers • Avoiding carer burnout • What I wish I knew when I became a carer

Support for carers

There are many other people out there who share your experience, and many services designed to help carers of people with mental health issues. Here are a few places to find support:

• SANE’s Friends, Family & Carers forum 
• SANE Counselling Support: 1800 18 72 63
• Mental Health Carers Australia (formerly ARAFEMI) 1300 554 660
• Carer Gateway - 1800 422 737
• NDIS families & carers page - 1800 800 110
• Young Carers

If you’re caring for someone and feeling isolated, you’ve got to reach out. You are honestly not alone, there are so many of us out there

— Penelope

Research has shown that involving family members in treatment for people with psychosis can help to reduce the likelihood of future episodes.

It helps to learn as much as you can about psychosis. When you’re well informed you can better understand what is happening and you can be more confident understanding and making decisions about treatment.

Stories from others caring for people with psychosis are also a reminder that recovery is possible.

Early stages of psychosis

You may be the first to notice that something isn’t right with your loved one. Because of the way psychosis affects thinking, they may be unaware that they’re unwell or unwilling to seek treatment.

Getting treatment early is one of the best things a person can do for their recovery, but while they are capable of making their own choices only the individual who is unwell can make the decision to seek help.

Be patient and avoid confrontation

As a family member, friend or partner, your role is to offer support in a non-judgmental way. Although you can make suggestions around help seeking, you can't make a person seek professional support if they're not ready. You may need to be patient in waiting for the person to take the appropriate steps of their own accord.

Related: How to manage conflict

I do pick up on him having a rough day – he will be restless and fidgety. Then I encourage him to go outside and run or walk the dogs

— Cameron’s wife Katie

Identify services and encourage help-seeking

As with any mental illness, the first stop is usually a doctor. A GP can conduct an initial assessment and refer the person to specialists as appropriate.

Once clinical support is in place, you may also be able to assist your loved one in finding further community support, such as peer support programs or a caseworker.

Sometimes fear of treatment arises from not knowing what is available. The thought of involuntary treatment in the hospital system can be scary, but Australia's public health system aims to treat people in the community – not in hospital – wherever possible. If risk is high or the person would prefer to be treated as an inpatient, then hospital is a possibility.

If you're both comfortable with the idea and the mental health professional agrees, you can accompany your loved one on their first appointment. You might be able to help explain some of what's been happening, or just be there as a support during the appointment.

During an episode

Seeing someone you care about experience psychosis can be incredibly distressing. It’s frightening for everyone involved and it can be difficult to know how to respond.

Prioritise safety

Your first concern is for the person’s safety and the safety of the people around them. If you think there’s a risk of physical harm, contact emergency services on 000.

You can also call a crisis assessment or acute care team. The name varies by state, but the service is the same: a small team of mental health professionals will come to you and assess the safety and support needs of yourl loved one to decide what urgent treatment they might need.

You can find out more about mental health acute care or crisis assessment teams and the numbers to call for your state at Health Direct Crisis Management.

Stay calm

Psychosis can be incredibly stressful for both the person experiencing it and those around them. Becoming distressed yourself can cause the situation to escalate more quickly, so try your best to stay calm.

Be respectful of their space. For example, try not to hover over them if they are sitting down and don't touch them without their permission. 

Show compassion

Remember that the person is likely to be feeling scared and confused. Where you can, keep them company and reassure them that they're not alone. Showing that you care and don't judge them can mean more than you imagine.

Never underestimate the positive impact of a single act of kindness

— David

Responding to delusions and hallucinations

Your loved one’s delusions and hallucinations are as real for them as what you are seeing and hearing right now. So focus on feelings rather than facts:

• Don’t try to disprove the delusion. Delusional thinking doesn’t respond to reason, so trying to talk them out of it can lead to arguments and distrust.
• The delusion isn’t real, but the underlying emotion is. Validating that emotion (‘I can see you’re really frightened’) can help the person feel less alone.
• Use language that normalises the person's experience, such as 'stress.' You can also use the language they use to describe their symptoms. Don't use stigmatising language like 'crazy.'

Responding to disordered thinking

Psychosis can seriously affect a person’s ability to put thoughts and words together, so:

• communicate in clear and simple language
• repeat things if necessary
• be patient and allow the person plenty of time to respond.

Working with the treating team

Once your loved one has taken steps to seek help, it can be helpful to ask for their consent to contact their treating professionals and support workers. Connecting with the treatment team means that you can notify them of any concerns you have and can ask for their advice on how to help your loved one at home.

Ask the treating team when it’s appropriate to contact them and how they would prefer to be contacted.

Having good communication with the treatment team also means you are in a better position to speak up for your loved one if they have concerns about their treatment.

Helping with medication

It’s very common for people with health issues – physical or psychological – to stop taking their medication. There are many reasons why this happens: because the side-effects are bad, because symptoms have reduced and the person is feeling better, because of distrust in the mental health system, or just the difficulty of remembering to take a tablet each day.

If you suspect your loved one is not taking their medication or sticking with treatment, the first thing to do is talk to them about it. Some reasons can be addressed easily: if they’re finidng it hard to remember, they could set up reminders on their phone or consult a health professional about other options that require less frequent doses. If they’re experiencing side effects, they may be able to reduce the dosage or try a different type of medication.

It’s vital that any changes to medication happen in consultation with the person’s treating health professional. Before considering any change to medication, contact the treating team.

Planning for the future

After an episode of psychosis, it can help to have a conversation with your loved one about how you could manage a similar situation together in the future, and what will happen if they aren’t able to make their own decisions. See the sections of the guide on relapse prevention plans and advance care directives.

I tell him he has to look after himself, that work can wait. It's quality that matters

— Evan’s wife Tammy

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