Schizophrenia

Schizophrenia two types of symptoms: short but intense episodes of psychosis and longer-term symptoms related to mood, motivation and emotional expression ​(1)​. 

Symptoms of schizophrenia can be referred to as ‘positive’ or ‘negative’, but they don’t mean ‘good’ and ‘bad’.  

‘Positive’ symptoms refer to something ‘added’ to the person’s normal experience. They refer to symptoms of psychosis, which usually occur in episodes. Psychosis can involve:  

• Delusions — false beliefs  

• Hallucinations — hearing voices or otherwise seeing or sensing things that aren’t real 
• Disorganised thinking — muddled, disrupted thoughts and speech 
• Disorganised behaviour — unusual, inappropriate or extreme actions. 

Other symptoms are called ‘negative’ because they take something away from your experience. They tend to last for a longer period of time These can include: 

• Low motivation/losing interest in activities 
• Experiencing and expressing fewer emotions 
• Feeling less pleasure in work, study, hobbies, or socialising 
• Speaking a lot less, or not at all 
• Difficulties with attention or memory 

For a useful summary, check out our schizophrenia factsheet and our psychosis factsheet. 

Everyone’s experience is different 

Symptoms of schizophrenia vary from person to person. 

Symptoms usually emerge between the late teens and early adulthood. But you might experience symptoms in childhood, or later in life. 

There’s also variation in terms of the types of symptoms you might experience, how often you might experience episodes of psychosis, how long episodes might last, and how much they impact upon your daily life ​(2)​.  

Here are some real stories from people with lived experience of schizophrenia: 

• Hannah’s story 
• Evan’s story 
• Cameron’s story 

It is possible to live a long and fulfilling life with schizophrenia 

There is no ‘cure’ for schizophrenia, meaning it is a long-term condition. While many people need to manage their symptoms over time, with the right support symptoms can have minimal impact on quality of life. 

The good news is that many people with schizophrenia can recover well from episodes, and can lead long and fulfilling lives. With time, you might understand your symptoms better, figure out which treatment and support options work for you, and learn how to stay well and improve your wellbeing. Many people with schizophrenia can stay in the workforce, connect with their local community, and have a range of fulfilling relationships. 

Recognising early signs of schizophrenia 

An episode of psychosis is rarely the first sign of schizophrenia. You might experience a lead-up period before a first episode of psychosis. This is sometimes called a ‘prodromal’ period ​(3)​.  This can be hard to spot, especially if they occur during an intense period like adolescence and early adulthood.  

Early stages of schizophrenia frequently begin with general, hard-to-pin-down changes to thinking, emotions and behaviour, such as these ​(3,4)​: 

• Trouble with attention and concentration 
• Irritability, low mood, anxiety or suspiciousness 
• Trouble keeping track of thoughts and conversations 

• Insomnia 
• Feeling disconnected from other people, withdrawing from others, and wanting to be alone 
• Decreased performance at work or school. 

These signs are common features of many mental health conditions, and some of them are normal parts of human experience, especially during adolescence. They don’t necessarily mean you are developing psychosis, but they indicate that something might not be right, especially if they worsen over time. 

The following signs are stronger indicators of psychosis: 

• Preoccupation with a particular person or subject (for example, religion, surveillance, or science fiction) 
• Speech or writing that is very fast, muddled, irrational or hard to understand 
• Increased sensitivity to light, noise and/or other sensory inputs 
• Increased anger, aggression or suspiciousness 

• Inactivity and/or hyperactivity 
• Behaving in a way that seems reckless, strange or out of character 
• Laughing or crying inappropriately, or being unable to laugh or cry 
• Poor personal hygiene 

If you, or someone you care about, recognise these signs, the first step is to speak with a health professional as early as possible. 

What to expect from an assessment 

A general practitioner (GP) can provide initial assessment and advice, and monitor symptoms over time. They can provide a referral to a mental health professional, usually a psychiatrist, who can provide a full assessment and advice around treatment. 

An assessment for schizophrenia may involve a combination of the following ​(4)​: 

• Talking in detail about your history and experiences, including any family history of mental health conditions, any experiences of challenging or traumatic events, your medical history, and any history of substance use 
• Exploring your symptoms, including their severity, age of onset, and how long they last. This sometimes involves a structured psychological interview or written questionnaires. 

• Physical examinations, cognitive tests, and medical tests to explore other things that might be contributing towards your symptoms  
• Monitoring symptoms over time 

It can be helpful to prepare for an assessment by bringing in some notes or dot points. 

Ideally, people you trust – such as families and friends – should also be invited to provide their observations and discuss any concerns. 

Assessments can take time 

Schizophrenia is a diagnosis that takes time to be confirmed. To have a confirmed diagnosis of schizophrenia, symptoms of psychosis need to have lasted at least a month, and other symptoms need to have lasted at least six months ​(1)​. 

Before then, you may be given a 'working’ or ‘provisional’ diagnosis of schizophrenia. This means there's reason to believe you're experiencing schizophrenia, so treatment and support can begin. Sometimes more evidence is needed to confirm the diagnosis. 

You may receive a different diagnosis early on. Often people experience co-occurring conditions, which means it can be difficult to understand which conditions are causing symptoms. It’s also important to rule out other mental health conditions that can include psychosis as a symptom, such as schizoaffective disorder, bipolar disorder, borderline personality disorder, major depressive disorder, and substance use disorders. 

It's normal for your diagnosis to change as time passes, as you and the health professionals you are working with learn more about your experience. 

Schizophrenia is a treatable mental health issue. The symptoms of schizophrenia are usually treated with psychological therapies and medication. It can take time to find the right combination of treatments that work for you, but for most people living with schizophrenia, good treatment leads to reduced symptoms and a better quality of life.

It is important that people experiencing symptoms of schizophrenia are able to collaborate with their healthcare providers to on treatment decisions. This is ethically essential as well as potentially having benefits for a person's understanding and treatment satisfaction.   

Antipsychotic medication

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

Options for treatment support depend on your individual circumstances ​(5)​. Schizophrenia is usually managed through a combination of medication and other treatment and support options – psychological support, support from community services, and looking after your physical health can help to keep you well. This might involve the support of a GP, a psychiatrist and other mental health professionals, social workers, case managers, or others. Consistent, long-term treatment with a support team you trust is very important. 

Some treatments can occur in community settings, like doctors’ clinics, whereas others might occur in private or public hospital settings. Some services offer dedicated early intervention and  early psychosis programs, such as headspace. 

Treatments are often long-term. It can take a while to figure out the right combination of treatment and support options for you. It can also take some time to find the right health professionals to support you. This is normal.  

Remember that it’s okay to ask questions, to explore your options, and to speak up if something doesn’t sit right with you. You have the right to be involved in treatment decisions, and make informed choices. 

Medication 

Antipsychotic medication 

Antipsychotic medication is considered a ‘first line’ treatment for schizophrenia. This means that most people with schizophrenia will be prescribed one or more medications which are designed to prevent or reduce the symptoms of psychosis.  

Several different options are available. They work by interacting with brain chemicals called neurotransmitters to reduce psychotic symptoms such as hallucinations, delusions and disordered thinking, and to prevent them from returning. These medications are usually prescribed and monitored by a psychiatrist.  

Here are some tips on how to get the most from your medication: 

• It’s important to take medication as directed – even if you’re feeling well – otherwise your symptoms won’t be controlled as effectively. Always tell your doctor if your medication is causing problems, or if you want to make changes. 
• Don’t be afraid to ask questions about your medication – understanding what it does, and why you need it, is important. Ask how the treatment will help you, any side effects, and pros and cons.  
• Be honest with your doctor about any current medications or substance use, as these can interfere with your medication. 
• Make it simpler – dosage dispensers available from pharmacies or calendars can help you keep on track and make it easy to remember to take medication. 
• Let trusted family and close friends know about your medication – people close to you can provide good support when you’re taking medication long term. 

• Consider long-lasting medication options, especially if you struggle take your medication regularly. Some medications can be taken long-lasting injectable (depot) medications.  

Other medication 

Many people with schizophrenia need medication to help manage psychosis, but you might also need medication to help manage other mental health concerns, like depression, anxiety, and the ‘negative’ symptoms of schizophrenia. This is relatively common — medications are often used together. 

Side effects 

Medications often have side effects, such as weight gain, metabolic complications, sleep disturbances, and dizziness ​(4)​.  

If you have any side-effects from your medication, tell your doctor – they may be able to reduce or change the dosage, or suggest other ways to manage the problem. 

It’s important to remember that the same medication can affect people quite differently. In other words, not everyone who takes a particular medication will experience the same side-effects.  

Psychological therapies 

Psychological therapies a involve working with a mental health professional. They might involve learning more about schizophrenia, understanding how different thought processes and behaviours can impact on your mood, developing self-management skills, and improving relationships ​(5)​.  

Some of these include: 

• Cognitive behavioural therapy for psychosis (CBTp): A type of therapy that explores the beliefs that influence how you react to events. 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. 
• Open Dialogue: This approach emphasises conversations between you and your support network, such as family, friends, neighbours, teachers or colleagues. The idea is to use listening and talking to find new and useful perspectives.  
• Cognitive remediation: This approach addresses the problems you may experience with thinking, memory, attention, problem-solving and social skills. Repetitive exercises are used to improve skills in these areas. 

There are also some therapeutic approaches designed specifically for early intervention ​(4)​.  Talk to your doctor about the options available to you. 

Family interventions 

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

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

Neurostimulation therapies 

Neurostimulation therapies stimulate the brain, with the aim of improving symptoms. They are sometimes offered during acute phases of schizophrenia, or in cases when other treatments have not been helpful ​(5)​. 

• Electroconvulsive therapy (ECT) works by using electrical stimulation to release brain chemicals that help restore normal functioning to your brain. ECT is given in a hospital under general anaesthetic. It’s an established, safe treatment that can be helpful for severe depression, mania, and psychosis.  

• Repetitive transcranial magnetic stimulation (rTMS) involves being exposed to a specific electromagnetic field for short periods of time. The field can be used to stimulate or reduce activity in your brain cells. There’s some evidence that it can help reduce auditory hallucinations in psychosis, including hearing voices ​(5)​. 

Peer support 

Connecting with other people who also have schizophrenia can really help. As well as overcoming isolation, it’s a good way to share useful information and strategies to help you cope. 
 
Peer support can be formal or informal. SANE has several peer support options; for more information, call the SANE Helpline on 1800 18 SANE (7263) or check out this page. 

Psychosocial interventions 

Support programs are available to help people access support in the community, based on your individual needs. 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 
• help with areas such as employment, study, or housing 
• recreation or social programs. 

You may wish to ask your GP or another health professional for options. Organisations that can connect you with community support services include: 

• SANE (1800 187 263) 

• Mind Australia 
• Wellways 

Schizophrenia an require longer-term treatment. It takes at least six months of symptoms to be diagnosed and treatment may be recommended after symptoms have reduced.

While your mental health issue is being treated, life continues. How can you live the best life you can with schizophrenia?

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

— Evan

Deciding what recovery means to you

Recovery is a word that means different things to different people. What does it mean to say you’ve recovered from schizophrenia?

Your doctors might say you’ve recovered when your symptoms reduce by a certain amount over a certain time. Other people might say that if you can take part in life again — if you can get and keep a job, have meaningful relationships and generally do the everyday things you want to do — that means you’ve recovered. Or maybe it means managing your symptoms so you can do some self-care tasks.

Your idea of recovery is personal, and it can change over time. Talk to your doctors, your family and friends and the other important people in your life, about how they picture your recovery. Their advice can help you decide your short-term and longer-term goals for recovery.

The outlook for people with schizophrenia is better than many realise, especially when you get consistent treatment that starts as early as possible after symptoms are diagnosed. Many people live a fulfilling life with a diagnosis of schizophrenia.

Related: Managing symptoms of schizophrenia

Self-advocacy is about learning to stand up for yourself. It is about building your confidence and self-esteem. It takes time

— Evan

Sticking with treatment

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 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

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

An important part of managing life with schizophrenia 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. So getting on track with work, study, housing, relationships and health is just as important, perhaps even more so, than eliminating positive symptoms like 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

Schizophrenia takes a toll on your physical health as well as your mental health. It can sap your energy, confidence and motivation — you might 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 a common one. 

People being treated for schizophrenia 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 schizophrenia.

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 issue who have undertaken training in mental health.

Organisations that can connect you with community support services include:

• SANE Counselling Support - 1800 18 72 63
• Mind Australia
• Wellways

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 ‘schizophrenic’ can be misused to refer to violence or danger. Some people react fearfully or judgmentally when they learn a person is living with schizophrenia.

The situation is improving, but it’s still very common for people with mental health issues 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 diagnosis or experiences.

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

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 schizophrenia can give you a strong sense of what this diagnosis 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 health 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 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 schizophrenia 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 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. You can find out more at 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

Mental health crises are very intense, and can be scary. They might not be frequent, but can be challenging to manage.  

During an acute episode, you might experience symptoms of psychosis which are to manage, and other symptoms like recklessness, impulsivity, and suicidal thoughts. You might be unable to make decisions for yourself in the same way you can during times when you’re feeling well. 

Monitoring early warning signs 

A relapse prevention plan is a powerful tool for staying well. A relapse is when, after you recover from an episode of psychosis, your symptoms return and you experience another episode.  

Making a plan involves: 

• identifying your triggers: what events or situations could result in your symptoms returning? 

• identifying your warning signs (‘relapse signature’): 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 contact when you experience triggers & warning signs? 
• what can friends and family do if they are concerned? 

Having a relapse prevention can make you, and the people who support 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. 

Planning next steps in advance 

You may also wish to look into advance care planning, which involves planning for your future health care in times where you may be unable to communicate your preferences or make treatment decisions.  

This is a team effort, involving identifying a trusted family member or friend who can make decisions on your behalf, and discussions with healthcare professionals. It also involves completing an Advance Care Directive. Information varies by state. You can find out more at Advance Care Planning Australia 

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.  

Treatment for acute psychosis 

It’s not always possible to manage symptoms of psychosis at home. Often, this requires an inpatient stay at a hospital, to stabilise symptoms and keep you safe.  

The chances are that your stay will be as short as possible and in a psychiatric unit of a hospital. In some cases, you may need a longer stay, for example, if your treatment team are concerned that you might harm yourself. 

Treatment might involve trialling new medications, or changing dosage of existing medications. You might also access other treatment and support options such as individual or group therapy, or neurostimulation therapies. 

Managing suicidal thoughts and behaviour 

Sometimes people have thoughts about harming themselves or taking their own life when they’re experiencing an acute episode of psychosis or their mood is very low – try to remember that these are only thoughts, that they will pass, and there’s no need to act on them. 
 
These thoughts can also be a real warning that your treatment needs improving, so talk to your doctor about them as soon as possible. Adjusting medication can help manage suicidal thoughts. Plus, psychological therapies can help address causes of the thoughts, and identify  strategies to cope if they arise again. 
 
For more information on how to manage and prevent suicidal feelings, please see our guide to support when you're concerned about suicide. 

If you, or someone you know, is having suicidal thoughts and is in immediate danger, please call triple zero (000) and ask for an ambulance. Don’t leave the person alone until help arrives.   

For help and support, call Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467.   

Treatment and consent 

If a psychiatrist or other health professional recommends someone needs treatment and the person doesn’t agree, they may sometimes be treated without their consent. In some parts of the country, this is known as ‘sectioning’ or ‘scheduling’. 
 
The exact circumstances for involuntary treatment vary between different States and Territories, but in general people receive treatment in this way to ensure their own health or safety, or that of others.    
 
There may be legal limits on how long someone can be treated without their consent, and they may ask to be discharged by a doctor or a body such as a Mental Health Review Board. These facts should be explained to anyone having treatment without their consent. 

To learn more about your rights, contact or visit the website of your state’s Office of the Public Advocate.  

This section describes the important things you can do to look after yourself – both by yourself, and with the support of your family, friends, and advice from trusted health professionals. By doing what you can to look after yourself, you are likely to feel more in control, and have a better chance at preventing or reducing the severity of symptoms.  

Check out our Healthy Living guide for more information on maintaining your wellbeing and physical health. 

Deciding what recovery means to you 

‘Recovery’ is a word that means different things to different people. 

Your doctors might say you’ve recovered when your symptoms reduce by a certain amount over a certain time. Other people might say that if you can take part in life— if you can get and keep a job, have meaningful relationships and generally do the everyday things you want to do — that means you’ve recovered. Or maybe it means managing your symptoms, feeling connected to others, or having hope for the future. 

Your idea of recovery is personal, and it can change over time. It can also help to talk to your doctors, your family and friends and the other important people in your life, about how they picture your recovery. Their advice can help you decide your short-term and longer-term goals for recovery. 

Getting regular check-ups 

People living with schizophrenia are at increased risk of physical health problems, due to issues such as medication side effects, poor diet, and smoking. Metabolic syndrome is common. This involves a cluster of risk factors for cardiovascular disease – including diabetes, raised cholesterol and blood pressure, and weight concerns ​(4)​. Other common issues include dental disease, sleep apnoea, headaches, asthma, and arthritis ​(5)​. 

For this reason it is important to see a GP regularly. Your GP can help monitor your physical health, including monitoring your weight, heart, liver and thyroid function, haemoglobin and glucose levels, and more.   
 
Your doctor can also advise on a healthy lifestyle, including nutrition, exercise, and sleep ​(4)​.  

For more information, please see the Healthy Living guide. 

Managing stress 

Everyone needs to find ways to manage stress – but it’s especially important if you have schizophrenia, because stress can sometimes trigger symptoms. 
 
Some suggestions: 

• Going for a walk, yoga, meditation, aromatherapy, or having a long bath can all help to relieve stress – find what works for you. 
• Relaxing with things you enjoy should be a regular part of your life – whether it’s a movie, a book, listening to music, watching TV, meeting people, or being with a pet. 
• Think about ways of reducing stress in your life. Don’t try to pack too much into your day, for instance, and try to deal with one thing at a time. 
• If you can’t avoid stressful events, give yourself time to relax and recover afterwards. If stress is becoming a problem, ask your doctor or a mental health professional to suggest ways of dealing with it. 

Avoid alcohol, smoking, and recreational drugs 

Health guidelines recommend that healthy adults should drink no more than 10 standard drinks of alcohol per week, and no more than 4 on any one day. While moderate alcohol intake is unlikely to be harmful, you might find that alcohol can intensify symptoms and worsen the symptoms of schizophrenia. Sometimes alcohol can interact in dangerous ways with prescription medications. For some people, not drinking at all is the best and safest option.  

If you smoke cigarettes, then giving up cigarettes is a dramatic way to improve your general health. While depression can be a temporary side-effect of quitting for some people, don’t let this put you off.  

Some types of recreational drugs can trigger episodes of depression and psychosis. For example, there is a link between cannabis and the onset of psychosis, though the relationship is complicated ​(5)​. Substance use can also negatively impact the course of schizophrenia. For these reasons, it is important to avoid recreational drugs.  

Talk to your GP or psychiatrist if any alcohol, cigarettes, or other substances are a concern for you. 

Stay connected 

Symptoms of schizophrenia can sometimes result feeling isolated and withdrawing from others. It’s important to try to push through this feeling – because not spending time with others can make symptoms worse. Try to make the effort to stay in touch with family, friends and neighbours – you’ll feel better for it in the long term.  

Connecting with others who also live with schizophrenia can also help you feel connected and understood. Check out SANE’s Forums and Peer Support options. 

Having a close relationship with someone who has schizophrenia can be challenging at times. It can be difficult to know how to help effectively. 

For example, the health system can be hard to understand and navigate. Recovery can be slow and uneven. The possibility of relapse can linger. Sometimes there might be conflict. 

Try to remember that their symptoms are not their fault – problems such as withdrawing from others, having trouble getting out of bed and lack of motivation aren’t laziness. They are symptoms of a mental health condition.  

Involvement in treatment 

When someone first starts exhibiting signs of psychosis, it can be difficult to know what to do. They may not be aware that their thoughts or behaviours are unusual or causing you concern. 

Try to stay calm and patient - although you can encourage help seeking, in most circumstances, you can't make a person seek professional support if they're not ready. You can talk to a doctor yourself if you are concerned, and not sure how to approach these conversations. 

If possible, try to be actively involved in their treatment. Family and friends can provide a valuable perspective and provide important information and suggestions. It’s okay to ask for consent to be involved, to attend appointments where possible, and to discuss what your role might look like. You might also be able to assist with treatment and support at home, such as providing support around taking medication. Their GP and any other members of the treatment team should also be able to provide you with support for your own wellbeing.  

It’s also a great idea to encourage planning for the future – including monitoring for early warning signs (relapse prevention plans) and what to do if the person you care for experiences a crisis or cannot make their own decisions (advance care directives). If possible, try to have a copy of these action plans on hand. 

If they are experiencing symptoms of psychosis 

If someone is experiencing hallucinations or delusions, it is important to approach the situation calmly and non-judgmentally. It is not helpful to dismiss their experiences, or to argue with them. It’s also not helpful to pretend to agree with their hallucinations or delusions.  

It can be helpful to:  

• Listen carefully  
• Validate any emotions they are experiencing (e.g. ‘That sounds scary’)  
• Be patient and clear, and allow plenty of time for them to respond 
• Encourage seeking help or engaging in self-care strategies 

For more detailed suggestions, check out Mental Health First Aid guidelines for psychosis. 

In a crisis  

In some situations, it might be necessary to escalate the situation. This might occur if: 

• They are acting erratically. 
• They are behaving aggressively or are threatening you or others. 
• They are suicidal. 

If you, or someone you know, is in immediate danger, please call triple zero (000) and ask for an ambulance. Don’t leave the person alone until help arrives.   

For help and support regarding suicidal thoughts or behaviours, call Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467.   

See How to help when someone is suicidal and How to help in a crisis for more advice. 

Coping with aggressive behaviour 

Most people who experience psychosis do not act aggressively. But in the rare occasion this does happen, it is important to know how to respond. 

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

• Stay at a safe distance 
• If possible, try to limit access to any items they could use to harm themselves or others 
• Try to keep your voice level and communicate in short, simple sentences 
• Avoid sudden or abrupt movements 

• Do not threaten them with police or emergency services 
• Never put yourself at risk 

If a person is experiencing a severe psychotic episode, it’s important that they are seen by a health professional as soon as possible. 

If there is an emergency, call 000. 

If you are concerned, but there is no immediate danger, you may wish to call a crisis assessment and treatment team (CATT) or an 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 your loved one to decide what urgent treatment they might need. You can find out more about these teams and the numbers to call at Health Direct. 

Check out Mental Health First Aid guidelines for psychosis for more information. 

Self-care and managing burnout 

Remember, carers need to look after their own health and wellbeing, too.  

When someone you care about is experiencing symptoms of psychosis, it’s natural for you to be affected by this. Carers can sometimes put the needs of the person they’re caring for first. But carers have needs too, and your wellbeing is important – not just because this might make you a better carer, but because everyone deserves to be mentally healthy. 

While caring for the person, try to maintain your own life, interests and feelings. Eating well, getting regular exercise, and making time to relax all help your physical and mental wellbeing – and that makes it easier to cope. It’s also okay to set boundaries around the types of support you can provide.  

Many people find it helpful to be in touch with a carer support group. The SANE Forums provide a safe, moderated online space where people affected by mental health conditions, as well as family and other carers, can share information and advice and provide mutual support. 
 
Carer resources 

For further information, please see our guide for families, friends, and carers or  

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

• Carer Gateway 
• Mental Health Carers Australia 1300 554 660 

• NDIS families & carers page - 1800 800 110 
• Young Carers Network 

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2. Morgan VA, Waterreus A, Jablensky A, Mackinnon A, McGrath JJ, Carr V, et al. People living with psychotic illness in 2010: The second Australian national survey of psychosis. Australian & New Zealand Journal of Psychiatry [Internet]. 2012;46(8):735–52. Available from: http://dx.doi.org/10.1177/0004867412449877 

3. Martínez-Cao C, de la Fuente-Tomás L, García-Fernández A, González-Blanco L, Sáiz PA, Garcia-Portilla MP, et al. Is it possible to stage schizophrenia? A systematic review. Transl Psychiatry [Internet]. 2022;12(1):197. Available from: https://doi.org/10.1038/s41398-022-01889-y 

4. Early Psychosis Guidelines Writing Group and EPPIC National Support Program. Second edition Australian Clinical Guidelines for Early Psychosis, 2nd edition. 2016.  

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