How To Help Someone With Psychosis Who Doesn't Want Help: Compassionate Tips

Psychosis is a term generally referring to a loss of contact with reality. Psychosis is typically used to reference the psychotic symptoms that accompany certain mental disorders, such as schizophrenia, brief psychotic disorder, and bipolar disorder with psychotic features. Some neurophysiological conditions may also feature symptoms of psychosis. Psychosis tends to be relatively uncommon, with research suggesting prevalence rates of approximately 1.5% to 3.5%. 

Additionally, some individuals with conditions featuring symptoms of psychosis may have what's referred to as anosognosia, a neurological condition in which one is unaware that they have a psychiatric condition or neurological deficit. Anosognosia can interfere with an individual's ability to recognize symptoms that disrupt daily function, like emotional dysfunction and unusual behaviors or speech. 

The difficulties faced by individuals with psychosis can create challenges for those who love them, too, especially if the person is resistant to accepting help in treating their disorder. When approaching this situation, practicing empathy, patience, active listening, and respect for your loved one’s boundaries may be beneficial. Educating yourself, practicing self-care, and seeking professional support if needed can also be helpful.

Caring for someone with psychosis can be challenging

Discuss your experiences in online therapy

Understanding psychosis

Psychoeducation is often the first step to understanding how to help a loved one experiencing psychosis. Psychotic symptoms can be frightening and distressing to those experiencing them and the people around them, and they can present challenges in all areas of life, including work, school, and interpersonal relationships. Some people with psychosis may feel overwhelmed and find coping with daily life difficult. While the etiology of psychosis isn't fully understood, multiple studies conclude that the condition may be connected to neurological dysfunction in some regions of the brain, which can be found in some people with neurological and psychiatric conditions like schizophrenia.

Types of psychotic disorders

Psychotic disorders are severe mental illnesses that can involve abnormal thinking patterns, perceptions, and behaviors. They're usually characterized by a disconnection from reality (or a "psychotic break") in which the individual has difficulty recognizing what's real and what isn't. Here are some examples of disorders that may feature psychotic symptoms:

• Schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder, schizoaffective disorder)

• Brief psychotic disorder

• Bipolar disorder

• Severe depression

• Paranoid personality disorder

• Schizotypal personality disorder

• Delusional disorder

• Postpartum psychosis

Psychotic symptoms also sometimes emerge in individuals with certain health conditions or as the result of medication side effects or substance use. 

Psychotic symptoms and diagnostic criteria

While psychotic symptoms often present differently between people, there are some core signs of which to be aware.

• Hallucinations: Common hallucinations may involve seeing, hearing, smelling, tasting, or feeling nonexistent stimuli. 

• Delusions: Individuals experiencing delusions typically hold untrue beliefs despite clear evidence that they aren't real. For example, one may experience delusions of grandeur, in which they believe they have special powers or abilities, or paranoia, in which the individual thinks others are conspiring against them. 

• Disordered thoughts and speech: Some may have difficulty organizing their thoughts such that they cannot form coherent sentences or communicate logically. This often manifests in one's speech patterns with words that may be nonsensical or strung together randomly. This is sometimes referred to as "word salad."

• Disordered behaviors: Individuals may behave in unpredictable, unusual, or inappropriate ways for the circumstances. They may appear agitated or disoriented. Some people experience catatonia, an absence of movement or response to stimuli. 

• Secondary mood and cognitive symptoms: Individuals with psychosis may experience a diminished ability to experience pleasure, a lack of emotional expression, and social avoidance. Cognitive symptoms often include memory problems, diminished problem-solving capabilities, and decreased executive function, including the ability to care for oneself.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), individuals must meet a set of criteria to receive a psychotic disorder diagnosis. While portions of these criteria may vary between conditions, core criteria include the following:

• Two or more primary symptoms presenting for a significant portion of time during a one-month period

• Symptoms that significantly impact an individual's function in one or more primary areas, including work, relationships, or self-care

• Continuous signs of the disturbance for at least six months, including at least one month of primary psychosis symptoms

Some psychotic disorders feature different duration criteria or additional symptoms that must be present for diagnosis. (For example, schizoaffective disorder must also involve symptoms of major depression and/or mania.)

Potential causes

While psychosis typically appears as a symptom of a psychotic disorder, medical condition, or medication interaction, research on what causes psychosis as a symptom is ongoing. Scientists posit a complex combination of factors most likely causes psychosis.

• Genetics: Studies suggest a strong connection between genetics and conditions involving psychotic symptoms, like schizophrenia and bipolar disorder.

• Environment: Birth complications, trauma, social isolation, and substance use disorders are a few examples of environmental risk factors that may contribute to the onset of psychotic symptoms. Many environmental factors work in connection with genetics to increase one's chance of developing psychosis. 

• Neurological conditions: Brain trauma, infection, epilepsy, and diseases affecting brain function can contribute to psychosis onset. 

Show patience and empathy

Avoid rushing the person or negatively judging their thoughts and behaviors. Demonstrate genuine empathy for and understanding of their emotions. When you validate their feelings, show patience, and approach them non-judgmentally, you may create a safe, supportive space for them to share their experiences. 

Practice active listening

Active listening generally involves giving the person your full attention. Let them know you're listening through body language and eye contact. Let them finish speaking before you talk, and repeat their key points to ensure you understand. For example, you may say something like, "If I understand you correctly, you're saying…" or "What I'm hearing is…" 

Respect their boundaries

Pushing an individual with psychosis to talk about their experiences can make them feel overwhelmed and less comfortable with sharing. Respect the person's boundaries and personal space and let them set the pace.

Provide consistent, non-judgmental support

Helping someone with psychosis may require reliability and consistency. Honor your commitments, be punctual, and follow through with any plans you've made. Staying consistent and keeping your promises may build trust and reliability.

Offer emotional support and reassurance

Emotional dysregulation is often a secondary symptom of psychotic disorders. Additionally, experiencing psychotic symptoms can be extremely frightening, potentially causing emotional distress. Reassure your loved one that you're there for them, that you intend to keep them safe, and that you'll help them find the right support. Assuring them that improvement is possible with help might instill a sense of hope and motivation to seek treatment. 

Offer practical assistance when they’re experiencing psychosis

Identify ways you can provide practical help in navigating the challenges many people with psychosis face in daily life. For example, you could assist with tasks like grocery shopping and other household chores. You may offer to accompany your loved one to appointments or explore options for resources that support individuals with psychosis. 

Educate yourself on how to help someone with psychosis

Psychoeducation can help cultivate empathy and understanding for others struggling with symptoms of psychosis. The entire family or friend group can better support your loved one by taking the time to educate yourselves about psychosis.

Seeking professional help for a loved one experiencing psychosis or psychotic symptoms

If your loved one has agreed to accept medical assistance, exploring resources and finding support together may be helpful. There are many organizations focused on providing services for those who seek help.

• National Alliance on Mental Illness (NAMI) 

• Substance Abuse and Mental Health Services Administration (SAMHSA)  

• Early Assessment and Support Alliance (EASA) 

Self-care for caregivers

Taking care of yourself as a caregiver of a loved one with psychosis can be beneficial for your well-being and ability to provide effective support. Finding the right formula might take time and perhaps some trial and error, but studies show that caregivers who engage in self-care are usually better able to care for others. Here are some self-care strategies to consider.

Prioritize your wellness when caring for someone with psychotic symptoms

Nurture your mental and physical well-being with regular physical activity, nutritious eating habits, and quality sleep. Set aside time to participate in activities that recharge and rejuvenate you. 

Learn stress management

Many people benefit from relaxation techniques like deep breathing exercises, mindfulness meditation, or activities like yoga and tai chi. Engage in activities that help you relax and unwind, such as spending time in nature, reading, listening to music, or taking a soothing bath. 

Get comfortable with setting boundaries

Learn to establish clear boundaries between your role as a caregiver and your other responsibilities. Designating time for yourself to focus on your needs and interests can help you better care for your loved one without becoming overwhelmed or resentful.

Practice self-compassion

For some, caring for a loved one with psychosis can be discouraging at times. You may be worried that you're not doing enough to "fix things" or that you’re neglecting the other important people in your life. However, holding yourself to unrealistic standards may only create more stress. Try to remember that everyone makes mistakes, so allow yourself to do the same. Honor your own feelings, and provide yourself with the same grace, patience, and compassion you would for your loved ones. 

Ask for help and mental health support

Whether it's reaching out to friends, family members, your family doctor, or a mental health professional, caregivers can benefit from a support system of understanding individuals. This might involve spending quality time together or relying on loved ones if you need assistance with a crisis plan during an emergency.

Seeking mental health support as a caregiver

Those caring for a loved one with psychosis may need to seek support, too. Recognizing whether you need help might not always be easy. While everyone experiences stress differently, there are some common signs you might benefit from professional support:

• You've lost interest in activities that once brought you joy or pleasure. 

• You feel impatient or are easily angered.

• You feel isolated or lonely.

• You feel overwhelmed, stressed, or exhausted.

• You’ve experienced disruptions in sleep or appetite. 

• You're experiencing chronic headaches or pain.

• You’ve been neglecting your personal hygiene. 

Caring for someone with psychosis can be challenging

Discuss your experiences in online therapy

Some caregivers experience barriers to mental healthcare that make it more challenging to get help. For example, some may not be able to find a therapist, or they may encounter scheduling challenges. Others might experience financial challenges that make it difficult to afford conventional therapy.  

For many, virtual therapy can provide a helpful alternative to conventional treatment and can overcome many of these obstacles. Online therapy platforms normally eliminate geographical factors, offering caregivers a greater pool of mental health professionals. Additionally, online platforms can make it easy to switch therapists as needed.

A 2021 study reported that “therapist-guided ICBT (internet-based cognitive behavioral therapy) can be effective in reducing caregiver burden, anxiety, depression, stress, and improving quality of life.”