It can be very distressing to realize that someone close to you is experiencing psychosis. You may feel shocked, confused, bewildered and guilty. There is no right or wrong way to feel.

Families, partners or friends find it hard to take the first step to obtain help for many reasons. They may be unsure what the problem is. The person experiencing a psychotic episode may not wish to get help or even acknowledge that they are unwell. It can be extremely difficult to cope with a person who is in a psychotic state.

The person may need help to find out exactly what is happening and what type of treatment is required. Help is also needed for families, partners and friends so they can understand what is going on and find out how to be involved in the assessment, treatment and recovery process.

Often the first step is to visit the family physician who can then refer to more specialized professionals such as psychiatrists, mental health centers, or programs that specialize in early psychosis.

When should a referral to a doctor or mental health professional be considered?

A referral to EPI is a good idea if some of these signs are present:

• a definite change in normal personality, which lasts weeks or months
  
• a change in speech, either speeded up or very slow, and hard to follow (makes no sense)
  
• the individual appears suspicious, guarded and fearful
  
• a severe change in sleep pattern
  
• an inability to function at his/her normal level (eg. can't perform at school or work, neglects hygiene or personal affairs)
  
• a preoccupation with unusual ideas (eg. thinks he/she hears God's voice or believes the TV is talking to him)

How to make a referral

Initial contact is made by telephone to the EPI Intake Clinician who will assess the situation and provide supportive counselling, education and outreach. The information obtained by the Intake Clinician helps to determine whether the referral fits into the EPI Program and what other services may be needed.

Being supportive

Family, partners and friends are very important in the process of recovery. When a person is recovering from their psychotic episode you can provide love, stability, understanding and reassurance.

Checking on safety (suicide risk, poor judgment)

Always take talk of suicide or self-harm seriously. It is important to stay calm. Be there to listen to the person's concerns, show them that you love and care for them, see about reducing any stressors that may be adding to their depression, notify your mental health professional if the ideas persist and above all, stay positive.

Getting agreement for help

Give hope. Assure the person that help is available and that things can get better. Point out that seeking help is a sign of strength rather than a sign of weakness or failure.

Most of the time the person will feel relieved that there is help available. Sometimes, however, getting the person to agree to seek help involves overcoming such things as the person's inability to see that something is wrong, their fear of appearing strange or abnormal, or of dealing with the stigma associated with mental illness.

Prepare the person for what they might expect. Tell them what you know about what help is available and reassure them that your decision to seek help is based on your best judgement. Tell them in clear and calm terms, what you have noticed that makes you concerned. Reassure them that you will support them throughout. Be patient and persistent. Mental illness is treatable.

Emergency situations

In an emergency or life-threatening situation, you must ensure that the individual gets professional help immediately. This may be done by accompanying the individual to the appropriate service or by utilizing emergency resources such as your local hospital emergency department or crisis program.

How to cope as a caregiver or friend

It is important to be yourself and to understand that psychotic symptoms are stressful for everyone. You may have a range of feelings - shock, fear, sadness, anger, frustration or despair.

Mental illness is not usually short term, and can continue for months or several years. Be prepared for setbacks, as recovery may not come quickly.

Remember that families, partners and friends also need a period of recovery and time to understand and accept what has happened. Don't keep things a secret. Talking with others, whether they be family members, friends or professionals, can be very helpful.

Stay positive. With proper treatment, most people make a successful recovery from a first episode of psychosis.