How to Deal with Somebody Who Is Having a Psychotic Episode

People with psychotic disorders aren't necessarily going to be violent. However, in some cases, the person might be so stressed and disconnected from reality that they don't understand what they are doing.

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   Assess the situation for danger. It is rare for an individual undergoing a psychotic episode to become violent, although it can happen. Psychotic individuals are at a greater risk of harming themselves. ^[6] Any threats of violence, self-harm, or suicide should be taken seriously.

   • A history of drug and alcohol abuse increases the likelihood of the person becoming violent.
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   Stay away if the situation becomes threatening or violent. If at any point you suspect the person might be dangerous, either to themselves or to others, call for help immediately. Consider calling an ambulance or other medical experts specifically—if there’s no time to look up phone numbers, just call emergency services .

   • If you’re in a room with an aggressive person, leave the room immediately.
   • If police arrive on the scene, try to explain the situation before they interact directly with the person experiencing the psychotic episode. Without interfering and endangering yourself or others, encourage officers to remain calm and resolve the situation without the use of force. ^[7]
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   Protect the psychotic individual from themselves. If the person is dangerous to themselves, remove any sharp objects and dangerous materials from the person and from the room, and lock any un-barred windows and balconies. Try to keep the person calm. Call the police or an ambulance if there’s a chance the person will attempt suicide or cause themselves serious physical damage.

   • If they ask why you are holding something dangerous (e.g. a knife), say "I'm putting it away." If someone is prone to psychotic episodes, it may be appropriate to keep sharps/potentially dangerous items locked.
   • Speak to the individual calmly, and try to de-escalate the situation. If the psychotic individual is asking for things or making demands, comply with those that are safe and reasonable. ^[8]
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   Avoid trying to restrain them, or put yourself in harm's way. If the psychotic individual is acting violent or threatening violence, don’t take it on yourself to solve the problem. You could risk personal harm, especially if you try to engage in a physical struggle with the psychotic individual.

   • Your main priority should be keeping yourself and others safe. If you can do things to protect the psychotic individual (e.g. removing a knife from a nearby table top), make sure to keep yourself safe while doing so.
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   Hold a calm conversation. If the psychotic individual is not violent, talk to them in a normal voice. It is best to give 5 times the amount of space, maintain an open posture, and avoid facing the person squarely, which could appear threatening. Try to comfort them, if they experience or hallucinate something unpleasant. The conversation should be simple; individuals going through a psychotic episode may find communication or speech difficult. ^[9]

   • Ask them questions, and if their mind seem to be drifting, try to grab their attention.
   • Make sure to reassure them and let them know that you are there for them.
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   Make sure you do not play into the person’s hallucinations. Although you want to avoid blaming or criticizing the psychotic individual, you should also avoid playing into their psychoses. ^[10] This will only worsen the situation and make the individual’s break with reality more difficult to come back from. However, try not to argue with them or engage in too much discussion with them. ^[11]

   • Instead of, “I hear the same voices too,” try saying “I don't hear those voices, but I can tell they are bothering you.”
   • It's best not to directly contradict the person and tell them whatever they're believing is untrue. That might make them feel angry and unsafe, which will cause them to retreat further into whatever they're experiencing. ^[12]
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   Show understanding. Empathize and validate their feelings . Psychosis can be a frightening and confusing thing to experience. The person may not understand how to handle it. Keep in mind that they can't “snap out of it,” nor is it their fault that this is happening to them. ^[13] Let the person know that you take them seriously and support them. Here are some examples of helpful things to say:

   • “I can’t imagine what you are going through, but I’m happy to listen.”
   • “I don’t fully understand what you’re going through, but I understand it must be really difficult.”
   • "Is there someone you trust that I can call for you?" ^[14]
   • "What can I do to help you feel safe right now?" ^[15]
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   Get them to a doctor. A psychiatrist or psychologist can help figure out what caused the episode, and help prevent future psychotic episodes. If the individual is not already undergoing therapy and medical treatment, strongly encourage them to do so after the psychotic episode has passed. ^[16]

   • Seeing a doctor is important. Psychosis may be a sign of temporary stress (such as grief or sleep deprivation), but it could also be a sign of a mental health disorder, or a physical health problem that causes psychosis.
   • Mental-health professionals will be able to help the person take steps to decrease the frequency and severity of their episodes. Make sure that the person has somewhere to go to get help after the episode. If they do not, then help them to find help.
   • Things like self-care, stress management, and counseling can make a large difference to the person’s mental health. ^[17]
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   Seek help yourself if you need it. Dealing with someone else’s psychotic episode can be very stressful, especially if the person is a loved one or you don't know what's wrong. It may help you to talk to a therapist or counselor.

   • If the person is a loved one, follow up with them as well. Make sure they’re safe and healthy. As long as you don’t downplay the importance of their own experience, you can tell them about your experience of their psychotic episode and why it was difficult for you as well.
   • Make sure not to criticize them or pass judgment about their experience. It is important to avoid making them feel bad about their behavior or to make them worry that they might have scared you away. They need to know that you don't blame them for their illness, and that you still care.
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