Schizophrenia

Typically, a person diagnosed with schizophrenia will experience two types of symptoms: short but intense episodes of psychosis and longer-term symptoms related to mood, motivation and emotional expression.

But experiences vary from person to person and episode to episode. Not everyone experiences schizophrenia the same way. The best way to be sure of your diagnosis is to talk to a health professional.

Psychosis

Psychotic symptoms are sometimes called ‘active’ or ‘positive’ symptoms. They tend to come in ‘episodes’: brief periods of more intense symptoms that diminish with time and treatment.

A person experiencing psychosis finds it hard to tell what is real from what isn’t. The main symptoms of psychosis are:

• delusions — false beliefs that can’t be changed by evidence
• hallucinations — hearing voices or otherwise sensing things that aren’t real
• disordered thinking — muddled, disrupted thoughts and speech
• disordered behaviour — unusual, inappropriate or extreme actions.

Related: Psychosis factsheet

Non-psychotic symptoms

The non-psychotic symptoms of schizophrenia tend to last much longer. They’re often referred to as ‘negative’ symptoms or ‘deficits’. They include:

Diminished emotional expression

A person with schizophrenia might show much less emotion than usual: they make less eye contact, use less hand gestures when they talk and show less emotion in their facial expressions and speech.

This doesn’t necessarily mean the person feels less emotion, just that they can’t express it.

Low motivation

It’s common for a person with schizophrenia to lose interest in work, study, hobbies or social life. They might find it hard to put thoughts and plans into action. Doing everyday things like getting out of bed or washing up can seem like an enormous effort.

This is why some people with schizophrenia become lethargic, lying in bed or watching TV all day. What can look like ‘laziness’ to family and friends may be the effect schizophrenia has on the part of the brain that helps with motivation.

Reduced speech

Schizophrenia can reduce a person’s capacity to express themselves in words. They might talk a lot less or not at all, repeat themselves or have trouble being specific.

Loss of pleasure

People with schizophrenia may feel less positive emotions. They might stop enjoying things they used to love and become distant from people they were close to. They can lose some or all of their capacity to feel happy.

I entered my forties with no future, identity or self-esteem, and left that decade with success, hope, and a much stronger sense of self

— Sandy

Why ‘positive’ and ‘negative’ symptoms?

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

Disordered thinking, hallucinations and delusions are called ‘positive’ symptoms because they are something ‘added’ to the person’s normal experience. Low motivation and changed feelings are called ‘negative’ because they take something away from the person.

Schizophrenia doesn’t have a single, obvious cause. It isn’t a virus or bacteria and it can’t be caught from someone else like a cold.

The causes are likely to include a combination of factors, including a genetic susceptibility to schizophrenia and a range of environmental factors like developmental problems, stress, trauma and drug use.

How common is schizophrenia?

Research suggests that up to 1 in 100 people will experience schizophrenia.

Schizophrenia is diagnosed about twice as often in men than women. It’s also more common in urban than rural areas.

Symptoms of schizophrenia usually emerge between the late teens and mid-30s, most often becoming evident in the early-to-mid 20s for men and late 20s for women. It is relatively rare for schizophrenia to be diagnosed in childhood. Adults diagnosed with schizophrenia have often experienced other emotional or behavioural disturbances during childhood.

Genetics: inheriting schizophrenia

If your parents have schizophrenia, will you get sick? Will you pass on your schizophrenia to your children?

These are common questions. Schizophrenia has a genetic component: part of what makes you vulnerable to developing schizophrenia is a combination of hundreds of different genes in your DNA. So you can inherit a higher chance of developing schizophrenia from your biological parents, and pass it on to your children.

But even with this added risk, the odds are still against a person developing schizophrenia, even when both biological parents have the illness. The majority of people who develop schizophrenia don’t have a family history.

Environment: triggers and influences

Research is continuing to reveal what influences a person’s chances of developing schizophrenia. Some of those factors are:

• your mother’s health during pregnancy or complications with your birth
• substance misuse
• difficult social circumstances and stressful life events
• trauma during childhood, such as abuse, neglect, parental death and bullying.

However, many people who experience these factors don't develop schizophrenia. We’re understanding more about the causes of schizophrenia all the time, but there’s some way to go. What we do know is that there is no single cause.

How do you know if you, or someone close to you, might be developing schizophrenia?

An episode of psychosis is rarely the first sign of a psychotic illness like schizophrenia. There can be a lead-up period lasting months or longer, where the person’s mental health deteriorates. That can be hard to spot, especially during an intense period like adolescence and early adulthood.

A psychotic illness like schizophrenia frequently begins with general, hard-to-pin-down changes to a person’s thinking, emotions 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
• feeling disconnected from other people, wanting to be alone
• decreased performance at work or school.

These signs are common features of many mental illnesses, 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 indicate that something might not be right.

Signs like these can come and go, but they tend to worsen over time. The following signs 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.

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 symptoms now, don’t wait for an episode of psychosis. See a doctor immediately.

Related: Getting better • Psychosis

Getting a diagnosis

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.

Schizophrenia is a diagnosis that takes time to be confirmed. To have a confirmed diagnosis of schizophrenia, your psychotic symptoms need to have lasted at least a month, and functional decline needs to have lasted at least six months.

Why your diagnosis can change over time

Before then, you may be given a 'working diagnosis' of schizophrenia. A working diagnosis means there's reason to believe you're experiencing schizophrenia, so treatment for schizophrenia will begin while more evidence is gathered to confirm it.

You may receive a different diagnosis early on. There are other illnesses that can include psychosis as a symptom, including:

• schizoaffective disorder
• bipolar disorder
• schizophreniform disorder
• postpartum disorder
• brief reactive psychosis
• borderline personality disorder (BPD)
• major depressive disorder
• organic psychosis.

So it’s normal for your diagnosis to change as time passes and more is learned about your illness. It means your doctors are getting a better idea about your illness that will lead to better treatment.

Related: What use is a diagnosis?

Schizophrenia is a treatable illness. 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.

Antipsychotic medication

Antipsychotic medications work by altering your brain chemistry 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 from one person to another.

Related: Antipsychotic medication factsheet

Other medication you might need to take

If you experience a psychotic illness, you may experience other mental health issues, like depression, mania, anxiety, and the ‘negative’ symptoms of schizophrenia.

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 schizophrenia. 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.

Related: Psychotherapy factsheet

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 illness, helps improve family life and may reduce the person with schizophrenia’s chances of 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, 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 living with schizophrenia 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

Many different therapeutic approaches may be useful for the effects of psychotic illness. 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.

Neurostimulation therapies

Electroconvulsive therapy (ECT)

In its modern form, ECT is used to treat severe depression and can provide short-term improvements for psychosis, especially when it is resistant to medication.

Related: ECT factsheet

Repetitive transcranial magnetic stimulation (rTMS)

During rTMS treatments, the patient is exposed to a very specific electromagnetic field for periods of 20 to 40 minutes at a time. The field can be used to stimulate or reduce activity in brain cells.

rTMS is 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. Your choice 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. Ask your GP for advice about the best options available for you.

Early intervention programs for young people

Schizophrenia most often develops for the first time between late teens and early twenties. 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 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 psychotic illnesses.

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 Help Centre 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

Schizophrenia is a long-term illness. It takes at least six months of symptoms to be diagnosed and treatment is recommended for 2–5 years.

While your illness 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 an illness?

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’s just managing your symptoms so you can do some basic 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 are able to 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 illness is taking.

While this can be leave you feeling insecure, it’s important that you stick with your treatment, even if you’re frustrated. Nothing helps with schizophrenia more than uninterrupted, longterm treatment.

Also, people who start taking their medication and feel their symptoms reduce sometimes believe they’re well enough to stop treatment. But your illness is still there, and stopping medication too soon can make symptoms return. It’s called the ‘wellness trap’. To avoid it, stick with treatment.

Related: Thinking about stopping your medication?

Functional recovery

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.

So an important part of managing life with schizophrenia is help 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 longterm recovery than just treating symptoms alone. So getting back 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 either 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 one that is still very common.

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 anyone 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 • Smoking & mental illness • Mental illness & physical health

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 illness who have undertaken training in mental health.

Organisations that can connect you with community support services include:

• SANE Help Centre: 1800 18 72 63
• Mind Australia
• Mental health programs (Department of Health directory)
• 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 illnesses, that doesn’t always happen. There’s a lot of ignorance about mental illness 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 illness.

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 schizophrenia can give you a strong sense of what the illness 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 • Fact vs myth: treatment & recovery • Fact vs myth: mental illness & violence • Fact vs myth: specific disorders

Get involved

Your illness 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 illness. 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 works, 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. 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. 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

Seeing someone you care for experience a mental illness can be frightening, 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 schizophrenia — their family, friends, colleagues 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: Seven to nine 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 knowing those things are helpful doesn’t make them easy to achieve. Be kind to yourself. If you’re struggling to make good health habits happen every day, it’s okay. Good health is no good to you if getting there makes you feel worse.

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 when supporting someone you care about is to recognise your own boundaries. Decide for yourself how much time and energy you can give, 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: Boundary-setting and mental illness • 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 illness. Here are a few places to find support:

• SANE’s carers’ forum, Help Centre 1800 18 72 63
• Mental Health Carers Australia (formerly ARAFMI) 1300 554 660
• Carers Australia 1800 242 636
• Carer Gateway (Commonwealth government)
• 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 schizophrenia can help to reduce the likelihood of future episodes.

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

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

Early on

You may be the first to notice that something isn’t right with your loved one. Because of the way schizophrenia 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 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, including you. 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 your unwell 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 to request one at Mindhealthconnect.

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.

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

Tips for specific symptoms

Delusions and hallucinations

Your loved one’s delusions and hallucinations are as real for them as what you are seeing and hearing right now is for you. 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.

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 psychotic illnesses to stop taking their medication. There are many reasons why this happens: because the side-effects are bad, because symptoms have reduced, 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 just struggling to remember, they could switch to monthly injections. 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

Wykes T, Steel C, Everitt B and Tarrier N (2008) ‘Cognitive Behavior Therapy for Schizophrenia: Effect Sizes, Clinical Models, and Methodological Rigor.’ Schizophr Bull, 34(3): pp.523-537.

Pharoah F, Mari J, Rathbone J, et al. (2010) Family intervention for schizophrenia. The Cochrane Database of Systematic Reviews 12: CD000088.

Lakeman R. 2014. The Finnish open dialogue approach to crisis intervention in psychosis: a review. Psychotherapy in Australia. 20. 3.

Matheson SL, Green MJ, Loo C, Carr VJ (2010), ‘Quality assessment and comparison of evidence for electroconvulsive therapy and repetitive transcranial magnetic stimulation for schizophrenia: A systematic meta-review’ Schizophrenia Research, 118(1-3), pp.201-210.

Hovington CL, McGirr A, Lepage M, and Berlim MT (2013) ‘Repetitive transcranial magnetic stimulation (rTMS) for treating major depression and schizophrenia: a systematic review of recent meta-analyses.’ Annals of Medicine 45(4), pp.1-14. 

Álvarez-Jiménez M, Gleeson JF, Henry LP, et al. (2012a) Road to full recovery: Longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years. Psychological Medicine 42: 595–606.