Responding to Psychosis in Homeless Services(this presentation has been adapted from the Youth Mental Health First Aid program)

WHAT ARE PSYCHOTIC DISORDERS?

• Psychosis is a mental disorder in which a person has lost some contact with reality.

• Psychosis is characterized by delusions, hallucinations and thought disorder.

• There may be severe disturbances in thinking, emotion and behaviour.

• Psychosis severely disrupts a person’s life.

• Relationships, work, study and self-care are difficult to initiate and/or maintain.

CHANGES IN EMOTION AND MOTIVATION

• Depression

• Anxiety

• Irritability

• Suspiciousness

• Blunted, flat or inappropriate emotion

• Change in appetite

• Reduced energy and motivation

COMMON SYMPTOMS WHEN A PSYCHOTIC DISORDER IS DEVELOPING

CHANGES IN THINKING AND PERCEPTION

• Difficulties with concentration or attention

• Sense of alteration of self, others or the outside world (e.g.; feeling that self or others have changed or are acting different in some way)

• Odd ideas

• Unusual perceptual experiences (e.g. a reduction or greater intensity of smell, sound or colour)

COMMON SYMPTOMS WHEN A PSYCHOTIC DISORDER IS DEVELOPING (cont’d)

CHANGES IN BEHAVIOUR

• Sleep disturbance

• Social isolation or withdrawal

• Reduced ability to carry out work and social roles

IMPORTANCE OF EARLY INTERVENTION FOR PSYCHOSIS

Some of the consequences of delayed treatment include the following:

• Slower and less complete recovery

• Poorer long-term functioning

• Increased risk of depression and suicide

• Slower psychological maturing

• Slower uptake of adult responsibilities

• Strain on relationships and loss of social support

• Disruption of study and employment

• Increased use of alcohol and drugs

• Loss of self-esteem and confidence

• Greater chance of problems with the law

MAIN PSYCHOTIC DISORDERS

• Schizophrenia

• Bipolar disorder

• Psychotic depression

• Schizoaffective disorder

• Drug-induced psychosis

OTHER PSYCHOTIC ILLNESSES

• Psychotic depression: a severe depression can have psychotic features.

• Schizoaffective disorder: has symptoms of both schizophrenia and bipolar disorder.

• Drug induced psychosis: is a psychosis brought on by drug use. Drugs that can cause psychosis are cannabis, cocaine, ecstasy, amphetamines and magic mushrooms.

SYMPTOMS OF SCHIZOPHRENIA

• Delusions

• Hallucinations

• Thinking difficulties

• Loss of drive

• Blunted emotions

• Social withdrawal

COMMON SYMPTOMS IN MANIA

• Increased energy and overactivity

• Elated mood

• Need less sleep than usual

• Irritability

• Rapid thinking and speech

• Lack of inhibitions

• Grandiose delusions

• Lack of insight

POSSIBLE CAUSES of PSYCHOTIC DISORDERS

Psychosis is caused by a combination of factors including:

• Genetic factors: Although psychosis is not directly inherited, those with it in the family are at greater risk of developing a psychotic illness

• Biochemistry: It is believed that psychosis involves a chemical imbalance in the brain

• Stress: It is recognised that stress can be a trigger for psychosis in vulnerable people

• Other factors include seasonal changes, head injury, birth complications and drugs.

Step 1: Assess Risk of Harm or Suicide

Two factors that may increase the risk of suicide are:

1. Hearing voices which command the person to hurt themselves.

2. Having multiple episodes and feeling that they cannot continue to live with the illness.

Seek further training on suicide prevention if needed

Young people who are psychotic may be at risk of self-harm, or occasionally, of harming others. Both these risks need to be considered.

Step 1: Assess Risk of Harm or Suicide (cont)

• A very small percentage of people with psychotic disorders may threaten violence.

• Violence accompanying a mental illness is not common.

• Violence is more common if alcohol or other drugs are involved.

• If the person is not at risk, move onto Step 2.

WHAT TO DO IF A PSYCHOTIC PERSON APPEARS THREATENING

1. Do not get involved physically.

2. Call the police.

3. Try to create a calm, non-threatening atmosphere.

4. Try to get the person to sit down.

5. Do not try to reason with acute psychosis.

6. Express empathy for the person’s emotional distress.

7. Comply with reasonable requests.

8. Adopt a neutral stance and a safe position.

Step 2: Listen non-judgmentally

• Listen without judging the person as weak.

• Do not be critical of the person.

• Don’t give glib advice.

• Avoid confrontation.

• Speak calmly, clearly and in short sentences

• Do not argue with the person.

• Accept the delusions and hallucinations are real for the person but

do not pretend they are real for you.

• Do not try to humour the person.

Step 3: Provide reassurance and information

It may not be appropriate to provide information about psychosis, when the young person has become more lucid.

Try to help the young person realise that:

• They have a real medical condition.

• Psychosis is not a common illness, but is well known and researched.

• Psychosis is not a weakness or character defect.

• Effective help and treatments are available.

• Do not make promises you cannot keep.

Step 4: Encourage young person to get appropriate professional help

• GPs

• Psychiatrists

• Mental health teams

• Family and friends

WHAT TO DO IF THE YOUNG PERSON DOESN’T WANT HELP?

• Discuss situation with local mental health crisis team.

• Attend a mental health carers’ support group.

• Make appointment with GP or mental health professional to talk about the problem.

• Find out about involuntary treatment.

• Help write an advance directive.

Step 5: Help the young person to use self-help strategies

• Many young people with a psychotic disorder also

have depression &/or an anxiety disorder.

• Therefore relaxation, meditation and exercise may be useful.

• Support groups may be very helpful.

YOUTH HOUSING SERVICES

• Police need to be contacted where there is a threat of violence

• Don’t forget to maintain the person’s dignity and self determination within reason

• Keep good records of strange behaviours

• Engage with a youth health services or GP who can help with tracking symptoms and diagnosis

• Use the medicare Better Access program to access allied health services

• Undertake training in mental health

• Develop relationships with your local Headspace or youth health centre if you have one locally.

Please note…..

This presentation also included excerpts from the Andrew Denton, Enough Rope episode called Angels and Demons. These include a simulated experience of

schizophrenia and feedback from young people about what helped with treatment and recovery.

You can view these sections and most of this episode at the following web address.

http://www.abc.net.au/tv/enoughrope/interactive/angelsanddemons/