Understanding Psychosis
When reality starts to feel different.
Psychosis can affect the way a person thinks, feels and experiences the world around them. Someone may hear or see things that others donât, develop strong beliefs that feel completely real, become confused, or begin behaving in ways that are unusual for them.
For the person experiencing psychosis, these experiences can feel completely real. They may not recognise that anything is wrong, which can make the experience confusing or frightening for both the person and the people who care about them.
Psychosis can happen for different reasons, and experiencing it does not define who someone is. With the right support and treatment, recovery is possible.
What is psychosis?
Psychosis is a term used to describe a change in the way a person experiences or interprets reality. It can affect thoughts, perceptions, emotions and behaviour.
A person experiencing psychosis may hear voices, see or sense things that other people donât, or develop beliefs that feel completely true even when others do not share them. Their thoughts may also become confused or difficult to organise.
Psychosis can look different from person to person. Some changes may be obvious, while others can develop gradually and be difficult for family and friends to recognise at first.
One of the most important things to understand is that the experience can feel completely real to the person going through it. Calm, compassionate support and early professional help can make a meaningful difference.
What can psychosis look like?
Psychosis can appear differently for everyone. Changes may happen suddenly or develop gradually over time. Some signs can also have other explanations, so experiencing one of these does not necessarily mean someone is experiencing psychosis.
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Changes in perception
Hearing, seeing, feeling or sensing things that other people may not experience.
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Strong or unusual beliefs
Becoming convinced of something that others do not believe or that may be difficult to explain.
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Confused thinking
Thoughts or speech becoming difficult to organise, follow or communicate.
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Changes in behaviour
Acting in ways that are noticeably different, unusual or concerning to people who know them.
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Withdrawing from others
Becoming more isolated, suspicious or disconnected from friends, family or everyday activities.
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Changes in sleep or functioning
Significant disruption to sleep, self-care, work, study or usual routines.
If youâre worried about someone
It can be difficult to know what to do when someone you care about seems disconnected from reality or is behaving very differently from usual.
Try to stay calm and speak gently. You donât need to agree with what the person is experiencing, but arguing with them or trying to prove that their beliefs arenât real may increase fear or distress.
Instead, focus on how theyâre feeling. You might say, âThat sounds frightening,â âI can see this feels very real for you,â or âIâm here with you and I want to help.â
Encourage professional support, particularly if their behaviour, thinking, sleep or ability to care for themselves has changed significantly.
If you believe they are experiencing an urgent mental health crisis, contact your local Mental Health Crisis Team. If there is immediate danger or urgent medical help is needed, call 111.
Signs of psychosis
Psychosis can develop suddenly, but sometimes changes appear gradually over days, weeks or even longer. The signs can be different for everyone, and experiencing one of these things does not necessarily mean someone is experiencing psychosis.
Some signs can include:
Changes in perception
Hearing voices, seeing things or sensing things that other people donât appear to experience.
Strong or unusual beliefs
Becoming convinced that something is happening even when other people donât share that belief. This might include feeling watched, followed, targeted or receiving special messages.
Confused thinking or speech
Thoughts may become difficult to organise. Someone might jump between subjects, struggle to explain what they mean or become difficult for others to follow.
Changes in behaviour
Acting noticeably differently, becoming unusually suspicious or fearful, withdrawing from other people or behaving in ways that seem out of character.
Changes in sleep and everyday functioning
Sleeping very little, struggling with work or everyday responsibilities, neglecting personal care or finding normal routines increasingly difficult.
Difficulty recognising that something has changed
A person experiencing psychosis may genuinely believe that what they are experiencing is real and may not recognise that they need help.
Changes like these are worth taking seriously, particularly when several happen together or become more intense. Getting support early can make a meaningful difference.
What can cause psychosis?
Psychosis does not have one single cause. It can occur in different circumstances, and sometimes several factors may contribute at the same time.
Some factors associated with psychosis can include:
Mental health conditions
Psychosis can occur alongside conditions such as schizophrenia, bipolar disorder and severe depression.
Alcohol and other drugs
Some substances, including cannabis and stimulants, can trigger or worsen psychotic symptoms in some people. Psychosis can also occur during withdrawal from certain substances.
Severe stress or trauma
Periods of significant stress or traumatic experiences may contribute to psychosis in some people, particularly when other risk factors are present.
Lack of sleep
Severe or prolonged sleep deprivation can affect thinking and perception and may contribute to psychotic symptoms.
Physical or medical conditions
Certain neurological conditions, illnesses, medications and other medical problems can sometimes cause symptoms that resemble psychosis.
A combination of factors
For many people, there may not be one clear explanation. Genetics, environment, life experiences, substance use, sleep and mental or physical health can interact in complex ways.
Experiencing psychosis is not a personal failure. Understanding what may have contributed can help healthcare professionals determine the most appropriate treatment and support.
Getting help and treatment
Psychosis can be frightening and confusing, but it is treatable. Getting professional support early can help reduce symptoms, understand what may be contributing to them and support recovery.
Treatment will depend on the person and their circumstances, but may include:
Mental health assessment
A health professional can assess what someone is experiencing, their physical and mental health, medication or substance use, sleep and other factors that may be contributing.
Medication
Antipsychotic medication may be prescribed to reduce symptoms such as hallucinations, delusions and severely confused thinking. The type of medication and length of treatment will depend on the individual.
Psychological support
Therapy and other forms of psychological support can help someone understand their experiences, manage stress, develop coping strategies and work towards recovery.
Support with everyday life
Recovery can also involve support with sleep, routines, relationships, work, study, substance use and gradually returning to everyday activities.
Family and whÄnau support
Family and whÄnau can play an important role in recovery. Learning about psychosis, recognising changes and knowing where to seek help can make it easier to support someone without having to manage everything alone.
Recovery from psychosis is possible. It may take time, and recovery can look different for everyone, but the right treatment, support and understanding can make a meaningful difference.
Supporting recovery after psychosis
Recovery after psychosis can take time. Even when the most intense symptoms have settled, someone may still feel exhausted, overwhelmed, emotionally flat or unsure of themselves. There is no single timeline for recovery, and progress does not always happen in a straight line.
Some things that may support recovery include:
Protecting sleep
Changes in sleep can sometimes be an early warning sign that someone is becoming unwell. Maintaining a regular sleep routine and taking significant sleep disruption seriously can be important.
Following your treatment plan
Taking medication as prescribed and attending appointments can help support stability. If medication is causing difficult side effects or you want to make changes, talk with your healthcare team rather than stopping or changing it suddenly on your own.
Avoiding substances that may trigger symptoms
Alcohol and other drugs can affect recovery, and substances such as cannabis or stimulants may increase the risk of psychotic symptoms in some people. Understanding your own triggers is important.
Learning your early warning signs
Early signs may be different for everyone. They might include sleeping less, becoming increasingly suspicious, withdrawing from people, unusual thoughts, changes in mood or feeling that things around you have special meaning.
Creating a plan while you're well
It can help to decide in advance what should happen if early warning signs return. A plan might include who you trust to notice changes, who should be contacted, your mental health team's details and what has helped during previous episodes.
Letting recovery be gradual
Returning to work, study, relationships and everyday responsibilities may take time. Small steps and realistic expectations can be more helpful than putting pressure on yourself to immediately feel exactly as you did before.
Staying connected
Trusted family, whÄnau, friends and healthcare professionals can provide valuable support. You don't have to manage recovery entirely on your own.
Having another difficult day does not automatically mean another episode is beginning. What matters is learning your own patterns, taking significant changes seriously and reaching out early when something doesn't feel right.
Creating an early warning & crisis plan
When youâre feeling well, it can be helpful to make a plan for what should happen if your mental health begins to change. During psychosis, recognising that youâre becoming unwell can sometimes be difficult, so having a plan already in place can make it easier for the people around you to know how to help.
Your plan could include:
Your early warning signs
Write down changes that have happened before an episode, such as significantly reduced sleep, unusual beliefs or thoughts, increased suspicion, withdrawing from others, changes in behaviour or becoming unusually distressed or agitated.
People you trust
Identify family members, whÄnau, friends or other people you trust to tell you if they notice concerning changes.
Your healthcare contacts
Keep the contact details for your GP, mental health team, psychiatrist or other healthcare professionals somewhere that you and trusted family or whÄnau can easily access.
What has helped before
Record treatments, environments, routines or approaches that have previously helped you feel safer and recover.
What makes things harder
Consider situations or experiences that may increase distress, including particular communication styles, environments, lack of sleep or substance use.
What you would like others to do
While you're well, talk with the people closest to you about how you would like them to respond if they become concerned. This might include contacting your mental health team, staying with you, helping you get somewhere safe or seeking an urgent assessment.
When urgent help should be sought
Include clear instructions for when family or whÄnau should contact your local Mental Health Crisis Team or call 111 if there is immediate danger or urgent medical help is needed.
A crisis plan isn't about expecting something to go wrong. It's about making important decisions while you're well, so the people you trust aren't left trying to work everything out during a crisis.
A note from lived experience
Psychosis can be incredibly difficult to understand from the outside because, when youâre experiencing it, what is happening can feel completely real.
From my own experience, I didnât simply feel as though I was imagining something. I believed what I was experiencing. That is part of what can make psychosis so difficult to recognise in yourself while it is happening.
Looking back with a clear mind can be very different from living through an episode. Things that may later seem unusual or impossible can make complete sense in the moment.
That experience has taught me how important compassion can be. Someone experiencing psychosis may already be frightened, confused or overwhelmed. Being argued with, judged or made to feel ashamed may not help them understand what is happening.
Sometimes the most helpful thing a loved one can do is stay calm, listen without reinforcing unusual beliefs, focus on the person's safety and feelings, and help connect them with professional support.
The person you know is still there, even when their experience of reality has changed.
When to seek urgent help
Sometimes changes in a personâs mental health require urgent professional support.
Seek urgent help if youâre concerned that someone experiencing psychosis is becoming significantly more unwell, is unable to care for themselves, is extremely distressed or agitated, or youâre concerned about their safety or the safety of others.
If youâre unsure what to do, it is okay to reach out for professional advice rather than trying to manage the situation alone.
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Mental Health Crisis Team
For an urgent mental health crisis, contact your local Mental Health Crisis Team for assessment and advice.
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1737 â Need to Talk?
For free, confidential support from a trained counsellor, call or text 1737.
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Immediate danger
If you or someone else is in immediate danger or needs urgent medical assistance, call 111.