Helping a family member with psychosis

When someone you love has psychosis, it can feel frightening and lonely. Psychosis is a state in which a person has trouble telling what is real from what is not. It may include hearing voices or holding strong beliefs that are not true. Families often do not know what to say or when to step in. You are not alone, and what you do really can help.

This page is for relatives and close friends. It covers how to talk during psychosis, what to do when the person does not believe they are ill, how to build a crisis plan, what involuntary care means, and how to look after yourself. To learn about the condition itself, start with the schizophrenia overview and signs and symptoms.

How should I talk with someone who is in psychosis?

To the person, voices and beliefs feel completely real.² Telling them "that's not real" rarely works. It can make them feel unheard and push them away. Expert guidelines built from the views of clinicians, people with lived experience and families suggest a calmer path.⁵

Do

• Talk in a quiet, private place. Let the person set the pace.⁵
• Use short, simple sentences. Repeat yourself if needed, and give extra time to answer.⁵
• Treat their experience as real to them. You can say, "That sounds frightening," or "I can see this is upsetting you." You do not have to say you agree with the belief.⁵
• Describe what you have seen instead of guessing at a diagnosis. For example: "You haven't slept in three days, and I'm worried."⁵
• Offer choices, such as "Would you like to sit here or in the kitchen?" Ask what would help them feel safe.⁵
• Keep your voice slow and quiet. Do not touch the person without asking.⁵

Try to avoid

• Arguing, mocking, or proving the person wrong.⁵
• Blame, criticism, sarcasm or talking down to them.⁵
• Acting shocked or afraid. Showing alarm can raise their fear.⁵
• Going along with a belief in a way that feeds fear, such as agreeing that neighbors are spying.⁵
• Threatening hospital or the police to get cooperation.⁵
• Taking symptoms personally. The illness is speaking, not your loved one.⁵

Some people with schizophrenia show little emotion or say very little. This is part of the illness. It does not mean they do not care or cannot understand you.⁵

What if they say, "I'm not sick"?

This is one of the hardest parts for families. Many people with schizophrenia do not recognize that they are ill. Doctors call this poor insight. NAMI uses the word anosognosia (an-oh-sog-NO-zhuh), which means a person cannot see their own illness.³ Research links it to changes in parts of the brain that help a person look at their own thoughts and behavior.⁴

This is not denial or stubbornness. A person who cannot see they are unwell is not choosing to ignore you.³

It matters because poor insight is linked to stopping treatment, more emergency care and more hospital stays that the person did not choose.⁴ So families often feel they must push. But pushing hard usually backfires. NAMI points to a different approach.

Build trust first

• Remember that adults have the legal right to make their own treatment choices, unless they meet strict legal rules for emergency care (see below).³
• Focus on their goals, not on the diagnosis. Instead of "You need medicine," try "You said you want to sleep better and get back to work. Could a doctor help with that?"³
• Listen to their reasons. People say no to treatment because of side effects, because they want to cope alone, or because they doubt it helps. Those are real concerns you can bring to the doctor.³
• Try the LEAP method. LEAP comes from Dr. Xavier Amador's book I'm Not Sick, I Don't Need Help! It teaches families to listen, show empathy, agree where they can, and then partner with the person. NAMI shares a free excerpt, and free videos are at leapinstitute.org.³
• Stay patient and friendly. If the person says no, remain open to the next chance. Do not give up the relationship.⁵

You can also ask the treating team how they would like to hear from you. Even if the doctor cannot share details without the person's permission, you can usually give information. It also helps to find out whether the person will sign a release, which lets the team talk with you.

How do I plan for a crisis?

Good treatment lowers the chance of a crisis.¹ Even so, planning ahead makes a crisis less scary for everyone. NAMI's guide includes a fillable crisis plan, a portable treatment record and a relapse plan.¹² You can make your own with these parts:

1. Write down early warning signs. These might be poor sleep, pulling away from people, new suspicion, or stopping medicine. Learn more about signs of relapse.
2. List who to call. Include the doctor, clinic, therapist, and the local crisis line. Add family or friends who can come over.
3. Keep a medical summary. Note the diagnosis, current medicines and doses (as written by the doctor), allergies, past hospitals and what helped before.
4. Write the person's wishes while they are well. Where would they prefer to go? Who should be contacted? What calms them? A legal form called a psychiatric advance directive lets a person state treatment wishes in advance. Many states have laws for these, and they take effect only if the person cannot make decisions.⁶
5. Plan for safety. Think about who else in the home needs protecting, and about safety planning.
6. Share the plan. Give copies to people in the care circle and keep one where you can find it fast.

When to call 911 or 988

Thoughts of suicide can happen with schizophrenia, especially when the illness is untreated or alcohol or drugs are involved.² If your loved one talks about wanting to die, take it seriously. Ask them directly and calmly. Stay with them, and call or text 988. Treatment lowers risk of both suicide and violence.¹ Most people with schizophrenia are not violent. They are more likely to be harmed by others than to harm anyone.²

What does involuntary care mean?

Sometimes a person is in danger but refuses help. In some cases the law lets a doctor, court or police officer arrange care without the person's agreement. This is called involuntary treatment or civil commitment. It is a last step, and it should be as gentle and short as possible.

Here are the basics. Rules differ by state, so check your own state's law or ask a crisis team or your local NAMI group.⁶

• Emergency hold. All states allow a short emergency hold, usually a few days, so a doctor can evaluate the person. It often begins without a prior court review.⁶
• Common reasons. Typical criteria are danger to self, danger to others, or being so unwell that the person cannot care for themselves. Standards and steps vary by state.⁶
• Longer commitment. After an emergency hold, the options are release, voluntary admission or a court process for longer care.⁶
• Least restrictive care. The idea is that a person should not be held longer than needed. Many states build this into their laws.⁶
• Court-ordered outpatient care. In 48 states and Washington, DC, a judge can order a person with serious mental illness who has stopped treatment before to follow a community treatment plan. Some states let family members start this request.⁶
• Mobile crisis teams. Many counties have teams that come to the home to evaluate and help. Call 211 or 988 to ask what exists near you.³

Unless a person meets those legal rules, they cannot be forced into care.⁵ That can feel unfair when you can see they are suffering. Keep the door open, keep building trust, and ask the treatment team about voluntary options such as a long-acting injection (see antipsychotic medicines).

What care should we ask for?

Good treatment is a team effort, and family can be part of it.

• Early programs. For a first episode, experts recommend coordinated specialty care, a team that offers therapy, medicine, help with work or school, and family education.^1,9 Strong evidence Read more in therapy and recovery.
• Family programs. The APA guideline suggests family interventions for people who have ongoing contact with relatives.⁹ England's NICE guidance says families should be offered a therapy with at least 10 planned sessions over 3 months to a year, with support for problem solving and handling crises.⁸
• What the research shows. A Cochrane review of 53 trials found family intervention may lower relapse. About 7 people would need to take part to prevent one relapse. The review warned that the effects may be overstated because many trials were not strong.⁷ Moderate evidence

How do I care for myself?

Caring for a person with psychosis can wear you out. You may feel worry, grief, guilt or anger. All of these are common. You cannot pour from an empty cup, and your health matters too.

• Join a support group. NAMI Family Support Groups are free, led by other family members, and many meet online.¹¹ NAMI Family-to-Family classes are another option through local NAMI groups.³
• Call the NAMI HelpLine at 1-800-950-NAMI (6264) or text 62640, Monday to Friday, 10 a.m. to 10 p.m. Eastern time.³
• Learn about the illness. Family education gives you coping and communication skills and helps with your own stress.²
• Protect your basics. Sleep, meals, movement and time with friends. See caregiver support for ideas.
• Share the load. Ask others for specific help, like a meal or a ride to an appointment. A care circle can help you organize it.
• Set kind limits. You can be respectful and caring without accepting dangerous or hurtful behavior.²
• Talk with your own doctor or a counselor if you feel hopeless, cannot sleep, or are thinking of harming yourself. Call or text 988 any time.

If your relative is an older adult and has sudden new confusion, hallucinations or suspicion, call the doctor soon. Causes can include infection, medicine effects or dementia. See psychosis in later life.

Common questions

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.