What is psychosis?
Psychosis is a state where you lose touch with reality. This might include things like hearing voices, seeing or feeling things that aren't there (hallucinations), feeling paranoid, or believing things that don't make sense (delusions). You might not be able to think logically and might struggle to communicate with other people.
Often these symptoms appear gradually, and they can become very distressing. For example, you might start struggling with your concentration or memory, have unusual ideas or behaviours, change how you communicate, experience mood changes, feel less social, or be less interested in your hobbies and other activities. There is no set time for how long this can last, and the symptoms can affect your school work and relationships with family and friends.
Experiencing the symptoms of psychosis is often referred to as ‘a psychotic episode’. How often a psychotic episode occurs and how long it lasts can depend on what has caused your symptoms.
Psychosis can be related to certain mental health conditions or can be triggered by events or experiences. Mental health conditions which might cause you to experience psychosis include schizophrenia (see below), bipolar disorder and severe depression. Events or experiences which might trigger symptoms of psychosis include trauma, stress, drug or alcohol misuse, medication side effects or certain physical health problems (such as severe infections or a brain tumour, although these would usually have other physical symptoms in addition to psychosis).
Often if you’re experiencing psychosis you might not notice that you are becoming ill. You might also worry that you can’t trust other people, which makes it difficult to ask for help. Because of this, it can often be your family and friends who will notice that you are becoming ill, and so they are often the ones who start looking for help for you.
Getting help early is important, because getting a diagnosis and starting treatment can help with your recovery. Because of this, if you might be experiencing psychosis then you should be referred to mental health services urgently and ideally start treatment within two weeks. Your treatment will be with specialist child and adolescent mental health services (CAMHS), or in some areas by early intervention in psychosis (EIP) teams.
If your psychosis symptoms are being caused by a physical health problem, then you will be referred for medical care that is suitable for your age and the type of physical health problem.
You can find more information about mental health referrals here and more information about local mental health services here.
What is schizophrenia?
Schizophrenia is a mental health condition, with symptoms often described as:
- Positive: such as hallucinations (e.g. seeing things that aren’t there) and delusions (strong beliefs that are not shared by other people)
- Negative: such as feeling emotionless and unmotivated, communicating less, withdrawing from the people around you and not taking care of yourself
Schizophrenia is rare in children and is usually noticed in young people who are over 15 years old. Asking for help early is important, because getting a diagnosis and starting treatment can help with your recovery. You might also have a mixture of symptoms of bipolar disorder or depression alongside symptoms of schizophrenia.
- Planning treatment
Diagnosis and assessment
To help your professional understand the symptoms you’re experiencing, they will ask you to have an assessment. During your assessment, your professional will ask about your symptoms, experiences and thoughts, as well as find out about your life, history, any other physical or mental health conditions, and your family history.
Your professional should treat you with sensitivity and respect and be aware that you might be worried about speaking with people because of the symptoms you are experiencing or worried about stigma surrounding psychosis or schizophrenia.
Because of the nature of psychosis, you may not have noticed that you were becoming ill, and so your professional will usually need to talk to your parents or carers as well. You might also not know whether other people in your family have had similar illnesses, and so your professional will usually need to ask your parents or carers about this too.
Your professional will also need to find out about any particular risks, such as whether you have thoughts of harming yourself or anyone else, and whether you have acted on these. Your assessment might also involve a physical health check.
Psychoeducation
Psychoeducation involves teaching you and your family more about psychosis and/or schizophrenia and how it can be treated. As you can often be very unwell at the point of your assessment, it might be difficult to take in information or you might not believe you are really unwell. If this is the case, your professional might plan to give you more information when you are better able to engage with it.
Making decisions
Your professional should also talk with you and your parents or carers about:
- the benefits and risks of your treatment options
- any worries you have
- any other physical or mental health conditions you have
- how to stick to your treatment plan
You should be involved in planning and making decisions about your treatment. However, sometimes if you are at risk of harm because you are very unwell and do not believe you are ill, decisions about your treatment may need to be taken for you. This may involve your parents, carers or doctors making decisions for you, and they will have to follow specific legal rules to make sure any decisions are in your best interests.
If you’re over 16, or you are able to make your own decisions about your care, then you can make decisions about whether and how you would like your parents or carers involved. Usually, it is helpful for your parents or carers to be involved, especially if you live with them. This doesn’t mean that your parents or carers will know everything that happens in your individual sessions. You can find more information about confidentiality and privacy here.
You can find more information about how treatment decisions are made here.
Your treatment for schizophrenia should be personalised to fit you, and should try to improve all the symptoms you experience. Schizophrenia can be a long-term condition, so your professional should also support you to help you manage your mental health alongside your everyday life.
Your professional should work together with you and your parents or carers to create a crisis plan.
- What about my parents or carers?
Your professional should give your parents or carers information about psychosis or schizophrenia and the treatment options. Your professional should work together with you and your parents or carers (if appropriate) to make decisions about your care. Read more about shared decision making here.
The wellbeing of your parents or carers is important, and they should be offered an assessment of their own needs and any support that might help them.
- Transitions between services
In England there are early intervention in psychosis (EIP) teams which work with people who are 14–65 years old. These teams often work across both CAMHS and mental health services for adults, so you might work with a CAMHS professional at first and then work with another professional from adult mental health services once you turn 18.
If you transition to another EIP service (e.g., if you move house), then your professional should work with you to make sure that your treatment continues smoothly, and that your new service has all the information they need. You can find more information about transitioning between services here.
- Additional support
The below organisations offer psychosis and schizophrenia specific support for children, young people and their families:
- AFC Crisis Messenger: a free, confidential, 24/7 text message support service for anyone who is feeling overwhelmed or is struggling to cope. If you need support, you text AFC to 85258
- Childline: Childline is there to help anyone under 19 in the UK with any issue they’re going through. Whether it’s something big or small, their trained counsellors are there to support you
- Hearing Voices Network: charity supporting those who hear voices, see visions or have sensory experiences in the UK
- Supportline: charity offering helpline for people of all ages on a wide range of issues including anger, eating disorders, self-harm, depression, anxiety, panic attacks, and addictions
- The Mix: support and advice for children and young people under 25
- Voice Collective: UK wide project hosted by Mind in Camden supporting young people who hear, see, or sense things that others don’t
Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.