Please support families of those experiencing psychosis
BMJ 2025; 389 doi: https://doi.org/10.1136/bmj.r598 (Published 17 April 2025) Cite this as: BMJ 2025;389:r598
- Anonymous
I was 10 when my sister first experienced psychosis. I remember her hearing voices, distressed and upset, shouting at someone we couldn’t see. She was soon admitted to hospital for the first time and has since had many further admissions for psychosis. To me her condition seems to have an extreme on-off tendency. She will be well for long periods of time, and then within days she will be convinced she is dead, that the room is full of snakes, and the world is falling apart around her. Her recovery is often slow, and several times she has had to spend many, many months in hospital.
Visiting my sister was hard. At times she would be so unwell that she could barely speak, transported to some other world that she was unable to escape. At other times, she would be distressed, bursting into tears constantly or inconsolable with fear. Although visiting felt important, it was hard to know what to do on these visits. When she was better, we got into the habit of sitting and playing cards. But there were long periods when this was not possible. On the way home after my visits, I would almost always cry.
Conversations about communication
My family and I often wondered how best to communicate with my sister when she was in the grip of psychosis. Her hallucinations and delusions clearly terrified her. It felt natural to tell her they were not real, but to do this continually was to spend time constantly in opposition to her, contradicting her experiences. Nobody ever talked us through how to handle this.
One positive legacy of the pandemic was that we were sometimes given the opportunity to join my sister’s ward reviews online. Then I was finally able to put the question about communication to a kind and patient consultant. He explained a way of recognising the emotional impact of my sister’s hallucinations, and then, if possible, trying to dispel it by displacing it with trust. Something like, “That sounds really scary for you. Perhaps let’s look under the bed together and see if there’s anything there.” I’m grateful to this consultant as this really helped. I just wish that conversation had happened sooner.
Role of families
Psychiatric wards are not always easy places on which to spend time. A visit might involve interactions with patients other than my sister, and knowing how to behave in those situations didn’t necessarily come easily. When relatives visit patients in an intensive care unit, nurses and staff members are trained to support those visitors: to explain what the machines mean, to warn them of what might be hard, and to ensure their emotional needs are met. I don’t ever remember such support for my family. The nurses and mental health support workers were generally kind and professional, but it wasn’t part of the culture to check in on visitors.
In some ways my sister is lucky: she has a well resourced and educated family advocating for her, which so many do not. Yet despite that, we have often not found it easy. Perhaps family support needs to become part of the culture on mental health wards, and we should recognise the need for help in communicating. More proactive support is needed, in the emotional aspects of the visits as well as in how to best help our relatives.
What you need to know
Psychosis can be very difficult to witness, especially when it is in a family member or loved one
Giving families guidance on how best to communicate with someone during a psychotic episode can be helpful
Family members need to be given more support when visiting a patient and to be seen as an important part of recovery
Education in practice
What support or advice could you give to a family member when a patient is going through psychosis?
How could you ensure you are working with a patient’s family to help with recovery?
Footnotes
Competing interests: none disclosed.