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The effectiveness of occupational engagement as an intervention for patients with schizophrenia

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OT for people with psychotic conditions in community settings, a pilot randomised controlled trial

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Focal point, youth young people and mental health

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Facilitators and barriers to living with psychosis, an exploratory collaborative study of the perspectives of mental health service users

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Early psychosis, treatment issues and the role of OT

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Early _Intervention _Teams __Services _For _Early _Psychosis _Factsheet

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EASA: A Model of OT's Role in Early Intervention Psychosis

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SCREENING 6 months prior Service options Insurance limitations Cultural considerations Graduations Ongoing opportunities INFRASTRUCTURE "Psychosis Risk Syndrome" PLANNING QMHP: Master's level clinician COMMUNITY Reduce Duration of Untreated Psychosis EIP is a platform to showcase

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Hitch, D., Pepin, G., & Stagnitti, K. (2013). Engagement in activities and occupations by people who have experienced psychosis: A metasynthesis of lived experience. British Journal of Occupational Therapy, 76(2), pp. 77-86.

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Hitch, D., Pepin, G., & Stagnitti, K. (2013). Engagement in activities and occupations by people who have experienced psychosis: A metasynthesis of lived experience. British Journal of Occupational Therapy, 76(2), pp. 77-86.

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Study looking into the role of activities in the lives of people with psychosis

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Brown, JA (2011) Talking about life after early psychosis: The impact on occupational performance. Canadian Journal of Occupational Therapy, 78(3), 1 56-63. |
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Engagement in Activities and Occupations by People Who Have Experienced Psychosis: A Metasynthesis of Lived Experience

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Brown, JA (2011) Talking about life after early psychosis: The impact on occupational performance. Canadian Journal of Occupational Therapy, 78(3), 1 56-63. | Google Scholar SAGE Journals Buckley, P, Jones, P (2010) Schizophrenia and paranoid psychoses. In: Puri, B, Treasaden, I, eds. Psychiatry: An evidence based text. London: Hodder Arnold, 593-609.

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https://www.nice.org.uk/guidance/cg155/chapter/recommendations

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Brown, J. A. (2011). Talking about life after early psychosis: The impact on occupational performance. Canadian Journal of Occupational Therapy, 78(3), pp. 156-163.

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Brown, J. A. (2011). Talking about life after early psychosis: The impact on occupational performance. Canadian Journal of Occupational Therapy, 78(3), pp. 156-163.

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Looking at the role of OT in early psychosis. Suggests several areas where there is evidence OT intervention can help people experiencing early psychosis.

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Documentary on young person with psychosis

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Documentary on young person with psychosis

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Don't Call Me Crazy Episode 2 of 3 Mental Health Documentary 2013

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A mental disorder is characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behaviour. It is usually associated with distress or impairment in important areas of functioning. There are many different types of mental disorders. Mental disorders may also be referred to as mental health conditions. The latter is a broader term covering mental disorders, psychosocial disabilities and (other) mental states associated with significant distress, impairment in functioning, or risk of self-harm. This fact sheet focuses on mental disorders as described by the International Classification of Diseases 11th Revision (ICD-11).

In 2019, 1 in every 8 people, or 970 million people around the world were living with a mental disorder, with anxiety and depressive disorders the most common (1). In 2020, the number of people living with anxiety and depressive disorders rose significantly because of the COVID-19 pandemic. Initial estimates show a 26% and 28% increase respectively for anxiety and major depressive disorders in just one year (2). While effective prevention and treatment options exist, most people with mental disorders do not have access to effective care. Many people also experience stigma, discrimination and violations of human rights.

Anxiety Disorders

In 2019, 301 million people were living with an anxiety disorder including 58 million children and adolescents (1). Anxiety disorders are characterised by excessive fear and worry and related behavioural disturbances. Symptoms are severe enough to result in significant distress or significant impairment in functioning. There are several different kinds of anxiety disorders, such as: generalised anxiety disorder (characterised by excessive worry), panic disorder (characterised by panic attacks), social anxiety disorder (characterised by excessive fear and worry in social situations), separation anxiety disorder (characterised by excessive fear or anxiety about separation from those individuals to whom the person has a deep emotional bond), and others. Effective psychological treatment exists, and depending on the age and severity, medication may also be considered.

Depression

In 2019, 280 million people were living with depression, including 23 million children and adolescents (1). Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. During a depressive episode, the person experiences depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day, for at least two weeks. Several other symptoms are also present, which may include poor concentration, feelings of excessive guilt or low self-worth, hopelessness about the future, thoughts about dying or suicide, disrupted sleep, changes in appetite or weight, and feeling especially tired or low in energy. People with depression are at an increased risk of suicide. Yet, effective psychological treatment exists, and depending on the age and severity, medication may also be considered.

Bipolar Disorder

In 2019, 40 million people experienced bipolar disorder (1). People with bipolar disorder experience alternating depressive episodes with periods of manic symptoms. During a depressive episode, the person experiences depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day. Manic symptoms may include euphoria or irritability, increased activity or energy, and other symptoms such as increased talkativeness, racing thoughts, increased self-esteem, decreased need for sleep, distractibility, and impulsive reckless behaviour. People with bipolar disorder are at an increased risk of suicide. Yet effective treatment options exist including psychoeducation, reduction of stress and strengthening of social functioning, and medication.

Post-Traumatic Stress Disorder (PTSD)

The prevalence of PTSD and other mental disorders is high in conflict-affected settings (3). PTSD may develop following exposure to an extremely threatening or horrific event or series of events. It is characterised by all of the following: 1) re-experiencing the traumatic event or events in the present (intrusive memories, flashbacks, or nightmares); 2) avoidance of thoughts and memories of the event(s), or avoidance of activities, situations, or people reminiscent of the event(s); and 3) persistent perceptions of heightened current threat. These symptoms persist for at least several weeks and cause significant impairment in functioning. Effective psychological treatment exists.

Schizophrenia

Schizophrenia affects approximately 24 million people or 1 in 300 people worldwide (1). People with schizophrenia have a life expectancy 10-20 years below that of the general population (4). Schizophrenia is characterised by significant impairments in perception and changes in behaviour. Symptoms may include persistent delusions, hallucinations, disorganised thinking, highly disorganised behaviour, or extreme agitation. People with schizophrenia may experience persistent difficulties with their cognitive functioning. Yet, a range of effective treatment options exist, including medication, psychoeducation, family interventions, and psychosocial rehabilitation.

Eating Disorders

In 2019, 14 million people experienced eating disorders including almost 3 million children and adolescents (1). Eating disorders, such as anorexia nervosa and bulimia nervosa, involve abnormal eating and preoccupation with food as well as prominent body weight and shape concerns. The symptoms or behaviours result in significant risk or damage to health, significant distress, or significant impairment of functioning. Anorexia nervosa often has its onset during adolescence or early adulthood and is associated with premature death due to medical complications or suicide. Individuals with bulimia nervosa are at a significantly increased risk for substance use, suicidality, and health complications. Effective treatment options exist, including family-based treatment and cognitive-based therapy.

Disruptive behaviour and dissocial disorders

40 million people, including children and adolescents, were living with conduct-dissocial disorder in 2019 (1). This disorder, also known as conduct disorder, is one of two disruptive behaviour and dissocial disorders, the other is oppositional defiant disorder. Disruptive behaviour and dissocial disorders are characterised by persistent behaviour problems such as persistently defiant or disobedient to behaviours that persistently violate the basic rights of others or major age-appropriate societal norms, rules, or laws. Onset of disruptive and dissocial disorders, is commonly, though not always, during childhood. Effective psychological treatments exist, often involving parents, caregivers, and teachers, cognitive problem-solving or social skills training.

Neurodevelopmental disorders

Neurodevelopmental disorders are behavioural and cognitive disorders, that? arise during the developmental period, and involve significant difficulties in the acquisition and execution of specific intellectual, motor, language, or social functions.

Neurodevelopmental disorders include disorders of intellectual development, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD) amongst others. ADHD is characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity that has a direct negative impact on academic, occupational, or social functioning. Disorders of intellectual development are characterised by significant limitations in intellectual functioning and adaptive behaviour, which refers to difficulties with everyday conceptual, social, and practical skills that are performed in daily life. Autism spectrum disorder (ASD) constitutes a diverse group of conditions characterised by some degree of difficulty with social communication and reciprocal social interaction, as well as persistent restricted, repetitive, and inflexible patterns of behaviour, interests, or activities.

Effective treatment options exist including psychosocial interventions, behavioural interventions, occupational and speech therapy. For certain diagnoses and age groups, medication may also be considered.

Who is at risk from developing a mental disorder?

At any one time, a diverse set of individual, family, community, and structural factors may combine to protect or undermine mental health. Although most people are resilient, people who are exposed to adverse circumstances - including poverty, violence, disability, and inequality - are at higher risk. Protective and risk factors include individual psychological and biological factors, such as emotional skills as well as genetics. Many of the risk and protective factors are influenced through changes in brain structure and/or function.

Health systems and social support

Health systems have not yet adequately responded to the needs of people with mental disorders and are significantly under resourced. The gap between the need for treatment and its provision is wide all over the world; and is often poor in quality when delivered. For example, only 29% of people with psychosis (5) and only one third of people with depression receive formal mental health care (6).

People with mental disorders also require social support, including support in developing and maintaining personal, family, and social relationships. People with mental disorders may also need support for educational programmes, employment, housing, and participation in other meaningful activities.

WHO response

WHO's Comprehensive Mental Health Action Plan 2013-2030 recognizes the essential role of mental health in achieving health for all people. The plan includes 4 major objectives:

to strengthen effective leadership and governance for mental health;

to provide comprehensive, integrated and responsive mental health and social care services in community-based settings;

to implement of strategies for promotion and prevention in mental health; and

to strengthen information systems, evidence, and research for mental health.

WHO's Mental Health Gap Action Programme (mhGAP) uses evidence-based technical guidance, tools and training packages to expand services in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. The WHO mhGAP Intervention Guide 2.0 is part of this Programme, and provides guidance for doctors, nurses, and other health workers in non-specialist health settings on assessment and management of mental disorders.

References

(1) Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx), ( https://vizhub.healthdata.org/gbd-results/, accessed 14 May 2022).

(2) Mental Health and COVID-19: Early evidence of the pandemic's impact. Geneva: World Health Organization; 2022.

(3) Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet. 2019;394,240-248.

(4) Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 2014;10,425-438.

(5) Mental health atlas 2020. Geneva: World Health Organization; 2021

(6) Moitra M, Santomauro D, Collins PY, Vos T, Whiteford H, Saxena S, et al. The global gap in treatment coverage for major depressive disorder in 84 countries from 2000-2019: a systematic review and Bayesian meta-regression analysis. PLoS Med. 2022;19(2):e1003901. doi:10.1371/journal.pmed.1003901.

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Facts sheet on mental disorders: key facts, depression, dementia, health and support and WHO response

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Luke Watkin was in year eight at school and alone in a corridor when he first heard a strange noise.

"I heard what sounded like a train brake, followed by a metal on metal noise.

"It was just something completely out of the ordinary. It was a bit of a shock to the system, something I just couldn't understand or really process.

"My experience at the time was quite terrifying."

It was his first experience of the mental health condition, psychosis. Luke was 12 years old.

He said it went on from noises to hearing words, hearing his name, to eventually hearing whole sentences "of it almost trying to talk to me".

The main symptoms of psychosis are hallucinations and delusions and it can be caused by a specific mental health condition, such as schizophrenia, bipolar disorder or severe depression.

It can also be triggered by traumatic experiences, stress, drugs, alcohol, as a side-effect of prescribed medication or a physical condition such as a brain tumour.

While it is not as common as depression - affecting fewer than one in every hundred - experts say it is important to recognise symptoms of psychosis early because early treatment can be more effective.

People with psychosis have a higher than average risk of self-harm and suicide.

The charity Rethink Mental Illness has surveyed 4,000 people and found more than half believe they wouldn't be able to identify the early symptoms.

They are concerned that a general lack of awareness leads to young people not getting help early on - especially as the first episode of psychosis is most likely to happen between the ages of 18 and 24.

More subtle early warning signs include withdrawing from friends, expressing strange beliefs, sudden changes in mood and confused thoughts.

Symptoms of psychosis:

hallucinations - where a person hears, sees, feels, smells or tastes things that aren't there

a common hallucination is hearing voices

delusions - where a person has strong beliefs that aren't shared by others

a common delusion is someone believing there is a conspiracy to harm them

rapid and constant speech

disturbed speech - for example, they may switch from one topic to another mid-sentence

a sudden loss in their train of thought, resulting in an abrupt pause in conversation or activity

Luke did try to talk to a teacher at the time but he said "it was kind of brushed aside. I was made to feel that it wasn't something that was supposed to be talked about."

So he decided to "be strong and keep it inside and just push forward."

Luke didn't talk about it again until he dropped out of university in his third year.

He acknowledges that it would have been hard for his family to spot what he was going through.

"They thought I was fairly quiet - because that was how I dealt with it. I'd hide myself away in my room, or focus down on something else and try and stay out of other people's way. That's just how my parents thought I was - I was just a quiet child."

But at university it reached a point where he couldn't manage both university life and trying to hide his psychosis.

He dropped out while his family thought he was still studying, and then lost contact with his family.

"When I reached the lowest point of my mental illness I disappeared," he explained.

"After I went missing it was fairly obvious to my family that something was wrong and so as things came to light they realised I hadn't been at university and that was the first step to getting help. They kind of confronted me about things and they were very understanding and incredibly caring."

It is recommended that anyone experiencing psychosis should see their GP immediately.

The typical treatment involves a combination of anti-psychotic medication, psychological therapies such as cognitive behaviour therapy (CBT) and family or social support.

Luke was put in contact with the early intervention service and given medication.

"Looking back on it it's bizarre. At that point it was so strange to think of - now I think if I'm having a bad day I can't help but tell almost everyone. I'm quite a complainer now - it feels like just such a different mentality at the time as I was almost afraid to talk about it."

Now 26, Luke is helping to support young people going through the same thing, and he says he can see a change in how people are more open at talking about psychosis.

"I feel it will get less likely that people feel that they want to hide it - it's far easier to talk about rather than being something almost taboo, it's just something that happens."

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Luke Watkin was in year eight at school and alone in a corridor when he first heard a strange noise. "I heard what sounded like a train brake, followed by a metal on metal noise. "It was just something completely out of the ordinary.

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Response to the Inquiry of the Five Year Forward View for Mental Health.

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Our Response to the Inquiry of the Five Year Forward View for Mental Health

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The Five Year Forward View for Mental Health was released by the Government in 2016. It outlined their strategy to improve mental health services and set targets that it aimed to achieve by 2020/21.

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In most cases when people are treated in hospital or another mental health facility, they have agreed or volunteered to be there. They may be referred to as a voluntary patient.

But there are cases when a person can be detained, also known as sectioned, under the Mental Health Act (1983) and treated without their agreement.

The Mental Health Act (1983) is the main piece of legislation that covers the assessment, treatment and rights of people with a mental health disorder. You can read the Mental Health Act on the government legislation website.

People detained under the Mental Health Act need urgent treatment for a mental health disorder and are at risk of harm to themselves or others.
Find out where to get urgent help for mental health

Advice for carers and families

If your loved one has been detained, they will have to stay in hospital until the doctors or a mental health tribunal decide otherwise.

You still have the right to visit. Visiting arrangements depend on the hospital, so check visiting hours with staff or on the hospital website.

In some cases the patient may refuse visitors, and hospital staff will respect the patient's wishes. If you're unable to see your loved one, staff should explain why.

With permission from your loved one, doctors may discuss the treatment plan with you.

You can also raise concerns or worries with the doctors and nurses on the ward.

Hospital accommodation should be age and gender-appropriate.

Not all hospitals will be able to offer a ward dedicated to each gender, but all should at least offer same-sex toilets and washing facilities.

For more information:

Who decides that someone should be detained?

In emergencies

An emergency is when someone seems to be at serious risk of harming themselves or others.

Police have powers to enter your home, if need be by force, under a Section 135 warrant.

You may then be taken to a place of safety for an assessment by an approved mental health professional and a doctor.

You can be kept there until the assessment is completed, for up to 24 hours. This can be extended to 36 hours, if it wasn't possible to assess you in that time.
Find out more about the Section 135 warrant on the GOV.UK website
If the police find you in a public place and you appear to have a mental health disorder and are in need of immediate care or control, they can take you to a place of safety (usually a hospital or sometimes the police station) and detain you there under Section 136.

You'll then be assessed by an approved mental health professional and a doctor.

You can be kept there until the assessment is completed, for up to 24 hours. This can be extended to 36 hours, if it wasn't possible to assess you in that time.
Find out more about the Section 136 warrant on the GOV.UK website
If you're already in hospital, certain nurses can stop you leaving under Section 5(4) until the doctor in charge of your care or treatment, or their nominated deputy, can make a decision about whether to detain you there under Section 5(2).

Section 5(4) gives nurses the ability to detain someone in hospital for up to 6 hours.

Section 5(2) gives doctors the ability to detain someone in hospital for up to 72 hours, during which time you should receive an assessment that decides if further detention under the Mental Health Act is necessary.
Find out more about Section 5 of the Mental Health Act on the government legislation website
Non-emergencies

In most non-emergency cases, family members, a GP, carer or other professionals may voice concerns about your mental health.

They should discuss this with you, and together you should make a decision about what help you may need, such as making an appointment with your GP to discuss further options.
Find out more about accessing NHS mental health services
But there may be times when there are sufficient concerns about your mental health and your ability to make use of the help offered.

In these circumstances your relatives or the professionals involved in your care can ask for a formal assessment of your mental health through the Mental Health Act process.

Your nearest relative has the right to ask the local approved mental health professional service, which may be run by local social care services, for an assessment under the Mental Health Act.

It's also possible for a court to consider using the Mental Health Act in some circumstances, or for a transfer to a hospital to take place from prison.

As part of this formal process, you'll be assessed by doctors and an approved mental health professional.

One of the doctors must be specially certified as having particular experience in the assessment or treatment of mental illness.
Find out more about getting a mental health assessment
The length of time you could be detained for depends on the type of mental health condition you have and your personal circumstances at the time.

You could be detained for:

up to 28 days under Section 2 of the Mental Health Act

up to 6 months under Section 3 of the Mental Health Act, with further renewals

During these periods, assessments will be regularly carried out by the doctor in charge of your care to determine whether it's safe for you to be discharged and what further treatment is required, if any.

You should always be given information about your rights under the Mental Health Act.
Find out more about your rights on the Care Quality Commission (CQC) website Read the Royal College of Psychiatrists' Q&A about being sectioned in England and Wales

What does the term 'being sectioned' mean?

The Mental Health Act is structured in many sections.

If someone says, "You're being sectioned under the Mental Health Act", they mean you're detained according to a particular section of the Mental Health Act.

In most cases, you'll be told which section of the Mental Health Act applied in your case. For example, "You're detained under Section 2 of the Mental Health Act".

How can I appeal against being detained?

Any person who's compulsorily detained has the right to appeal against the decision to the Mental Health Tribunal (MHT) or to the hospital's managers.

The MHT is an independent body that decides whether you should be discharged from hospital.

You may be eligible for legal aid to pay for a solicitor to help you do this.
Visit GOV.UK if you want to apply to the Mental Health Tribunal
You also have the right to see an independent mental health advocate if you're detained.

Ask the nurses on your ward or the hospital manager how you can get to see one.

An independent mental health advocate can help you understand your rights and could also help if you're not happy with your situation.

You can also make a complaint to the CQC if you're unhappy with the way the Mental Health Act has been used. Find out how to make a complaint on the CQC website.

Consent to treatment

If you're held under the Mental Health Act, you can be treated against your will.

This is because it's felt you do not have sufficient capacity to make an informed decision about your treatment at the time.

This is also the case if you refuse treatment but the team treating you believe you should have it.

The CQC provides detailed guidance about your rights in terms of consenting to medication and electroconvulsive therapy if you're detained in hospital or placed on a Community Treatment Order (CTO). Find out more on the CQC website:
CQC: Information for people detained in hospital CQC: Information for people subject to Community Treatment Orders (CTOs)

What is 'Section 17 leave'?

Going on leave from the hospital should form an important part of your care as you recover.

This means that while detained under the Mental Health Act, you may be able to leave the hospital if authorised by the doctor or clinician in charge of your care (also known as the responsible clinician).

This leave is often referred to as "section 17 leave", as it's Section 17 of the Mental Health Act that allows this leave.

The responsible clinician in charge of your care can place conditions on the leave, such as where you should stay while away from the hospital and whether this will be for a fixed period of time.

You should be given a copy of the Section 17 leave form that sets out these conditions so you're clear what they are.

The responsible clinician can revoke your leave and make you come back to hospital at any time.

If you do not return to the hospital at the end of the leave period, you can be made to go back to the hospital.
Find out more about Section 17 of the Mental Health Act on the government legislation website

What's a Community Treatment Order?

If you have been treated in hospital under the Mental Health Act and are being discharged or allowed out of the hospital on short-term leave, you may be put under a Community Treatment Order (CTO).

Under Section 17 of the Act, you can get leave but can be recalled to hospital if, for example, you stop taking required medication or your condition gets worse.

Make sure you know how long any leave is agreed for (usually 1 night or a weekend) before leaving the hospital.

You may be recalled to hospital during the leave if there are significant concerns about how you manage in the community.

If you're on leave or are being discharged, you may be made subject to a CTO if your doctor is concerned that you may not continue your treatment when you leave hospital.

Generally, a CTO means you can go home under certain conditions that you have to meet.

This is to protect yourself or others from harm and ensures you continue your treatment.

As normally occurs when someone is discharged from hospital, you'll be assigned a care co-ordinator, who'll help you with your mental health needs.

If you break the conditions of the CTO or your situation gets worse, you could be readmitted to hospital.

You could be detained for up to 72 hours while a decision is made about the next steps in your care.

Depending on your circumstances, your CTO could be revoked, which means you'll have to stay in hospital, or you could be allowed to leave hospital and continue your CTO.

While you're on a CTO, you can appeal against it. You may be eligible for legal aid to pay for a solicitor to help you do this.

You also have the right to see an independent mental health advocate and appeal to a mental health tribunal when you're on a CTO.

Ask your care co-ordinator, the nurses on your ward or hospital manager how you can get to see one.

An independent mental health advocate can help you understand your rights and could also help if you're not happy with any of your CTO conditions.
Find out more about your rights in relation to consent to medication and electroconvulsive therapy if you're subject to a CTO on the CQC website

What's the SOAD service?

The second opinion appointed doctor (SOAD) service safeguards the rights of patients subject to the Mental Health Act.

SOADs are consulted in certain circumstances when a patient refuses treatment, or is too ill or otherwise incapable of giving consent.

They'll check whether the recommended treatment is clinically appropriate and that your views and rights have been taken into account.

For example:

If you have already received medication for 3 months without consent under the Mental Health Act, the SOAD has to review whether continuous medication is really necessary.

If you're too ill to give valid consent to electroconvulsive therapy and your doctor feels it's necessary, the SOAD has to review whether it's appropriate for the treatment to be given. Electroconvulsive therapy cannot be given to a patient who's able to give consent but refuses to do so, except in urgent situations.

What's an approved mental health professional (AMHP)?

An approved mental health professional (AMHP) is a mental health worker who has received special training to provide help and give assistance to people who are being treated under the Mental Health Act.

Their functions can include helping to assess whether a person needs to be compulsorily detained (sectioned) as part of their treatment.

An AMHP is also responsible for ensuring that the human and civil rights of a person being detained are upheld and respected.

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In most cases when people are treated in hospital or another mental health facility, they have agreed or volunteered to be there. But there are cases when a person can be detained, also known as sectioned, under the Mental Health Act (1983) and treated without their agreement.

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https://www.time-to-change.org.uk/category/blog/psychosis

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A group of young adults share their experience of Psychosis.

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Mental health of young people: a global public-health challengeAuthor links open overlay panel  Dr Vikram Patel MRCPsych

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Mental health of young people: a global public-health challengeAuthor links open overlay panel  Dr Vikram Patel MRCPsych

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Psychosis is when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions).

Symptoms of psychosis

The 2 main symptoms of psychosis are:

hallucinations - where a person hears, sees and, in some cases, feels, smells or tastes things that do not exist outside their mind but can feel very real to the person affected by them; a common hallucination is hearing voices

delusions - where a person has strong beliefs that are not shared by others; a common delusion is someone believing there's a conspiracy to harm them

The combination of hallucinations and delusional thinking can cause severe distress and a change in behaviour.

Experiencing the symptoms of psychosis is often referred to as having a psychotic episode.

When to seek medical advice

You should see a GP immediately if you're experiencing symptoms of psychosis.

It's important psychosis is treated as soon as possible, as early treatment can be more effective.

The GP may ask you some questions to help determine what's causing your psychosis.

They should also refer you to a mental health specialist for further assessment and treatment.
Find out more about diagnosing psychosis

Getting help for others

If you're concerned about someone you know, you could contact a GP for them.

If they're receiving support from a mental health service, you could contact their mental health worker.

If you think the person's symptoms are severe enough to require urgent treatment and could be placing them at possible risk, you can:

A number of mental health helplines are also available that can offer expert advice.
Find out more about how to get help for others

Causes of psychosis

It's sometimes possible to identify the cause of psychosis as a specific mental health condition, such as:

schizophrenia - a condition that causes a range of psychological symptoms, including hallucinations and delusions

bipolar disorder - a mental health condition that affects mood; a person with bipolar disorder can have episodes of low mood (depression) and highs or elated mood (mania)

severe depression - some people with depression also have symptoms of psychosis when they're very depressed

Psychosis can also be triggered by:

How often a psychotic episode occurs and how long it lasts can depend on the underlying cause.

Treating psychosis

Treatment for psychosis involves using a combination of:

antipsychotic medicine - which can help relieve the symptoms of psychosis

psychological therapies - the 1-to-1 talking therapy cognitive behavioural therapy (CBT) has proved successful in helping people with psychosis, and family interventions (a form of therapy that may involve partners, family members and close friends) have been shown to reduce the need for hospital treatment in people with psychosis

social support - support with social needs, such as education, employment or accommodation

Some people are recommended to take antipsychotics on a long-term basis (and possibly for the rest of their lives). Other people may be able to gradually reduce their dosage and then stop taking them altogether if there is a marked improvement in symptoms.

Do not stop suddenly taking any prescribed medicines as this could trigger a relapse of your symptoms.

If a person's psychotic episodes are severe, they may need to be admitted to a psychiatric hospital for treatment.

Complications of psychosis

People with a history of psychosis are more likely than others to have drug or alcohol misuse problems, or both.

Some people use these substances as a way of managing psychotic symptoms.

But substance abuse can make psychotic symptoms worse or cause other problems.

Self-harm and suicide

People with psychosis have a higher than average risk of self-harm and suicide.

See a GP if you're self-harming.

You can also call the Samaritans, free of charge, on 116 123 for support.

The mental health charity Mind also has some useful information and advice.

If you think a friend or relative is self-harming, look out for signs of unexplained cuts, bruises or cigarette burns, usually on the wrists, arms, thighs and chest.

People who self-harm may keep themselves covered up at all times, even in hot weather.

Read more about:

If you're feeling suicidal, you can:

call the Samaritans support service on 116 123

go to your nearest A&E and tell the staff how you're feeling

contact NHS 111

speak to a friend, family member or someone you trust

make an urgent appointment to see a GP or your psychiatrist or care team

Read more about warning signs of suicide

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Psychosis is when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions).

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Intervention Research in Psychosis:Issues Related to the Assessment ofQuality of Life1

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Intervention Research in Psychosis:Issues Related to the Assessment ofQuality of Life1

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Prediction of Psychosis in Adolescentsand Young Adults at High RiskResults From the Prospective European Prediction of Psychosis Study

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Prediction of Psychosis in Adolescentsand Young Adults at High RiskResults From the Prospective European Prediction of Psychosis Study

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European predictors of psychosis

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Sets out the government's quality standards for mental health services. (UK)

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Sets out the government's quality standards for mental health services. (UK)

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Guidance

Sets out the government's quality standards for mental health services.

Documents

Details

The 'National Service Framework for Mental Health' sets quality standards for mental health services. It says what they aim to achieve, how they should be developed and put into practice and how they should be measured.

The NSF for mental health will:

combat discrimination against individuals and groups with mental health problems

make it easier for for anyone who may have a mental health problem to access services

create a range of mental health services to prevent or anticipate crises where possible

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National service framework: mental health

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Guidance Sets out the government's quality standards for mental health services. The 'National Service Framework for Mental Health' sets quality standards for mental health services. It says what they aim to achieve, how they should be developed and put into practice and how they should be measured.

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Visual summary of treatment positive and negative symptoms by the BMJ.

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Intervention Research in Psychosis:Issues Related to the Assessment ofQuality of Life

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Intervention Research in Psychosis:Issues Related to the Assessment ofQuality of Life

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by A. Qeorge Awad and Lakshmi N.P. Voruganti
Discussion on psychosis in a wide age range, and how it affects the person's
QoL

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Blog about screen use and psychotic symptoms

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Blog about screen use and psychotic symptoms

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"I hear voices at night, and sometimes I think someone's outside my window," the 19-year-old young man informed me. "I know no one's really there, but it's still scary."

In my practice in the past six months, no less than five youths have reported psychotic symptoms that were attributed to, or exacerbated by, electronic screen devices.

As per my protocol, I always get a "screen-time" history:

video games (including handheld)

computer/internet use, especially using laptops and ipad

cell phone/smartphone use (talking, texting, streaming, and internet

television (especially cartoons/animated, 3-D, or watching on a laptop)

Not surprisingly, all five of these patients, ranging from 15-22 years old, were "plugged in" for six or more hours each day. Three were female and two male. After discussing electronic screens' toxic influence on the brain, I recommended to each of these patients that they forego all interactive electronic media for at least four weeks.

The three females all decided to go "cold turkey " and gave up their games, laptops, and phones. All three saw their symptoms resolve completely within a month. Of the two males, one cut down use significantly and his hallucinations disappeared; his paranoia remained but was less severe which in turn improved dysfunction. The other male turned out to be severely addicted to the internet and video games and flat out refused to change his habits at all. Needless to say the young man continues to suffer from psychotic symptoms.

Importantly, the therapeutic effects were achieved without using medication! This is a big deal, because medications used to treat psychotic symptoms are heavy duty, and have serious side effects--weight gain, hormone dysfunction, and movement disorders, which can be irreversible.

Electronic screens, particularly interactive ones (as opposed to passive ones, like television), increase dopamine in the reward center of the brain. This effect has been demonstrated by brain scan (Koepp, 1998: http://www.nrc-iol.org/cores/mialab/fijc/Files/2002/120402_Koepp_Nature_... ) Dopamine is known as the brain's "feel good" chemical, but is also related to stress, addiction, anxiety, mood, and attention. Dopamine in excess can lead to psychotic symptoms--voices, delusions, paranoia, or confusion.

Psychosis is defined by abnormal thinking. This can involve thought content, such as hallucinations, delusions, or paranoia, or thought process (highly disorganized thinking, or feeling like thoughts are "blocked"). It is typically attributed to the severely mentally ill, like schizophrenics, but can also be seen in "normal" people under extreme stress. Children in particular are more likely to hallucinate when traumatized, sleep-deprived, or over-stimulated. Interactive electronic screen use cause or mimic all three of these states!

Take home point: Children, teens, and young adults who have unexplained hallucinations or delusions should have ALL electronic screen devices removed for at least 3 weeks, as part of the diagnostic work up. This includes cell phones, as texting, media viewing, and internet use can quickly rack up hours. Virtually all teens and many young adults do not yet have the impulse control to moderate their own usage, so parents should physically remove these devices. While this may seem extreme, drastic times cause for drastic measures. Psychosis-and treatment thereof-is serious and has long-lasting effects.

As psychiatric disorders in young people continue to explode, and evidence mounts about the toxic effects of electronic media on the developing brain, parents and clinicians would be prudent to remove this offending environmental trigger from the child's life, as part of the diagnosis and as one "arm" of any mental health treatment plan.

When you start to feel conflicted about removing screens--they are so ingrained in our lives, after all--this is what I tell my patients and their parents: "You will never regret removing video games and computer use, but you may sorely regret letting them remain. "

For more information on how screen-time affects the brain, visit www.drdunckley.com/videogames.

For help addressing screen-time in a child or teen experiencing psychosis, to review more case studies, and to learn more about screen-related mechanisms that can induce paranoia and hallucinations, see Reset Your Child's Brain: A Four Week Plan to End Meltdowns, Raise Grades and Boost Social Skills by Reversing the Effects of Electronic Screen-Time.

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Computer, Video Games & Psychosis: Cause for Concern

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"I hear voices at night, and sometimes I think someone's outside my window," the 19-year-old young man informed me. "I know no one's really there, but it's still scary." In my practice in the past six months, no less than five youths have reported psychotic symptoms that were attributed to, or exacerbated by, electronic screen devices.

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Global mental health: a failure of humanity Arthur Kleinman

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Global mental health: a failure of humanity Arthur Kleinman

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A look at the world-wide views of mental health, taking culture, socio-economic status and tradition into account.

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Mental health needs of young offenders in custody and in the community

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Mental health needs of young offenders in custody and in the community

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Chritsabesan et al. (2006) surveyed the mental health needs of young offenders in England and Wales. Researcher found both groups showed symptoms of psychosis and various other mental illnesses. Concluded that the ax of MH within youth justice system were integral to delivery of effective youth justice services.

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An enthralling short film made by John Richardson (former service user). Surrounding the experience of psychosis and the positive role the Early Intervention service can play in that often rocky voyage. Featuring captivating personal insights alongside a tightly woven narrative. Provocatively packed with vintage newsreel footage, humorous animations and imaginative imagery.

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An enthralling short film made by John Richardson (former service user). Surrounding the experience of psychosis and the positive role the Early Intervention service can play in that often rocky voyage. Featuring captivating personal insights alongside a tightly woven narrative. Provocatively packed with vintage newsreel footage, humorous animations and imaginative imagery.

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An enthralling short film made by John Richardson (former service user) and Belinda Giles. Surrounding the experience of psychosis and the positive role the Early Intervention service can play in that often rocky voyage. Featuring captivating personal insights alongside a tightly woven narrative. Provocatively packed with vintage newsreel footage, humorous animations and imaginative imagery.

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22 year old Loga Suren developed psychosis in her teens. She teamed up with the charity Fixers to make this film about a young man who begins to experience delusions, but manages to get help.
https://www.themix.org.uk/mental-health/psychosis/psychosis-6636.html

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Time to change campaign began in 2017. Its main purpose is to get people talking about mental health to engender more positive attitudes among the public. 

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Time to change campaign began in 2017. Its main purpose is to get people talking about mental health to engender more positive attitudes among the public. 

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Lots of people have shared their stories.

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Copyright © 2023 Time To Change. Time to Change is led by Mind and Rethink Mental Illness.

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RCOT calls for prevention and early intervention in mental health services with new report Published in May 2018

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RCOT calls for prevention and early intervention in mental health services with new report Published in May 2018

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Report demonstrates the impact of occupational therapy in four keys areas: helping young people to achieve their educational potential, supporting people with mental health issue into employment, improving the physical health of people with serious mental health problems and in leading innovative service delivery that improves access to mental health support in primary care.

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Early psychosis for the non-specialist doctor

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Early psychosis for the non-specialist doctor

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(Published 08 November 2017) with Podcast discussing early intervention BMJ talk medicine.

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1. Musa Basseer Sami , MRC clinical research training fellow, honorary specialist registrar 1 2,

2. David Shiers , former GP, honorary reader in early psychosis 3,

3. Saqib Latif , clinical lead & consultant child and adolescent psychiatrist 4,

4. Sagnik Bhattacharyya , reader in translational neuroscience and psychiatry, consultant psychiatrist 1 5

1. 1Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK

2. 2South London and Maudsley NHS Foundation Trust, London

3. 3Manchester University, Manchester, UK

4. 4Kent and Medway Children & Young People Services, Sussex Partnership NHS Foundation Trust, Broadstairs, UK

5. 5Lambeth Early Onset Inpatient Unit, Lambeth Hospital South London and Maudsley NHS Foundation Trust, London

Correspondence to: S Bhattacharryya sagnik.2.bhattacharyya{at}kcl.ac.uk , M B Sami musa.sami{at}kcl.ac.uk

A general practitioner may support four to eight patients with psychotic disorder and see one new presentation each year.1 2 Other non-specialist doctors will encounter patients presenting to an emergency department or complicating comorbid illness.

Psychosis often emerges for the first time in adolescence and young adulthood.3 In around four out of five patients symptoms remit, but most experience relapses and further difficulties.4 The first two to five years of psychosis are considered a critical period for intervening to improve long term outcome.5 6 7 The non-specialist plays a key role in early identification. The challenge is to identify a relatively rare but serious disorder and distinguish this from more common but less severe disorders, occurring in a typically young population experiencing developmental and often stressful transitions.

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Early psychosis for the non-specialist doctor

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What you need to know A general practitioner may support four to eight patients with psychotic disorder and see one new presentation each year.12 Other non-specialist doctors will encounter patients presenting to an emergency department or complicating comorbid illness.

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Brief guide: capacity and competence to consentin under 18s- A summary number of key policy documents, listed in the appendices, relate tothis issue. In this document they have referenced the term child to refer to anyone under the age of 18. 

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Brief guide: capacity and competence to consentin under 18s- A summary number of key policy documents, listed in the appendices, relate tothis issue. In this document they have referenced the term child to refer to anyone under the age of 18. 

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Mind Mental Health Charity on stigma and young people's experience of Psychosis

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Mind Mental Health Charity on stigma and young people's experience of Psychosis

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Hallucinations or delusions could make you feel anxious, scared, threatened or confused. If you have delusions about certain people or organisations, you may find it hard to trust them.

It can also be upsetting if people around you dismiss your experiences as untrue when they seem very real to you. You may feel misunderstood and frustrated if other people don't understand. It might help to share our section for friends and family with them.

The sense of shame and guilt I felt because was I incapable of functioning day-to-day as an adult left me isolated from others and aggressive to those who cared and wanted to help.

Is psychosis a diagnosis or a symptom?

The word psychosis is usually used to refer to an experience. It's a symptom of some mental health problems and not a diagnosis itself.

Doctors and psychiatrists may say someone is experiencing psychosis rather than giving them one of these diagnoses. Some people prefer this.

Psychosis and stigma

There are a lot of misunderstandings about what it means to experience psychosis. Lots of people wrongly think that the word 'psychotic' means 'dangerous'. The media often shows people with psychosis behaving like this even though very few people who experience psychosis ever hurt anyone else.

It's important to remember that you aren't alone and you don't have to put up with people treating you badly. Here are some options for you to think about:

Show people this information to help them understand more about psychosis.

Talk to other people who experience psychosis by going to a support group - or setting one up for yourself.

Get involved in awareness raising about psychosis.

Share your experience with others. Mind publishes blogs and video blogs (mental health selfies).

Know your rights. Our pages on legal rights provide more information.

Take action with Mind. See our campaigning page for details of the different ways you can get involved with helping us challenge stigma.

It's an illness that can be treated just like any other. I don't choose or want to be psychotic any more than people choose or want any other types of ill health.

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Hallucinations or delusions could make you feel anxious, scared, threatened or confused. If you have delusions about certain people or organisations, you may find it hard to trust them. It can also be upsetting if people around you dismiss your experiences as untrue when they seem very real to you.

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Fusar-Poli, P., McGorry, P. D., & Kane, J. M. (2017). 'Improving outcomes of first-episode psychosis: an overview.' World psychiatry : official journal of the World Psychiatric Association (WPA), 16(3), 251-265. doi: 10.1002/wps.20446

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Fusar-Poli, P., McGorry, P. D., & Kane, J. M. (2017). 'Improving outcomes of first-episode psychosis: an overview.' World psychiatry : official journal of the World Psychiatric Association (WPA), 16(3), 251-265. doi: 10.1002/wps.20446

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An overview of different "stages" of psychosis and the interventions done at each stage.

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Improving outcomes of first-episode psychosis

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Schimmelmann, B. G., Walger, P. and Schultze-Lutter, F. (2013) ‘The Significance of At-Risk Symptoms for Psychosis in Children and Adolescents’, The Canadian Journal of Psychiatry, 58(1), pp. 32–40. doi: 10.1177/070674371305800107.

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Schimmelmann, B. G., Walger, P. and Schultze-Lutter, F. (2013) ‘The Significance of At-Risk Symptoms for Psychosis in Children and Adolescents’, The Canadian Journal of Psychiatry, 58(1), pp. 32–40. doi: 10.1177/070674371305800107.

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A discussion of the potential problems with the high-risk criteria as it applies to young people.

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The Significance of At-Risk Symptoms for Psychosis in Children and Adolescents

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Fusar-Poli, Paolo & Borgwardt, Stefan & Bechdolf, Andreas & Addington, Jean & Riecher-Rössler, Anita & Schultze-Lutter, Frauke & Keshavan, Matcheri & Wood, Stephen & Ruhrmann, Stephan & Seidman, Larry & Valmaggia, Lucia & Cannon, Tyrone & Velthorst, Eva & de Haan, Lieuwe & Cornblatt, Barbara & Bonoldi, Ilaria & Birchwood, Max & Mcglashan, Thomas & Carpenter, William & Yung, Alison. (2012). The Psychosis High-Risk State A Comprehensive State-of-the-Art Review. Archives of general psychiatry. 70. 1-14. 10.1001/jamapsychiatry.2013.269.

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Fusar-Poli, Paolo & Borgwardt, Stefan & Bechdolf, Andreas & Addington, Jean & Riecher-Rössler, Anita & Schultze-Lutter, Frauke & Keshavan, Matcheri & Wood, Stephen & Ruhrmann, Stephan & Seidman, Larry & Valmaggia, Lucia & Cannon, Tyrone & Velthorst, Eva & de Haan, Lieuwe & Cornblatt, Barbara & Bonoldi, Ilaria & Birchwood, Max & Mcglashan, Thomas & Carpenter, William & Yung, Alison. (2012). The Psychosis High-Risk State A Comprehensive State-of-the-Art Review. Archives of general psychiatry. 70. 1-14. 10.1001/jamapsychiatry.2013.269.

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A summary of the history and research about people considered to be at-risk for developing psychosis.

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Perspectives and Practices of Xhosa‐speaking African Traditional Healers when Managing PsychosisKanyiswa G. Mzimkulu  & Leickness C. SimbayiPages 417-431 | Published online: 28 Nov 2006

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Perspectives and Practices of Xhosa‐speaking African Traditional Healers when Managing PsychosisKanyiswa G. Mzimkulu  & Leickness C. SimbayiPages 417-431 | Published online: 28 Nov 2006

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An insight into the way psychosis across all age ranges is looked at through the lens of South African tradition and mysticism.
Implications of the findings for the continued co‐existence and cooperation between traditional and western healing systems are discussed.

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The aim of this study was to investigate perspectives and practices of Xhosa‐speaking African traditional healers, known as " amagqirha", in managing psychosis. Four traditional healers, 3 male and one female, were chosen to take part in the study through their association with psychosis patients undergoing treatment at a South African psychiatric hospital in Cape Town. In‐depth interviews were used to collect data. The interviews were conducted in Xhosa and were tape‐recorded. Following translation, the verbatim transcripts were analysed using thematic content analysis. The main themes that emerged from the analysis were grouped under the following 3 main issues: diagnosis, aetiology, and treatment. In terms of diagnosis, the African traditional healers identified symptoms of psychosis, which are consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) criteria for schizophrenia. With regards to aetiology, supernatural powers such as witchcraft, spirit possession, angered ancestors, and genetic predisposition were articulated. Regarding treatment of psychosis, cleansing the patient and his or her family of evil spirits through washing, steaming, and induced vomiting were of major importance, followed by a group of traditional healers evocating evil spirits at the patient's home through singing and dancing. Implications of the findings for the continued co‐existence and cooperation between traditional and western healing systems are discussed.

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Perspectives and Practices of Xhosa‐speaking African Traditional Healers when Managing Psychosis

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The aim of this study was to investigate perspectives and practices of Xhosa‐speaking African traditional healers, known as " amagqirha", in managing psychosis. Four traditional healers, 3 male and one female, were chosen to take part in the study through their association with psychosis patients undergoing treatment at a South African psychiatric hospital in Cape Town.

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A report from the independent Mental Health Taskforce to the NHS in EnglandFebruary 2016

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A report from the independent Mental Health Taskforce to the NHS in EnglandFebruary 2016

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Young people often worry that they may be 'going mad' when they are feeling stressed, confused or very upset.

In fact, worries like this are rarely a sign of mental illness. 'Psychosis' is when your thoughts are so disturbed that you lose touch with reality. This type of problem can be severe and distressing.

Psychosis affects people of all ages, but is rare before you reach the older teenage years.

When you have a psychotic episode, it can be a signal of another underlying illness.

You can have a psychotic episode after a stressful event like losing a close friend or relative.

It can also be the result of a physical illness ( like a severe infection), the use of illegal drugs (like cannabis) or a severe mental illness (like schizophrenia or bipolar disorder).

Sometimes it is difficult to know what caused the illness.

When you have psychosis, you will usually experience very unusual and sometimes unpleasant thoughts and experiences. They may appear suddenly making you feel really frightened. They can also creep in so gradually that only people like your close family and friends notice you are behaving strangely.

You may experience one or more of the symptoms below:

Unusual beliefs called 'delusions'. These are very strong beliefs which are obviously untrue to others, but not to you. For example, when you are ill you may think that there is a plot to harm you or that you are being spied on by the TV or being taken over by aliens. Sometimes you may feel you have special powers.

Thought disorder. This is when you cannot think straight. Your ideas may seem jumbled, but it is more than being muddled or confused. Other people will find it very difficult to follow what you say.

Unusual experiences called 'hallucinations'. These are when you can see, hear, smell or feel something that isn't really there. The most common hallucination that people have is hearing voices. Hallucinations are very real to the person having them. This can be very frightening and can make you believe that you are being watched or picked on.

Having these strange thoughts and experiences can affect you at school, home or when with friends. You may find it difficult to concentrate and enjoy your usual activities. They can even affect your sleep and appetite.

It is important that you seek help early. The earlier you are treated for psychosis, the quicker you can get back to your normal life.

Firstly, you could talk to your family, school nurse or GP. They may get you specialist help from a Child and Adolescent Mental Health Service (CAMHS) team or an Early Intervention Team or Service (EIS) - a specialist team for young people with psychosis.

With psychosis, you often don't realise that you are unwell, which means the people around you might notice it first. If you become very unwell, you could need some time in hospital until your condition stabilises.

What is the treatment for psychosis?

Medications called 'antipsychotics' are an important part of treatment. They may need to be taken for a long time in order to stay well. As with medication of any kind, there can be side-effects; the doctor you see will be able to advise you on these and what can be done to help.

If the psychosis is related to drug use or an underlying physical illness, you may need specific help and treatment to manage this.

Other forms of treatment are also important. You and your family will need help to understand more about your illness, how to manage it, and how to help prevent it coming back. You may need support to rebuild your confidence to continue with school, college or work.

Talking treatments can be helpful as well, but need to be in addition to medication.

Most young people with early help and treatment recover from their psychotic episode.

If the illness is due to an underlying physical illness or the use of drugs, you might avoid having another episode by taking the right treatment and avoiding using drugs.

It is often difficult to know what the long-term effects of a psychotic episode will be, and a definite diagnosis may not be possible straight away.

Is there anything else I should do?

It is important to continue with any treatment advised by your doctor and keep a balanced, healthy lifestyle.

Talking to others when you feel stressed can help in identifying problems early and getting the right treatment.

"I was about 14 when it happened. I had a good family, did well at school and had group of good friends. Life had been good to me although my mum said I could not handle stress. I would be a bag of nerves before exams, was scared of failing and could not face is someone was unwell.

Uncle Rob's death a year back in the accident was just too much. I knew I would feel upset for a long time. But then I didn't feel upset. It was strange. I thought people were doing strange things to me like controlling me through radio signals. I felt I had lost control of myself and even felt my body was changing in a strange sort of way... not just the puberty.

And then I could not face school, I was swearing, felt muddled in my head. My learning mentor got worried and spoke to my mum, who had noticed my strange behaviour. I couldn't sleep, couldn't be bothered about going out. I didn't like the idea of seeing a psychiatrist from the Child and Adolescent Mental Health Service and I thought they would judge me.

But it was very different. She seemed to know and understand how I felt, what I thought. I felt relieved. She even said I was not going to be locked away in a hospital. It was just an illness for which I needed to take medication for few months or year.

She then introduced me to Kay, a worker from Early Intervention Psychosis team. Kay explained to me and my family all about psychosis, what we could to keep me well. She was there when I felt I was losing it before my exams. It's nearly a year now. I am like any other 16 year old, going to school, with friends etc... I take my meds and staying away from drugs and alcohol."

Changing Minds: A Multimedia CD-ROM about Mental Health is intended for 13-17 year olds; it talks about addiction, stress, eating disorders, depression, schizophrenia and self-harm.

Epic friends - mental health problems are common. This website is all about helping you to help your friends who might be struggling emotionally.

Rethink Mental Illness - Offers help to people with severe mental illness (not only schizophrenia) and their carers.

Talk to Frank - Helps you find out everything you might want to know about drugs (and some stuff you don't).

YoungMinds - Information to young people about mental health and emotional well-being. YoungMinds have also developed HeadMeds gives young people in England general information about medication.

HeadMeds does not give you medical advice. Please talk to your Doctor or anyone else who is supporting you about your own situation because everyone is different.

References

Rutter's Child and Adolescent Psychiatry, Fifth Edition (2008). Publisher: Wiley-Blackwell.
The Young Mind: an essential guide for parents, teachers and young adults
Credits

Revised by the Royal College of Psychiatrists' Child and Family Public Engagement Editorial Board (CAFPEB).

With grateful thanks to Dr Lokesh Nukalapati and Dr Kavitha Pasanuru, Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy..

This resource reflects the best possible evidence at the time of writing.

About this information

This information reflects the best available evidence at the time of writing. Our mental health information for young people was written in 2017 and will be reviewed in 2020.
© March 2017 Royal College of Psychiatrists

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Young people often worry that they may be 'going mad' when they are feeling stressed, confused or very upset. In fact, worries like this are rarely a sign of mental illness. 'Psychosis' is when your thoughts are so disturbed that you lose touch with reality. This type of problem can be severe and distressing.

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Psychosis data report describing variation in numbers ofpeople with psychosis and their accessto care in England

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Psychosis data report describing variation in numbers ofpeople with psychosis and their accessto care in England

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Pg 25 in particular discusses early prevention

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17 year old on Being Diagnosed With Psychosis

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17 year old on Being Diagnosed With Psychosis

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A 17 year old American discusses his experience with his first presentation of psychosis, how it effected him and his diagnosis

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Young Man on Being Diagnosed With Psychosis

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Pyle, M., Stewart, S. L., French, P., Byrne, R., Patterson, P., Gumley, A., Birchwood, M. and Morrison, A. P. (2015). Internalized stigma, emotional dysfunction and unusual experiences in young people at risk of psychosis. Early intervention in psychiatry, 9(2), pp. 133-140.

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Pyle, M., Stewart, S. L., French, P., Byrne, R., Patterson, P., Gumley, A., Birchwood, M. and Morrison, A. P. (2015). Internalized stigma, emotional dysfunction and unusual experiences in young people at risk of psychosis. Early intervention in psychiatry, 9(2), pp. 133-140.

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Study discussing the impact of diagnosing/ labelling a young person as high risk of psychosis, and the internalisation of negative stigma associated with that label.

The internalisation of this stigma can contribute to an individual becoming depressed by the time of a 6 month follow up.

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"Please check your email for instructions on resetting your password. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.

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Kuipers, E., Yesufu-Udechuku, A., Taylor, C. and Kendall, T., 2014. Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. bmj, 348, p.g1173.

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Kuipers, E., Yesufu-Udechuku, A., Taylor, C. and Kendall, T., 2014. Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. bmj, 348, p.g1173.

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Summary of nice guidance into psychosis treatment including a section on first episode of psychosis pathway

Also highlights the trauma caused by early psychosis by detailing how individuals can be left with PTSD by their experiences.

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Bird, V., Premkumar, P., Kendall, T., Whittington, C., Mitchell, J., & Kuipers, E. (2010). Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: Systematic review. British Journal of Psychiatry, 197(5), 350-356.

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Bird, V., Premkumar, P., Kendall, T., Whittington, C., Mitchell, J., & Kuipers, E. (2010). Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: Systematic review. British Journal of Psychiatry, 197(5), 350-356.

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Study into efficacy of early intervention in psychosis. It found that early intervention can be more effective than standard clinical care alone. However only included individuals that are already diagnosed and not high risk groups.

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Background

Early intervention services for psychosis aim to detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments.

To evaluate the effectiveness of early intervention services, cognitive-behavioural therapy (CBT) and family intervention in early psychosis.

Systematic review and meta-analysis of randomised controlled trials of early intervention services, CBT and family intervention for people with early psychosis.

Early intervention services reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission.

Conclusions

For people with early psychosis, early intervention services appear to have clinically important benefits over standard care. Including CBT and family intervention within the service may contribute to improved outcomes in this critical period. The longer-term benefits of this approach and its component treatments for people with early and established psychosis need further research.

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Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review | The British Journal of Psychiatry | Cambridge Core

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Background Early intervention services for psychosis aim to detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments. To evaluate the effectiveness of early intervention services, cognitive-behavioural therapy (CBT) and family intervention in early psychosis.

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A freestyle by a london rapper who was sectioned with psychotic symptoms as a young person