Psychosis and Schizophrenia: A Guide for Care and Support Staff

The NHS describes psychosis as losing contact with reality, so that a person perceives things differently from other people. It can be frightening for the person experiencing it, and it can be unsettling for staff who are not sure how to respond. This guide explains the main symptoms, what can trigger them and how care and support staff can help. It is general information, not clinical advice.

The three main symptoms

According to the NHS, psychosis has three main symptoms:

• Hallucinations. A person hears, sees and, in some cases, feels, smells or tastes things that do not exist, but which feel completely real to them. Hearing voices is common.
• Delusions. Strong beliefs that are not shared by other people, such as believing others are plotting against them.
• Disordered thinking. Thoughts and ideas come very quickly, which can make speech fast and confusing.

Psychosis and schizophrenia: what is the difference?

Psychosis is a symptom, not a diagnosis in itself. The NHS says it can stem from specific mental health conditions, including schizophrenia, bipolar disorder and severe depression. Schizophrenia is a specific condition that causes psychotic symptoms such as hallucinations and delusions. But psychosis can also occur independently of schizophrenia, so staff should avoid assuming a diagnosis. Our guide to bipolar disorder covers another condition that can involve psychotic symptoms.

Other causes and triggers

The NHS lists a range of triggers. These include trauma, stress, substance misuse, alcohol use disorder, medication side effects, physical health conditions, head injury and childbirth. This matters in practice: a sudden onset of psychotic symptoms should always prompt a conversation with a senior colleague and a health professional, because there may be a physical or medicine-related cause that can be treated. Where substance use is part of the picture, our guide to dual diagnosis and NICE NG58 is a useful next read.

How to respond in the moment

• Stay calm and keep your voice steady. Speak slowly and clearly, with short sentences.
• Do not argue about what is real. Acknowledge the person's feelings, such as fear, without agreeing or disagreeing with the content of a delusion.
• Reduce stimulation. A quieter, less crowded space can help.
• Keep yourself and others safe. Give the person space, keep exits clear and call for help if you feel at risk.
• Do not take it personally. Accusations or fear are symptoms.
• Record what you observed. Note what was said, what happened before, and how long it lasted.

When to get urgent help

The NHS advises seeking immediate GP care if someone is experiencing psychotic symptoms. In severe cases, contact emergency services, go to A&E or call 999. Follow your organisation's escalation procedure and make sure you know who to call out of hours. If a person is at risk of harming themselves or others, treat it as an emergency.

Treatment and long-term support

The NHS describes treatment as antipsychotic medication, talking therapies such as cognitive behavioural therapy (CBT) and family interventions, and social support. Some people take medication long term, while others may gradually stop with symptom improvement. Staff should never encourage a person to stop or change medicine on their own. Support them to take medicine as prescribed, and report side effects or changes to the prescriber.

Legal frameworks to understand

Some people experiencing psychosis may be detained or treated under mental health legislation. Staff should understand the basics of the law that applies in their country, and how it interacts with capacity and consent. See our overview of the key changes to the Mental Health Act and our guide to Mental Capacity Act and DoLS training.

Supporting wellbeing

• Keep routines predictable and activities meaningful.
• Encourage sleep, healthy eating and social contact.
• Notice early warning signs the person or family mention, such as disturbed sleep or growing suspicion, and share them with the team.
• Involve family and carers, with the person's consent.
• Look after your own wellbeing after a difficult incident. A debrief with your manager helps.

Talking with families and carers

Relatives are often frightened and unsure what to do. With the person's consent, explain what is happening in plain language, tell them who to contact, and listen to what they have noticed. Family members often spot early warning signs before anyone else, and their knowledge of what helps the person is valuable for the care plan.

Recording and reporting

Good records protect the person and the team. Write down what you saw and heard, factually and without judgement, including times, triggers, what helped and who you told. Avoid labels such as "paranoid" or "manipulative". Use the person's own words where you can, and share records through the proper channels so the clinical team can see patterns over time.

Avoiding stigma

People with psychosis are far more likely to be frightened than frightening. Language matters: refer to a person experiencing psychosis rather than "a psychotic" or "a schizophrenic". Treat the person with the same dignity and respect you would want for yourself or a family member.

Training for staff

Confidence comes from training and practice. Short courses on recognising mental ill health, de-escalation and escalation routes help staff respond safely and kindly. Our guide to mental health first aid at work is a good starting point, and you can browse our CPD courses for care teams.

Key points to remember

• Psychosis involves hallucinations, delusions and disordered thinking, according to the NHS.
• It can be caused by conditions such as schizophrenia and bipolar disorder, but also by trauma, substance misuse, medication and physical illness.
• Do not argue with delusions. Stay calm, acknowledge feelings and keep everyone safe.
• Seek urgent help for sudden or severe symptoms, and call 999 in an emergency.
• Support people to take medicine as prescribed and report side effects.

Sources

• NHS: Psychosis, overview (nhs.uk), accessed October 2026