"Early treatment is bending the curve of outcome"
Patrick McGorry
Psychosis can seem like a scary term, and something that teachers feel does not affect their students. However, it is important that teachers have an understanding of three key things:
Psychosis is a severe symptom of mental ill health, and describes when an individual experiences a loss of contact with reality. Psychosis is relatively rare and can vary from a brief episode to longstanding. Lots of people confuse schizophrenia and psychosis, but these are not synonymous. In fact, psychosis is actually considered a symptom rather than a disorder, and you can have psychotic episodes in lots of different disorders.
Psychosis is more common in young people aged 14-35 years, however no matter the age of the individual psychosis always requires professional support from mental health services. Teachers can play a key role in early intervention, by spotting signs and symptoms of psychosis and helping young people access the help that they need. Outcomes of psychosis are better if the young person receives professional support early on, during their first episode of psychosis.
Identifying psychosis early presents a challenge, as psychosis rarely begins with stark symptoms, meaning it can often be difficult to recognize. That being said there are sometimes some common early warning signs to look out for:
Behavioural
Emotional
Thoughts and Speech
Due to the stigma associated with psychosis, young people developing early symptoms may be both confused and embarrassed by their experience, and may not readily share what they are going through. Sometimes, they may hear voices discouraging them from confiding in others, or they may mistrust others’ intentions, and withdraw from social situations.
To make sure teachers stand the best chance of detecting warning signs of psychosis we have included the types of symptoms you might see.
Positive symptoms describe behaviour that is in addition to typical behaviour – be mindful that a positive symptom is not something that is helpful or beneficial to the individual. The most prominent positive symptoms of psychosis are delusions, hallucinations and thought disorder.
…are ideas or beliefs that are held despite not actually being true.
Some notes…
Although it is normal for young people to disagree about football teams, politics, celebrities and many other beliefs, delusional beliefs are different.
Delusional beliefs are held tightly and persistent even when confronted with contradictory evidence.
…are when someone experiences things other people cannot sense.
Some notes…
This can mean seeing something that other people cannot see, hearing voices or noises that other people cannot hear, or even smelling or tasting things that are not really there.
Although hallucinations are what most people think of when they think or hear about psychosis, they are actually quite rare and less common than delusions.
…is when a person has trouble keeping track of their thoughts, making it hard to concentrate and communicate.
Some notes…
Sometimes people describe things becoming “hazy” or “misty” when this happens.
Often this affects a person’s speech, making words jumbled and confused
Negative symptoms describe the absence of behaviours. This means that there is a decline in typical functioning for the individual, which can result in them being unable to start and continue towards a goal. For example, as a teacher you may notice that a student has not been able to take care of their personal hygiene as well as they usually can
It can be difficult to spot psychosis as we unfortunately are not able to experience the school day from other people’s perspectives. The symptoms of psychosis that you will notice are also seen in many other, more common, mental illnesses such as and .
Young people may appear withdrawn, and not want to take part in activities or games in the classroom or in leisure time. They may seem flat, low on energy, and simply wish to be alone. This can be indicative that the young person feels detached from what is going on around them.
The more often that an individual withdraws, the more at risk they are of feeling isolated. If you are able to speak to family members of the pupil, then you can get an idea of whether they are withdrawn at home too. If the young person is only uncomfortable at school, this may indicate other problems, such as low .
It is important to note that every individual with psychosis will experience different symptoms, so it can be hard for teachers to look out for specific tell-tale signs. Look at the examples above. What might you notice if a pupil was experiencing these negative symptoms?
Teachers play an invaluable role in assisting with their pupils. Whilst we are preparing ourselves to help others we must also look after ourselves, we’ve got some advice and guidance on this in the section. As with all matters of mental health taking time to gain awareness of conditions like eating disorders helps to build confidence in what to do and how to support early intervention and prevention.
Psychosis is a serious mental health conditions that always need professional mental health support. Teachers therefore are only expected to be alert to the early signs of illness and try and facilitate further professional support.
Perhaps you notice a pattern of the signs mentioned above (for example maybe you notice they haven’t been taking care of their personal hygiene), then it is important to talk to them. Don’t be afraid to ask them if everything is ok and if anything is worrying them, these simple steps can often facilitate conversations that can lead to a young person receiving help. We’ve got some advice and guidance on regarding their mental health that can give you some ideas on how to go about this and we outline the some of the potential support pathways you can suggest in the support section here.
There are few things that are specific to psychosis that can be helpful to consider when approaching someone you think may have one or be in the process of developing one;
Try to think psychologically about helping the young person to begin owning the hallucination or beliefs as belonging to them. Reassure them and remind the young person hat these are their own thoughts, and that they cannot physically hurt them. It is important not to minimise the young person’s distress. Although the hallucinations and delusions are not real the experience of them and the distress, they can cause is very real.
Try to avoid triggers by working with the young person to identify what brings on their symptoms, or makes hallucinations and delusions louder, more abusive, or scarier. Triggers may be certain other students, a certain time of day, or a certain classroom activity. As long as this does not interfere too greatly with everyday life, for example avoiding all other students or school altogether, then an action plan can be put together to lessen the distress the student is experiencing whilst in school.
Try to utilise distraction techniques, as these can help a young person tolerate distress caused by psychosis, and if they are experiencing other emotional difficulties. A quiet classroom may trigger hallucinations or delusions to surface. When possible, a young person may find it useful to listen to music in headphones to help ignore voices, or to have a fidget cube to keep them busy.
None of us are able to solve every problem we face and sometimes a young person’s wellbeing becomes the most important focus. If you have serious concerns about a young person’s mental health you should contact your mental health representative in your school (sometimes this might be a headteacher or deputy head) or contact professional MH support.
Lots of people confuse schizophrenia and psychosis, but these are not synonymous. In fact, psychosis is actually considered a symptom rather than a disorder, and you can have psychotic episodes in lots of different disorders.
Identifying symptoms of psychosis early can often be difficult to recognize. There are some early warning signs to look out for with regards to behaviours, emotions, thoughts and speech such as unusual sensitivity to stimuli, deterioration of personal hygiene, inappropriate laughter, excessively muted or high emotions, a new extreme preoccupation of beliefs or thinking things around them have changed in some way.
Try to think psychologically. Try to avoid triggers. Try to utilise distraction techniques. We have provided some concrete suggestions in the ‘read more’ section but please remember that psychosis is a serious mental health conditions that always need professional mental health support.
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