Active Psychosis: What to Do, How to Engage, and Important Do’s and Don’ts

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Would you know how to respond to a person who is experiencing active psychosis?

Most people don’t. In fact, they can become quite frightened or overwhelmed by the situation, preventing them from helping in an effective way.

Fortunately, learning about psychosis, what to do, and how to engage with a person in this state can give you the confidence to handle these delicate situations with ease and compassion.

Whether you’re a family member, friend, caregiver, or passerby, knowing how to respond can help keep the person safe and supported, while reducing fear and stigma. Here’s what to know, what to do, and how to communicate effectively with someone experiencing active psychosis.

What Is Active Psychosis?

Psychosis is a condition that affects how a person perceives reality. During psychosis, an individual may experience hallucinations (seeing or hearing things that aren’t there), delusions (strongly held false beliefs), disorganized thinking, or confusion. For the person experiencing it, these symptoms are very real, and often frightening or overwhelming. Your support can be calming and reassuring for them.

Active psychosis, in particular, refers to the acute phase of a psychotic episode when symptoms are intense and impairing. It can occur in conditions like schizophrenia, bipolar disorder, severe depression, schizoaffective disorder, substance-induced psychosis, and post-traumatic stress or dissociation. Symptoms may include:

  • Hearing voices
  • Seeing things that others do not
  • Intense fear, paranoia, or confusion
  • Beliefs that others are trying to harm them (delusions)
  • Disorganized speech or behavior

What to Do If Someone Is Experiencing Psychosis

If someone is experiencing active psychosis, you’ll want to stay calm and grounded. Your tone and body language matter. Speak slowly and gently. Avoid showing fear or frustration, as it can escalate the situation. Scan the environment and remove potential hazards, such as sharp objects, loud noises, or distractions. If possible, find a quiet, low-stimulation setting.

Keep in mind that psychosis can be disorienting and terrifying for the individual. Don’t rush the conversation or try to “snap them out of it.” Validate their feelings without agreeing with the delusions. Instead of saying, “That’s not real,” try “I’m not hearing voices myself, but I believe that you are. I’m here with you.” Also, ask the person how you can help them. Do they want you to stay with them? Is there someone you can call for them?

How to Engage: Tips for Communication

When engaging with a person in active psychosis, use simple, clear sentences. Avoid sarcasm, metaphors, or abstract language. This can be confusing for them, causing them to feel even more frustrated. Address the person by name (if you know it) and make eye contact without forcing it. Giving the person space is also important if they seem to be overwhelmed or paranoid; your focus in this situation is keeping the environment safe.

Do’s and Don’ts When Someone Is in Psychosis

DO:

  • Stay with them (if safe to do so)
  • Speak in a calm, nonjudgmental tone
  • Listen more than you speak
  • Offer reassurance that help is available
  • Call for professional support if necessary

DON’T:

  • Argue about what’s real or try to “logic them out” of delusions
  • Shout, touch them unexpectedly, or crowd their space
  • Make fun of or dismiss their experience
  • Use threatening language or commands
  • Assume they are dangerous—most people in psychosis are more scared than threatening

When to Call for Help

You should seek immediate help if the person:

  • Is threatening to harm themselves or others
  • Becomes violent or extremely agitated
  • Is unable to care for themselves (e.g., wandering in traffic or exposed to danger)
  • Has lost touch with reality and cannot be calmed

Who to call:

  • 911 (tell the dispatcher you’re dealing with a mental health crisis)
  • Mobile crisis units (available in many areas)
  • Mental health helplines or crisis text lines (e.g., Text HOME to 741741)

Evidence-Based Treatment for Psychosis

Witnessing someone in active psychosis can be distressing, but with compassion, patience, and the right approach, you can help keep the person calm and safe. Psychosis is a medical condition, not a character flaw, and those experiencing it deserve respect and care.

If your loved one is going through episodes of psychosis, it’s important to get to the root of the issue, which may be a medical or mental health condition, substance use, or past trauma. Spearhead Health will help you find treatment to manage psychosis and address underlying mental health challenges. Contact us today at (310) 561-1704 to learn more about finding the services and treatment approaches to support your needs.