What if someone has a psychotic break from reality?

Every now and then I receive a call from someone who has had a significant break in their mind- it is like a bone breaking, except it takes place in the mind.
It is called a psychotic episode, or having a "breakdown", or going over the deep end.
Whatever you call it, when you see it or experience it, it is very serious and very scary.

How to recognize it:
1- The person is repeating a thought, over and over. It is like their mind is stuck going in a circle. They are repeating one or two sentences again and again.
2- The person is not making sense. The things they say are not logical. The things they say are bizarre in a way that people listening would be very concerned.
3- The person strongly believes their bizarre thoughts.
5. The person can't do life tasks. Things they used to do, they can't do.
6. You are worried they are so depressed they could kill themselves.

You don't need to see all 6 of the ways to recognize it.  Any of these is reason to be very concerned.

What to do:
1- Take the person to an EMERGENCY ROOM. Get a mental health assessment to determine if the person needs to be hospitalized for a few days to help get them safe and stable. There are hospitals that have good inpatient psychiatric services, check to be sure the hospital you are going to is set up to provide help. If they aren't they will tell you the names of hospitals that can help.
2- Call the doctor or nurse practitioner to get referrals for a "good psychiatrist".
3- Call the health insurance company to get an urgent care referral for psychiatric help.
4- This is an urgent situation and is best if treated very quickly with medication and psychiatric support.
5- Do NOT leave the person alone to be by themselves EVER while they are sounding psychotic, bizarre, not making sense. This is why it is important to take them to a hospital for care, they can hurt themselves  or others if they are left alone.

Getting a treatment team is essential:
1- Sometimes people are very resistant to getting help. Do not let someone who is psychotic decide if they need help or not.
2- Be supportive of using medication. It can be very scary to go through this and the treatment team may need to use medication to help stabilize the brain.
3- The medication can be scary, especially if you do not have experience with this. Ask the treatment team about the medications that are used and how long they are usually used, and why they are using the medication. While going through figuring out which medication can help, sometimes people are heavily sedated at first.
Again, ask why they are using a high sedation. I find that when people understand why and how the medications are used, it can be helpful. Sometimes the care team does not explain this, so ask to help you understand.

How you can help:
When a person has a psychotic break, they need responsibilities lifted while they recover. It is best to stop all responsibilities and just take care of things while the person's mind is resting.
Be patient with the person that is recovering. They may not want to take medication, they may not want to go to appointments, let them know they can stop doing all of that as soon as they are better.
Be very reassuring that they will get better.  This is incredibly scary to the person going through it.
It helps to tell people: THE MIND HEALS SLOWLY.

When you break a leg or arm, we put the limb in a cast to hold it still so the bone can heal. The mind is similar, when it breaks, we need to hold it still, give it a rest, take the pressure off. Sometimes this can be achieved with the use of medications. It allows the person to sleep, etc.

Long term:
While the person is healing, when they are strong enough, the treatment team will help figure out when the person is ready to learn the life skills for the issues that overwhelmed them. There are usually things that have been building and building internally that the person needs to work with. When they are ready to do the work, then it is important to work with a therapist or the psychiatrist that the person wants to work with. It can be very hard to trust a new doctor or psychiatrist and people may be fearful of the care team recommendations. It is OK to get second opinions. Please call a therapist you trust or a doctor you trust who may have experience and help prepare you for what to expect. This person could consult or advise you. It is very helpful to talk to someone you know and trust in the medical profession. They can provide very valuable advise.

Getting a Treatment Team:
It can be very hard to get appointments. Many people have waiting lists. Not all of the providers will be taking your insurance. It can bey very expensive to get help. It is essential that you get help- therapy for yourself if you are taking care of someone who has had a psychotic break. It can be very confusing and hard to make decisions.

If children are in the situation, it is important to make sure the person having the psychosis is not responsible or alone with the children until they are feeling better. If the children or teens are alone with this person, they will be made responsible to take care of an adult without really the "authority" or skills to "manage" the adult. Please do not leave children or teens alone in such a situation.

Healing takes time. I have seen many people have a full recovery from psychosis if they get help, treatment, and support. It is important to be sure you are getting an accurate diagnosis. Sometimes other things do need to be evaluated and treated.