• Psychosis is a term used to describe when people lose some contact with reality.
• Common symptoms of psychosis are hearing voices or having strong beliefs that are not shared by other people. For example, you may be worried that secret agents are trying to harm you and your loved ones.
• Psychosis can be a one-off experience or be linked to other long-term mental health conditions. Some people can make a complete recovery.
• There is no single cause of psychosis. Researchers suggest that the environment and someone’s genetics may cause psychosis. Psychosis can also be caused by physical health problems, such as a brain tumour.
• Medication and talking therapy are the main treatments for psychosis.
• To access treatment for psychosis, you usually need to have an assessment by a NHS specialist mental health service. Such as the early intervention in psychosis team’ (EIT) or a community mental health team (CMHT).

Psychosis is a term used to describe when a person interprets or perceives reality in a different way to those around them.  

If you experience psychosis, you may process the world around you differently to other people. You might see, hear, or believe things that others do not. Some people describe psychosis as a "break from reality".

There are different terms used to describe psychosis, such as “psychotic symptoms”, “psychotic episode” or “psychotic experience”. If you are experiencing psychosis for the first time, this can sometimes be called “first-episode of psychosis.”

Traditionally psychosis has been seen as a symptom of mental illness. But this is not necessarily the case. Psychosis is not always because of a mental illness.  

There are many theories about what causes people to experience psychosis.  

You may not find it helpful to think of your experiences as symptoms of a mental illness. You may have a different reason as to why you experience psychosis. For example, due to traumatic experiences.

The way you experience psychosis may be different to the way someone else experiences it. 

Some people make a complete recovery from psychosis.

This information will use the word ‘experiences’ to describe what you may go through if you have psychosis. In mental healthcare, your experiences may be referred to as ‘symptoms of psychosis.’

Common symptoms of psychosis are:

• Hallucinations
• Delusions
• Issues with thoughts, feelings, and speech

These symptoms are described in further detail below. 

Hallucinations 

Psychosis hallucinations are when you see, hear, or feel things that are not really there, like voices or images. But they seem very real to you.  For example:

• hearing voices or sounds other people cannot,
• seeing things which other people do not see,
• tasting things when you have not eaten something,
• feeling someone touching you who is not there, or
• smelling things which other people cannot.

Hearing voices or other sounds is the most common type of hallucination.  

For example, voices may be:

• female or male,
• someone you know or someone you have never heard before,
• in a different language or in a different accent to your own,
• whispering or shouting,
• friendly and nice, or
• negative and disturbing.

You might hear voices sometimes, for example only for a few minutes, or once a month. Or, you may hear voices every day that lasts for hours at a time.

Delusions 

Psychosis delusions are when you have strong beliefs that are not true. Like thinking someone is spying on you or that you have special powers, even when there’s no real proof.    

For example, you may worry:    

• that you are being followed by secret agents or members of the public,
• that people are out to get you or trying to kill you. This can be strangers or people you know,
• that a chip has been planted in your brain to monitor your thoughts, or
• your food or water has been poisoned.

There are different types of delusions that people experience. For example, you may think you are a very powerful person or that you are God. These kinds of thoughts are called 'delusions of grandeur'. 

You may not always find delusions or your unusual beliefs distressing, although people often do. You may be able to stay in work and function well even if you have these worries. 

There is a video example of what a delusion might feel like in our Further reading section below. The video might feel distressing to watch if you have had delusions before. So do not watch this video if you feel it might be upsetting. 

Issues with thoughts, feelings, and speech 

Hallucinations and delusions can make your thoughts feel messy and hard to follow.

You might notice you have racing thoughts, or your thoughts switch quickly and make strange connections.

If your thinking is mixed up, you might:

• Talk really fast and trip over your words.
• Use words that do not make sense together.
• Say things that confuse people or do not seem to mean anything.
• Change topics quickly or stop talking mid-sentence.
• Find it hard to focus on one thing at a time.

Nobody knows exactly what causes psychosis. Researchers have not identified one single cause. 

There are different reasons why you may experience psychosis. It is thought that for most people, it is due to life experiences that are out of their control. ,  

Psychosis can be: 

• triggered during times of severe stress or anxiety,
• part of a neurological condition such as dementia, Alzheimer’s or Parkinson’s,
• triggered by a brain injury,
• a side effect of medication,
• an effect of illegal drugs such as cannabis, 
• an effect of withdrawal from illegal drugs or alcohol, or
• triggered by menopause. 

Some people also experience hallucinations if they experience severe sleep deprivation.

Research shows:

• men from Black, Asian and Minority ethnic (BAME) backgrounds are more likely to experience psychosis, and
• that voice hearing experiences are different across different cultural backgrounds.  

See below for more details on how life experiences, genetics, and brain chemicals may lead to psychosis. 

Life experiences

There is evidence that stressful life experiences can cause psychosis. In particular, abuse or other experiences involving trauma.  

A review looked at people that were in hospital for mental health problems. It found that over 1 in 2 people had either been physically or sexually abused as children. 

There can be different types of life experiences that can trigger psychosis or make you relapse. These include: 

• stress, or anxiety,  
• living through stressful life events, like losing your job,  
• drugs and alcohol misuse or withdrawal, 
• homelessness,
• delirium. This is a feeling of mental confusion which may follow a serious physical illness or an operation,
• grief, divorce or separation,  
• childbirth  
• racism, and
• tiredness.

Genetic causes

Research suggests that mental illness can run in families. But at the moment it is not possible to separate genetics and life experiences to work out the cause of mental illness.

Changes to your brain 

Research suggests that changes to chemicals that send information inside your brain can cause psychosis. But it is not known why the chemicals in your brain change.

For more information see our webpages on the following: 

• Does mental illness run in families?
• Drugs, alcohol, and mental health
• Cannabis and mental health
• Stress - how to cope

Psychosis can be a one-off experience or part of a mental health condition. Some conditions psychosis can be related to are: 

• Schizophrenia
• Bipolar
• Schizoaffective disorder
• Drug induced psychosis
• Depression with psychotic symptoms
• Postpartum psychosis
• Delusional disorder
• Brief psychotic episode
• Delirium

Below we explain how psychosis can be linked to these mental health conditions.

For more information about psychosis linked to neurological conditions or brain injuries, please look at the Useful contacts section.

Schizophrenia

You may get a diagnosis of schizophrenia if you experience a mixture of what medical professionals call:

• Positive symptoms. Hallucinations – including hearing voices, delusions, and issues with thoughts, feelings, and speech. You can read more about these above in ‘What are the common symptoms of psychosis?’ section and
• Negative symptoms. Including things like lack of motivation, a reduced range of emotions, and less interest in socialising or hobbies and activities.

For more information see our webpages on the following:

• Schizophrenia
• Hearing voices

Bipolar disorder

Bipolar disorder can be a life-long mental health problem that mainly affects your mood. Your mood can change a lot. You may experience episodes of mania and depression. 

If you experience manic symptoms, you may also experience psychosis. For example, you may experience grandiose delusions. This means that you may believe that you are able to achieve something which cannot be achieved. For example, you may believe you have special powers.

Not everyone with bipolar will experience psychosis. And you may feel well between episodes of mania and depression. When your mood changes, you might see changes in your energy levels or how you act.

You can find more information about Bipolar disorder on our webpage.

Schizoaffective disorder

Schizoaffective disorder is a mental illness that can affect your thoughts, mood and behaviour. You may experience symptoms of both bipolar and psychosis.   

You can find more information about Schizoaffective disorder on our webpage.

Drug induced psychosis

People who use or withdraw from alcohol and drugs can experience psychosis.  

In rare situations side effects of medication can cause psychosis. Also taking too much medication can cause psychosis. 

You can find more information about Drugs alcohol and mental health on our webpage.

Depression with psychotic symptoms

You may experience symptoms of psychosis if you live with severe depression.

For more information see our webpages on the following:

• Depression
• Depression with psychotic symptoms 

Postpartum psychosis 

If you experience symptoms of psychosis after giving birth, this is known as postpartum psychosis. 

This is a serious mental health condition and should be treated as an emergency. If you do not get treated quickly there is a risk that your mental health could deteriorate fast. 

You are likely to make a full recovery if you get the right treatment. 

You can find more information about postpartum psychosis from our webpage on New parents, pregnancy, and mental health.

Delusional disorder 

You may have a delusional disorder if you have delusions for several months or more. These are likely to be constant and lifelong beliefs. You are unlikely to hear voices with this disorder.

Acute psychotic disorder 

You will experience psychosis for less than 3 months. Often this is linked to extreme stress, but not always.

Delirium 

Delirium is when there is a sudden change in someone’s thoughts or behaviours. This condition can come on very quickly, in hours or days.  

Someone experiencing delirium may seem confused, say or do unusual things, or forget where they are.  

Delirium can come with psychotic symptoms like hallucinations or delusions.  

Delirium can be caused by many different things. It can be caused by some medications, or a serious illness or infection. 

It can be frightening, but the condition can be treated. You should see a doctor for diagnosis and treatment if you think you are experiencing delirium.   

You can find more information about Delirium on the Royal College of Psychiatrists website here.  

The earlier you seek help, the better the chances of getting effective treatment. 

 You can get help from:

• The NHS
• Adult social services
• Charities
• Self-help information

How can the NHS help me?

How can I get urgent mental health support?

For urgent mental health support, you can call NHS 111 or you can go to the NHS 111 website. 

You will need to answer some questions. The NHS will refer you to an appropriate service or tell you what to do next.

The phone line is available 24 hours a day 7 days a week. 

You can find out more about urgent mental health support options on our Get help now page.

What are NHS early intervention in psychosis teams (EIT)?

Early intervention in psychosis teams (EIT) can support you if you experience psychosis for the first time.  

Some EIT services’ websites say they only treat you if you are 35 or under. But the National Institute for Health and Care Excellence (NICE) recommends that EIT teams should be open to people of all ages.   

If you are experiencing psychosis, EIT teams usually accept referrals from you or your friends or relatives. But you can check on your local EIT website or by contacting them.

You can find details of your local team by searching online. You can search ‘NHS early intervention in psychosis team X’, where X is your local area.

You can also call NHS 111 or ask your GP.

EIT teams aim to see you within 2 weeks of your referral.   

How can my GP help me? 

You can speak to your GP about your concerns. They will be able to talk to you about treatment options and support. 

If they think you are experiencing the symptoms of psychosis, your GP should refer you to an NHS specialist mental health team. You should be assessed quickly. You might be referred to the following NHS specialist mental health teams:

• early intervention in psychosis team (EIT)
• community mental health team (CMHT), or
• crisis team.

For more information see our webpages on the following:

• GPs and your mental health
• NHS mental health teams 

Support for physical health 

If you are experiencing psychosis, you are at a higher risk of physical health issues. Your risks can include being overweight, having coronary heart disease or diabetes.  

Because of the increased risk you should have regular physical health checks. If you start antipsychotic medication, these include a full health. That includes weight, blood pressure, and other blood tests. 

It could also include:

• a combined healthy eating and physical activity programme.
• support to help you to stop smoking. 

You can find out more information on our Severe mental illness and physical health checks webpage.

How can social services help me?

If you need help and support to look after yourself then you can have an assessment by social services. For example, you may need support so that you can: 

• get out of the house,
• keep in touch with friends and family,
• get a job or take part in education,
• clean your house,
• prepare meals or go shopping,
• keep safe,
• manage your money,
• take part in leisure activities, or
• contribute to society. For example, volunteering.

You can find more information about Social care assessment - Under the Care Act 2014. on our webpage.

What other help is available?

Charities

In some areas, charities will support people who experience psychosis. This may be through support groups where you can talk to other people who also experience psychosis. Or, there may be a different service available for you, such as employment or isolation support.

You can look here to see if Rethink Mental Illness has any services or groups in your area. 

Some other national mental health charities are:

• Mind
• Way Through
• Together
• Turning Point

You can look at their websites to see what support they offer in your area. 

Self-help

There are things that you can do to help manage your mental health. This is called ‘self-help.’ You can read more about self-help below in the ‘What can I do to manage psychosis? section

If you experience psychosis, The National Institute for Health and Care Excellence (NICE) recommend that you should be offered:  

• antipsychotic medication, and
• talking therapy. 

If you decide not to take medication you should still be offered talking therapy. 

NICE produce guidelines for how health professionals should treat certain conditions. NICE have guidelines on Psychosis and schizophrenia in adults: prevention and management.

Medication

Antipsychotic medication can help with psychosis. Your doctor should give you information about antipsychotics, including side effects. You and your doctor should choose the medication together.  

Some people find they do not start to recover until they get the right medication. It is important to take the medication as prescribed to help your symptoms.

There are different types of antipsychotics. You might have to try different ones to find the right one for you.

You can discuss your medication with your doctor if:

• your medication is not working, or
• you are finding the side effects hard to deal with. 

There might be another medication that will suit you better. 

Doctors should check that your medication is working. They should also give you a physical health check 12 weeks after the start of medication and then at least once a year after that. Some antipsychotic medication can make you put on weight. So, your weight should be monitored each week for the first 6 weeks.

There is a high risk of relapse if you stop taking medication within the first 1 to 2 years, following your first episode of psychosis. 

Talking therapies

There are different types of talking therapies recommended for people who experience psychosis.

Cognitive behavioural therapy for psychosis (CBTp)

CBTp can help you understand your experiences and any upsetting and worrying thoughts and beliefs.   

You can discuss new ways of thinking about them and dealing with them with your therapist. You may also discuss what may have triggered your psychosis, like traumatic experiences. 

What is CBTp? 

CBTp is a talking treatment. It is there to try and help you to:

• understand links between your thoughts, feelings, and actions,
• understand your symptoms and how they affect your day-to-day life, and
• explore your perceptions, beliefs and reasoning.

CBTp aims to:

• help you to be aware of signs that your thoughts, feelings or behaviours are changing,
• give you a way of coping with your symptoms
• reduce stress, and
• improve your functioning.

Family intervention

Family intervention is where you and your family work with mental health
professionals to help you to manage your relationships. This should be offered to people who you live with or who you are in close contact with. Like your close family and friends.

The support that you and your loved ones are given will depend on what problems there are and what preferences you all have. This could be group family sessions or individual sessions. Your family should get support for 3 months to 1 year and should have at least 10 planned sessions. 

Family intervention could help you and loved ones to:

• learn more about your symptoms,
• understand what is happening to you,
• improve communication with each other,
• know how to support each other,
• think positively,
• become more independent,
• be able to solve problems with each other,
• know how to manage a crisis, and
• improve mental wellbeing.

Art therapy

Art therapy may be more useful if you have depressive symptoms. Such as, withdrawing from people or losing interest in things that you used to enjoy. 

You will have art therapy with a therapist which usually takes place in a group. It is there to mix different communication techniques with creativity. 

Art therapy aims to help you to:  

• learn new ways of relating to other people,
• show how you are feeling,
• manage your feelings, and
• understand your feelings.

Digital therapies

Some new digital therapies  have been developed for treatment of psychosis, that are still being tested. They have been approved for use by the National Institute for Health and Care Excellence (NICE).  Read more about these new digital therapies below. 

Avatar therapy

Avatar therapy is a new kind of treatment that uses technology to help people who hear voices. A digital version of your main distressing voice is created, and you talk with it. The digital version is called an ‘avatar’.  

Some researchers think this therapy can be used with talking therapy to help people feel more in control of the voices they hear.  

You can find out more about avatar therapy from Kings College London. It includes a helpful 7 minute video.

SlowMo

SlowMo is a blended digital therapy. It has been developed over 3 years with people who have experienced psychosis. It is designed to help people slow down their thoughts. It can also help manage distressing thoughts, fast thinking, and paranoia. 

It uses a mix of interactive web app modules and face-to-face individual therapy in each session. It is delivered over 8 sessions by a mental health professional. It can be used as a standalone therapy or used with therapies like CBTp.

SlowMo has been developed over 10 years. Pilot studies and a large-scale UK trial have shown it to be effective. The people involved in these studies have seen their symptoms improve by the end of treatment. The positive effects of treatment lasted for at least 6 months, and some people continued to improve after 6 months. 

You can find out more about SlowMo from the Maudsley Biomedical Research Centre. It includes a helpful 2 minute video.

CareLoop

CareLoop can be used to look out for symptoms of psychosis and prevent relapse. 

You record your symptoms, thoughts and feelings in an app through questionnaires and journal entries. CareLoop uses an algorithm to look out for signs of potential relapse. It then shares information with mental health professionals to keep you safe. 

CareLoop has been tested in controlled trials, with up to 90% recommendation for use from users. An improvement in symptoms is seen over several different statistical measures. When it identifies a potential relapse, a key worker or care worker is contacted. It also has a CBT-informed library of resources to help you manage your symptoms.  

You can find out more about CareLoop, including a helpful 3 minute video.  

gameChangeVR

gameChangeVR is a virtual reality (VR) therapy that can help manage agoraphobic symptoms. Agoraphobic means someone has difficulty leaving the home because of anxiety. 

The VR therapy is delivered in 6 weekly sessions with a virtual therapist that teaches CBT techniques. It is supported by a mental health professional. 

Clinical trial results of gameChangeVR have shown symptoms have improved for people who use this therapy. Symptoms have still been reduced at 6 months for some users.

You can read more about gameChangeVR From Oxford University. It includes a helpful 2 minute video. 

Therapy for trauma

If you have experienced trauma, your psychosis may have been triggered by this. 

This is something which can be treated with counselling or therapy. Your therapist should help you:

• to understand the root causes of your hallucinations or delusions,
• explore ways to over-come and control difficult voices and beliefs, and
• to manage the impact of the trauma you have experienced.

For more information see our webpages on the following:

• Antipsychotics
• Medication - Choice and managing problems
• Talking therapies

People deal with their experience of psychosis in different ways. You might need to try different things before finding something that works best for you. 

Support groups

You could join a support group. A support group is where people come together to share information, experiences and give each other support. 

Hearing about the experiences of others can help you feel understood. This may help you feel less alone and boost your self-confidence.

You might be able to find a local group by searching online. The charity Hearing Voices Network has face-to-face support groups in some areas of the country. Their contact details are in the 'Useful contacts' section.

Rethink Mental Illness have support groups in some areas. You can find out what is available in your area, or get help to set up your own support group here.

Recovery College

Recovery colleges are part of the NHS. They offer free courses about mental health to help you manage your experiences. 

They can help you to take control of your life and become an expert in your own wellbeing and recovery. 

You can usually self-refer to a recovery college. But the recovery college may tell your care team that you have been in touch.

Recovery colleges are available in most areas. 

To see if there is a one in your area you can:

• search the Mind Recovery Net website 
• search on the internet, or
• call NHS 111.

Peer support through the NHS

Your doctor may refer you to peer support. Peer support is when you work with someone who has lived experience of psychosis, who is now in recovery.   

Your peer supporter should be able to offer advice and support with:  

• side effects,
• recognising and coping with symptoms,
• what to do in a crisis,
• meeting other people who can support you, and
• recovery.

For more information see our webpages on the following:

• Hearing voices 
• Recovery and mental illness 

It can be very distressing if you are a carer, friend or relative of someone who experiences psychosis. You can get support. 

How can I get support for myself?

You can do the following:

• Speak to your GP about medication and talking therapies for yourself.
• Speak to your relative’s care team about family intervention. For more information about family intervention see ‘What treatment should the NHS offer me?’ section above.
• Speak to your relative’s care team about a carer’s assessment or ask for one yourself. This might lead to getting help from social services.
• Join a carers service. They are free and available in most areas.
• Join a carers support group for emotional and practical support, or set up your own.

For carers’ services and support groups see:

• Rethink Mental Illness
• Carers UK.
• Carers Trust.

You can find out more information on the following webpages: 

• Carer’s assessment – Under the Care Act 2014
• GPs and your mental health
• Stress – How to cope

How can I support the person I care for?

You can do the following:

• Read information about hearing voices or psychosis.
• Ask the person you support to tell you what their symptoms are and if they have any self-management techniques that you could help them with.
• Encourage them to see a GP if you are worried about their mental health.
• Ask to see a copy of their care plan. They should have a care plan if they are supported by a care coordinator.
• Help them to manage their finances or do other practical things.

How can I get mental health support for my loved one?

Your loved one might be experiencing symptoms of psychosis for the first time. You can contact their local NHS early intervention in psychosis team.

You can find out more about the early intervention team in the 'how can I get help if I am experiencing psychosis?' section. 

Sometimes people experiencing psychosis do not believe they are unwell, so do not want to reach out for help. This is called ‘lacking insight’. So, it can be helpful if you try to get help for them, if necessary.

If they are already supported by a NHS mental health team, you can contact them. Or you could contact their GP.

You can find out more about 'Worried about someone’s mental health?' on our webpage.

What if my loved one needs urgent mental health support?

For urgent mental health support you or your loved one can call NHS 111 or visit the NHS 111 website.

They will ask some questions. The NHS will refer your loved one to an appropriate service or say what to do next.

The phone line available 24 hours a day 7 days a week. You can call them for advice and support for yourself or your loved one.

You can find out more options for urgent support on our Getting help for someone in a mental health crisis' webpage.

Your loved one might have a care plan that says what they can do if they need urgent mental health support.

What should my loved one’s mental health team provide to me?

Your loved one’s NHS mental health team should provide you with information in an accessible format about: 

• Diagnosis and management of psychosis.
• Positive outcomes and recovery.
• Types of support for carers.
• The role of teams and services.
• Getting help if your loved one is in a crisis.

They should also offer you a carer-focused education and support programme. This may be part of a family intervention for psychosis. 

Can I be involved in care planning?

Your loved one’s NHS mental health team should involve you in the planning of their care. 

It is usually up to your loved one how much information they want the NHS mental health team to share with you. But they should encourage your loved one to share information with you about risks. And to help you understand things from your loved one’s perspective.

You can find out more about the following on our webpages: 

• Supporting someone with a mental illness
• Suicidal thoughts - How to support someone
• Responding to unusual behaviour linked to mental illness
• Confidentiality, information and your loved one - For loved ones of people living with mental illness

Back to Life, Back to Normality: Cognitive Therapy, Recovery and Psychosis by Douglas Turkington et al. (Cambridge University Press, 2009)

This is a self-help guide for people who experience psychosis and their carers. It helps readers use Cognitive Therapy techniques to control their symptoms and delay or prevent becoming unwell again.

Me and My Mind

A website produced by the South London and Maudsley (SLaM) NHS Foundation Trust. The service is for young people in the SLaM area. But there is lots of useful information on the website and resources you can download. 

Caring for someone with psychosis or schizophrenia

This is a free, online course provided by Kings College in London. It is aimed at people who care for people who have psychosis or schizophrenia. 

Psychotic episode simulation. Trapped in a horror film - Illustrating psychosis with AI

This video is on Rethink’s YouTube channel is based on someone’s personal experience of a psychotic episode. It might help you understand what this experience feels like. 

Warning: The video might feel distressing to watch if you have had delusions before. So do not watch this video if you feel it might be upsetting. 

The Hearing Voices Network (HVN)

HVN are a charity. They give information, support and understanding to people who hear voices and those who support them. They also support people who have visual hallucinations and people who have tactile sensations. They have a list of self-help groups across the country. 

Action on Postpartum Psychosis

A national charity for women and families affected by postpartum psychosis. They run a peer support service, provide information, training for health professionals, do research, and promote awareness.

Intervoice 

Intervoice are a charity. They encourage people all over the world to share ideas through their online community. You can also find information about hearing voices through their articles and resources.

Headway

Headway help people with a brain injury and their families. They offer a helpline and online community support for those living with brain injury. The can provide access to some emergency funding. They can also provide access to a brain injury identity card. This is to help those living with brain injury explain their situation more easily. 

Alzheimer’s UK

Support people with Alzheimer’s and their families. They offer support around the country, online community support, and a dementia helpline. They also provide a range of advice and information on living with dementia. 

The Royal College of Psychiatrists 

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