For many of us, the world around us remains fairly constant, familiar. But for some people with severe mental illness, psychosis can turn that world upside down, as their relationship with reality becomes distorted.

Here, counsellor and psychotherapist Lindsay George explores psychosis, what it really means, and treatment options, with the insight of her patient who has experienced this first hand. Hira opens up to quell the stigma attached to the condition, and speaks out for others living with mental illness

She was standing in the corner of the classroom shouting at me, so I shouted back!” Hira told her friends, who, confused, asked: “Hira, who are you yelling at? There’s no one there.” She now felt even more frightened and alone.

“It was very, very scary. I thought I was going crazy back then,” Hira told me recently. “I just couldn’t make sense of why I was feeling the way I was.”

Sadly for Hira, she felt unable to tell anyone about her experience, for fear of being stigmatised.

Now a mental health advocate for Youth Mental Health Matters (a Manchester-based charity, who provide a platform for young people’s mental health needs), and in her first year at university, Hira is working hard at keeping herself mentally well.

woman walking alone

For her, what helps is a combination of a little exercise, checking in weekly for her counselling sessions, and socialising with her wide circle of friends, who have provided her with much needed additional emotional support over the years. “They actually saved my life,” she freely admits.

However, three years ago, things were very different for Hira. She had been in year 11, studying for her GCSEs. Little did anyone know back then, but she was regularly hearing voices and seeing people, who she now acknowledges, weren’t actually there.

Unfortunately for Hira, they had felt very real at the time, and had become part of her normal day-to-day life for well over a year. “They would say negative things to me, and encourage me to self-harm,” she tells me. Even more terrifyingly, these voices would goad Hira in to attempting to take her own life.

Tragically, it took a suicide attempt and an admission to hospital for Hira’s situation to finally come out into the open. She was diagnosed with severe depression, and was experiencing psychosis. She was just 15 years old.

What is psychosis?

Psychosis is a symptom, often of an underlying mental health condition, where there is a loss of contact with reality. Individuals may experience hallucinations (hearing or seeing things that do not exist), and delusions (believing things others don’t).

The fear of not understanding what is happening, and not knowing why we are feeling the way we do, is both frightening and isolating. It can make us feel even more alone in not knowing who or where to go for help, as Hira knows only too well.

It was after Hira’s sucide attempt that she finally told someone about what she was experiencing.

It was at this point that, thankfully, she was able to receive the much needed mental health support and medical intervention she required, in order for her to begin her slow recovery process.

Unfortunately this is not always the case. The scary fact is that 75% of mental health issues (apart from dementia) arise before adulthood.

Statistics state that mental health issues affect one in four of us in the UK, but what about those specifically related to psychosis? While it is hard to actually track the exact figure, it is believed that 0.7% of the UK population experience this extreme mental health disorder at any one time.

Research has also shown that support from family and friends can be invaluable, and helps to reduce the need for hospital treatment

What are the causes of psychosis?

It is sometimes possible to identify the cause of psychosis through a specific mental health condition, such as schizophrenia, and bipolar disorder. However, psychosis can also be triggered by extreme stress, trauma, alcohol misuse, substance abuse, or the side-effects of certain prescribed medication.

In Hira’s experience, her severe depression was linked to long-term bullying at school. Like many young people, she tried to manage the situation on her own. The extremes of that particular story are not within the scope of this article, however, suffice to say she became very unhappy and mentally unwell over a period of time.

What are the symptoms of psychosis?

While no one person's experience will be exactly the same, the following are symptoms often associated with psychosis that might help you to know when someone might need support:

• Difficulty concentrating
• Disorganised thinking and speech, switching topics erratically
• Sleeping too much or not enough
• Restlessness
• Anxiety
• Suspicion, or paranoia
• Withdrawal from family and friends
• Delusions
• Hallucinations
• Depression
• Suicidal thoughts or actions

Getting help

If you’re concerned about someone who you think might be experiencing psychosis, you could contact their GP. Alternatively, if they’re receiving support from a mental health service, you could contact their mental health worker for advice or support.

In addition, if you think the person’s symptoms are placing them at possible risk of harm, and they are in agreement, you could suggest taking them to the nearest accident and emergency (A&E) department. Alternatively, call their GP, or 999, and ask for an ambulance.

Treatment options

Treatment options for psychosis involve a combination of antipsychotic medication, and psychological therapies. One-to-one talking therapy such as cognitive behavioural therapy (CBT) has proved successful in helping people with psychosis.

friends holding hands

Research has also shown that support from family and friends can be invaluable, and helps to reduce the need for hospital treatment. Usually after an episode of psychosis, most people who get better with medication need to continue taking it for at least a year. Generally 50% of people require long-term medication to prevent symptoms recurring.

It is only with hindsight that Hira wishes she’d spoken out sooner. Sadly, her words resonate in my therapy room all too often. People can often feel at a loss about what to do, and unable to address their own mental health issues head on. They may feel embarrassed and prefer to avoid taking the risk of being judged.

Hira is fiercely passionate about mental health issues. This is proving to serve her well in her recovery, as it provides a healthy coping mechanism for her.

In the same breath, Hira has waived her anonymity for the purpose of this article, so that she can help others who may be experiencing their own mental health issues.

“People need to start opening up about their own mental health needs,” says Hira. “That way we can help remove the stigma that is all too often associated with having a mental health issue.”

As I said to Hira, it takes a courageous person to do this. Hira is definitely one of the brave ones.

In my experience, early intervention is key to recovery, as with any mental health issue, including psychosis. I am privileged to witness Hira’s experience, and to be a part of her recovery process.

As a member of the BACP, Lindsay follows the rules and regulations with regards to client confidentiality. With this article, Hira has agreed for her story to be shared publicly, with the hope that it will dispel stigma.