Spend time with the person and keep lines of communication open. It is easiest to express your concerns in a helpful, non-threatening way when you maintain regular contact and communication. Even if the person has been withdrawing from you, continue to invite the person to join you for dinner, go for a walk, or talk on the phone—but also be willing to take no for an answer if the person isn’t up for it.
Express your concerns. Be open and honest as much as possible. In a gentle, non-judging way, let the person know that you have noticed he seems to be going through a tough time or experiencing changes, and that you are available to listen and help when he is ready to talk about it.
Let the person know she is not alone. Between 4-17% of young people report experiencing sub-clinical (mild) psychotic-like symptoms. These experiences are not rare, and there could be a number of reasons why they occur. Letting the person know that you are familiar with what they are going through and that they are not alone can be very reassuring.
Let the person know that there is hope and practical help available. Clarify what the young person may want to gain from seeking help. Balance talking about what the young person wants and what you think would be helpful. Both medical and psychological therapies (for the individual and his/her family) can help to reduce symptoms, distress and daily difficulties associated with clinical risk. If you live near the Boston Area, you can help the person to get a careful assessment and practical help through CEDAR Clinic. You can also see a list of other clinics specializing in services for young people experiencing early signs or risk for psychosis.
Be patient and avoid pushing too hard. When you first express your concerns, the young person may not want to talk about it. Let the person know that you respect his privacy—but are available to talk and share information about potentially helpful resources when he is ready. Then keep the lines of communication open with the person so that he can warm up to the idea of talking with you about his concerns.
Treat the person as responsible and capable of making (or at least having some say in) decisions about whether and when to seek help. Be honestly interested in what the young person has to say by taking a respectful, curious, open, and non-intrusive and non-controlling stance.
Ignore changes in functioning or recurrent odd behavior as being “just a phase” or “teenagers being teenagers”. Contrary to popular belief, research has found that it is not typical for adolescence to be a time of significant turmoil and distress. While increases in privacy concerns are common, it is not typical for teenagers to refuse contact with friends over long periods or to withdraw significantly from family relationships. If you know a young person who has recently begun to withdraw from others, behave oddly and/or struggle at school and with friends, it is important to offer support and help. There can be a number of reasons why these experiences are occurring. A careful assessment can help the young person (and you) better understand what is going on and what types of supports and/or treatments can help. Ignoring early warning signs delays early treatment—and early treatment has the best chance of being effective.
Act as if you are giving dreadful news when talking about risk for psychosis. There is a lot we know about treating psychosis and there is much hope for recovery—especially when it is treated early. Talking with the person about risk can provide an important opportunity for the person to better understand what is happening to them and to get effective treatment that can prevent further distress and negative changes in functioning. If you are comfortable talking directly about the symptoms and daily difficulties as treatable, the young person will often take your lead and feel reassured. Using everyday language such as “stress” and “changes in experiences or functioning” is also helpful in normalizing people’s experiences.
Push too hard or argue with the person if they deny that anything is wrong. If the person denies experiencing difficulties or refuses to talk with you about your concerns, respect her privacy and let her know that you are there to help if and when she wants to talk. You might gently describe some specific behavioral changes that you have noticed (e.g., “OK, I had just noticed that, since December, you have been spending a lot of time in your room, your grades have gone down, and you have been wearing sunglasses most of the time. I know that a lot of young adults can experience stress during their senior year of high school, and sometimes it can help to talk to someone about it. I am here if you decide you want to talk.”)
Give up and forget to take care of yourself in the process. Your loved one may seem more interested in engaging in treatment at some times more than others and steps forward may often be followed by steps backwards as well. To help a young person get into treatment and stick with it, you may have to try several times and even enlist the help of other family members and friends. Keep a sense of priorities, and avoid “sweating the small stuff.” Focus your efforts on the important activities and tasks that matter the most in the long run (school, well-being/safety, relationships), and not so much on the smaller things (keeping a room clean). Keep your perspective: you/your loved one did not choose to have these difficulties. Rather he is currently being challenged by a significant change in functioning that may be due to a neurodevelopmental process or disorder. Lastly, maintain your own positive daily routines and keep in touch with your best supports to recharge your batteries. You can’t help your loved one if you are not first caring for yourself.