A staggering one in five teens experiences a mental health condition and half of all lifetime cases of these conditions begin by the age of 14, 75% by age 24. This is especially true for those experiencing psychosis, which affects about 100,000 youth and young adults each year. What’s important to know is that psychosis is treatable, especially when it is identified early.

COMMON SYMPTOMS ASSOCIATED WITH PSYCHOSIS:

Voices or auditory hallucinations

Hearing single or multiple voices, which can be simple or complex, abusive, neutral or soothing. They may hear whispers or clear/distinct voices; they may describe changes in their hearing acuity (e.g., hearing things from another room); they may describe indistinct or clear noises or sounds (e.g., buzzing/ringing) which are new and/or distressing. They may tell you directly that they are experiencing these perceptions, or you may notice cues in their behavior such as: they may appear to be talking to themselves, looking somewhere and you don’t know why, or focusing on certain body parts.

Tactile or somatic sensations or hallucinations

Body sensations or feelings that are new and strange. These are sometimes described as electrical charges or feeling something crawling on a body part. People sometimes feel that a part of their body has changed in some significant and troublesome way (e.g., bigger/smaller).

Unusual or delusional thinking

Persistent beliefs not shared by others. A student may report thinking other people are watching them or that they are under surveillance, feeling very good at certain tasks, having a connection to a famous person, or any number of thoughts that are different and unusual. They sometimes report that television, music or other media are communicating directly to them. You may also notice that a student is pulling away in social situations, seems uneasy with others, or makes comments indicating suspiciousness about others’ intentions.

Depersonalization and/or Derealization

Feeling they are an outside observer of their own thoughts, feelings, and actions. Examples are feeling that their speech or movements are uncontrollable or controlled by outside forces, that parts of their body are distorted, or feel their memories are not their own. They may feel alienated from their surroundings, or disconnected from people (as if they were separated by a glass wall). Their surroundings may seem distorted, colorless, two-dimensional or artificial and they may have misperceptions of time and space.

Cognitive disorganization

A student’s speech and writing may become disorganized and/or tangential. They may draw connections between words or terms that seem illogical or non-sensical, or they may have more difficulty than usual following conversations. Slowing of speech, movement and motivation. A young person may demonstrate changes in the amount, tone, rate, pitch, or rhythm of speech. Psychosis may slow people down and significantly lower one’s motivational energy.

Depression and demoralization

Many individuals with psychosis experience significant depression and/or demoralization.

A student with psychosis may experience all or only a few of the above symptoms. The intensity and impact of symptoms can also vary enormously from one individual to another. If a student shares that they are experiencing any of the above symptoms, it is important to connect them to a First Episode Psychosis Center.

The tone of initial engagement should be considerate, kind and flexible. Keep in mind the goal is to establish trust and make the student feel safe to express their experiences and specific concerns.

• Begin with broad, open-ended questions, using follow-up questions that reflect the student’s own language. “How are you feeling?” versus “You seem like you are feeling scared” “I hear that you are feeling nervous that others are talking about you when you walk into the room.”
• Avoid potentially triggering and frightening language. Unless otherwise indicated by the student, avoid clinical language.
• Stay positive, using hopeful, reassuring language. The experience of psychosis can often be scary and difficult to describe.
• Normalize the experiences without undermining their significance. Students will often identify unusual experiences which can be in response to many things such as changes in sleep, drug use, and stress; a student experiencing psychosis symptoms will not necessarily go on to develop a psychotic disorder. It is best to connect to a First Episode Psychosis Center early to help identify the best pathway to recovery.

Gently explore the idea of contacting the student’s loved one(s). Inquire if the student has already expressed their struggles with their caregivers or family members. If not, gently ask the student if communicating with a loved one may be helpful. To retain the trust between you and the student, try not to force them to disclose to their loved one unless it is an emergency.

RTI “Response to Intervention”

RTI plans can sometimes be offered at schools for students with psychosis if a sudden deterioration in symptoms occurs. These plans offer more immediate redress of circumstances within the educational arena that may be contributing to the symptoms. Students with psychosis symptoms could receive an RTI plan in conjunction with a more thorough mental health evaluation

Transitions from Hospital to School Plan

Hospitalization may be required for some students experiencing psychosis. Schools should work to implement a collaborative transition plan for the student’s return to school. Creating a transition plan takes a great deal of thought and should begin as soon as the school is notified that the student is absent due to hospitalization. Developing a partnership among the family, providers, and school clinicians while the student is being treated can help ease the student’s transition back to school.

All school staff members should be trained on the concepts of implicit bias, stigma, and importance of language (such as avoiding stigmatizing words like“crazy” or “psychotic”). School staff members should maintain a positive, shame-free environment to help uplift the safety of all students. This security opens more carefree pathways for trust and disclosure to educators regarding mental health concerns they might have about themselves or their peers. School staff set the tone around mental health awareness. They can formally provide learning resources for students and parents that includes normalizing and hopeful language about psychosis.

The care received at an FEP (First Episode Psychosis) Center is designed with each individual in mind and involves many types of trained, caring people who will collaborate with the individual and their family to plan a path towards recovery.

Coordinated Specialty Care: A Treatment Team

Our programs typically offer a team of people who will help. Each program is a little different but will often include:

Talk Therapy

Talk therapy to help build personal skills of resiliency, management, and coping.

Supported Employment & Education Assistance

Help continuing to engage in or adjust to school and work goals while receiving care.

Medication Management

If necessary, finding the best medication at the lowest possible dose.

Peer Support

Guidance from those currently on their own recovery path.

Case Management

Skills and support to organize the practical issues presented during treatment. This includes communication with other team members.

Family Support and Education

Tools designed to keep family members engaged and informed.