13.8.1  Management of acute psychoses

When you suspect that someone in your community is suffering from an acute psychosis, your first responsibility should be the management of risk. This involves concern for the risk posed to the patient by the illness, by the patient’s own actions or inaction, and by the actions of others, and also the risks posed by the patient to property, family and friends, and to others in the community (see also Section 10.4 of Study Session 10).

Remember, people suffering with acute psychoses can often respond very well and very quickly to interventions, if these are undertaken in a supportive and confident manner. There is a great deal you can do to calm and reassure such people, just by talking to them. You should also try to involve family and friends to create a supportive environment that will be there to assist the patient when you are not present.

If the patient or their family have traditional views about mental health, you will need to be very careful in challenging these, as such challenges are unlikely to improve the relationship with the patient or gain you the community support you will need to manage the various risks (see Study Session 9).

After you have provided emergency care, if appropriate, you should arrange an urgent referral to a health centre or a hospital where the patient can continue their treatment. When the person returns, it will be your responsibility to follow up this treatment by arranging continuing care within the community.