9 Tips for Helping Someone Experiencing Delusions and Hallucinations

In social service settings (and some customer service settings) it is not uncommon for a helper to be in the middle of an interview with a person and suddenly realize that person sees the world through a very skewed lens. For many people starting out in the helping professions, this can be one of the more challenging situations they encounter.

First, let’s define our terms. A delusion is when a person has a fixed belief that does not match reality. This is typically part of a mental illness, but occasionally can be cultural. A person with a delusion is not going to be swayed by facts, because she already knows the “truth”.

A hallucination is when someone sees or hears something that isn’t there. The most common hallucinations come in the form of semi-audible voices, often repeating very negative statements over and over to the person hearing them.

When you encounter a person having active delusions and/or hallucinations, here are some basic rules of thumb:

  1. First, if the person’s delusion or hallucinations are posing an immediate risk of harm to herself or others, call an emergency service immediately or follow your agency’s protocol for involuntary commitment, if you have one. While the vast majority of active delusions and hallucinations are not immediately harmful, it is very important that you act quickly when they are.
  2. It does no good to challenge a delusion or hallucination head-on when you first meet someone. Focus on the service the person is asking for, and see if you and he can figure out a way within the confines of a delusion to meet those needs.
  3. If you think that the person you are helping would benefit from psychotropic medicine, suggest it to them, but if they decline, that is not the end of the conversation. At that point, you can talk about alternatives, including helping the person with reality testing (comparing their thoughts to objective truths about their environment), or helping the person to evaluate benefits and costs of remaining unmedicated.
  4. There are several reasons people with psychosis may not want to take psychotropic medicines. The medicines can have very unpleasant and even unhealthy side effects, including weight gain and an increased risk of developing diabetes. The medicines can be expensive. Sometimes a person feels their delusions or hallucinations are an important part of who they are. It is also very common for someone with psychosis to think that she is the sane one and the rest of us are crazy.
  5. Make sure that you provide the person with information on who to see about treatment for his illness, if you are not the mental health expert. It is often very helpful to help the person set up an initial appointment, making the call and talking to the contact in front of them, in order to establish trust and good “hand over”. It is also a good idea to develop a solid relationship with at least one intake person in order to make it easier to help in these situations.
  6. While it is very common for people to feel uncomfortable in the presence of people experiencing active delusions or hallucinations, it is important that you manage your emotions, and continue to treat the person with dignity and respect regardless of your own level of comfort.
  7. Maintain boundaries. Sometimes people with delusions and hallucinations will get you wrapped up in their belief system. If the person you are helping veers repeatedly off the subject and into trying to convince you of the truth of her delusions, simply keep redirecting her back to the work at hand.
  8. A person in the midst of psychosis can sometimes get a helper “caught up in” the delusion, either in the role of an ally to the delusion or as a target. Be aware of this possibility, and if a person’s delusions make it difficult for you to meet his helping needs, provide him with a referral to someone else. Always keep your personal safety in mind.
  9. Finally, hallucinations and delusions can be very frightening to the person experiencing them, especially if the condition causing them is either new (most develop in a person’s late teens to early thirties) or temporary (caused by drug use or a medical condition). Empathy is critical to developing the relationship necessary to effectively help someone experiencing psychosis. Be honest and explain what you can and cannot help them with and why at each step, to help her manage her frustration and anxiety and keep her engaged.
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About Maureen O'Danu

Maureen O'Danu is the webmistress of Am I the Only One Dancing? where there is a new discussion every day on any one of dozens of topics and ideas, as well as reviews, geekery, family, fun, and enough politics to season the pot.
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