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Spotting psychosis

May 12 2016
Detail of Paradise Lost © Sophia Platts-Palmer Detail of Paradise Lost © Sophia Platts-Palmer
The rate of psychosis among people who are homeless is around 10 times that of the general population

As a psychiatric nurse based in inner London, I encounter lots of young people who have a diagnosis of psychosis and are currently homeless. The rate of psychosis among people who are homeless is estimated at 11 per cent, which is around 10 times that of the general population. The Unhealthy State of Homelessness audit in 2014 also revealed that as many as 18.2 per cent of people who are homeless ‘hear voices’, a symptom of psychosis.

Psychosis is a medical term for a severe mental disorder that impairs our emotions so much that we can lose contact with external reality. People with psychosis may hold some unusual beliefs that others around them don’t, and they may see or hear things that others also don’t. These experiences often require treatment.

It is estimated that approximately one in every 100 people will experience psychosis at some point in their life.

Dr Gregory Shields, a London-based psychiatrist who works with people with psychosis, explains that the more obvious signs of delusions (paranoia or bizarre ideas) and hallucinations (typically hearing voices, talking to oneself or seeing things) are known as ‘positive symptoms’ and are generally easy to spot. Negative symptoms may be less obvious and include poor self-care, social withdrawal/introversion, reduced motivation, disorganised behaviour or thinking, and showing a reduced range of emotions.

When we’re busy trying to maintain and watch out for our own mental health, it can be hard to notice changes in those around us – particularly if psychotic illness is something that we have not encountered or considered before. Dr Shields says: “Despite being more subtle, it is often negative symptoms that have the most impact on managing day-to-day existence, as something as simple as applying for benefits, cooking a meal or shopping becomes difficult. It can be more tricky to detect psychosis in the early stages, as symptoms may not be fully developed. You may see a change in personality occurring over a few weeks or months, with sufferers acting oddly, saying strange things and becoming less sociable, or losing interest in their usual activities. In some cases they may seem confused, perplexed or uncharacteristically angry. It’s important to keep in mind that these sorts of changes can be accounted for by other mental illnesses, stress or physical conditions. If you are concerned, you should consult a qualified mental-health professional.”

Research has shown that stress can trigger a first episode of psychosis

A link has also been found between city life, social adversity, migration and psychosis. Studies have shown that people who live in cities are more likely to develop psychosis compared to those who live in the countryside. While it is difficult to pinpoint exactly why, it is thought to be because it is much easier to become socially isolated in the city because of the stress of urban life and easier access to drugs, which are also known to play a role in triggering psychosis.

Psychosis can also lead to homelessness. “As well as causing distress to sufferers,” says Dr Shields, “chronic psychotic illnesses are commonly associated with impaired organisational skills, impairments in thinking, and altered social skills – leading to disruption or disconnection of family relationships. Consequently, sufferers may become socially isolated and less likely to access housing, welfare or medical services. It is no wonder that so many end up chronically homeless.”

Mike Opitz, who previously worked in a 30-bed hostel, says that “mental health problems are pretty much endemic in the homeless population due to the stress and trauma that comes with losing everything and sleeping rough.”

If you have been diagnosed with psychosis, a mental health professional will usually assess whether you need to start medication or they may prescribe some psychological treatment. Self-help groups are also available, and some people feel they benefit from being around others who have had similar experiences. The mental health charity Mind, for example, has local networks across the country and can help to direct you to a support group in your area.

Dr Shields advises that community-based mental-health services can be accessed via your GP or hospital emergency departments. Most boroughs have dedicated services for homeless people, including community mental health teams and outreach teams. They can usually be found on the internet, or by calling your local NHS mental health trust.

Word of mouth is also a powerful tool, noticed Mr Opitz.

“Service users [..] would encourage their peers to access a service that they had found useful, and the key work between staff and service users had a big focus on recommending services and then accompanying people to appointments. To me, the best intervention was a project or activity, which gave people focus and a goal. These were often educational or vocational, like apprenticeships.”

If you are worried about yourself or someone you know, recognising the early warning signs and reducing triggers may help to reduce the severity of the psychotic episode. The key is to seek help from a mental health professional as quickly as possible.


Useful links

Mental Health Foundation – Getting Help:


NHS Choices:

Depresssion Alliance: