Psychotic symptoms (as shown on the list of warning signs) are a serious matter, both for the person experiencing them and for family members and friends close to them. Often, the ill person is unaware that the symptoms are unusual, or that he or she should seek help. It can be distressing for family members and friends to realize that someone close is experiencing psychotic symptoms, and it may be confusing to try to get help. A good place to start is the family doctor or a local mental health center. Mental health centers are usually listed in the telephone book, either in the yellow pages under "mental health services" or in the listing of community services numbers. The local Mental Health Association or the local chapter of the Alliance for the Mentally Ill are also likely to have referral phone numbers, as well as information on local support groups for families. It is important to seek help from a mental health professional to deal with psychotic symptoms since early treatment can improve long-term prognosis of psychotic disorders.

Under certain circumstances, it is important to seek emergency psychiatric help. The following are examples of actions or problems that indicate emergency psychiatric help is appropriate:

• Expressing thoughts about suicide.
  
• Hearing very disturbing voices, especially voices that command suicide or injury to self or others.
  
• Experiencing uncontrollable anxiety.
  
• Exhibiting manic or otherwise bizarre behavior, severe depression, disorientation, or extreme confusion.
  
• Reacting unusually to psychiatric medication.
  
• Feeling uncontrollable anger.

Emergency psychiatric help is available in a variety of ways:

• The current case manager, therapist, or counselor at the mental health center is a good first choice if the person is already under treatment. Most mental health centers and clinics have 24-hour emergency numbers that may ring to a hotline or helpline or directly to a nearby hospital emergency room. It is a good idea to keep the emergency number handy so that it is easy to find in a time of crisis.
  
• The 911 operator or the local helpline or hotline can be a good source of assistance if the person is not already receiving psychiatric care.
  
• If the situation is very serious and no other help is available, call the local operator or 911 and ask for help from the police or the Sheriff.

For persons with severe and persistent mental illness, a plan of action in case of psychiatric emergencies can be very helpful for the individual with the illness, as well as those who care for him or her. Such a plan can be created by the person with the illness, together with family members and other caregivers, usually with guidance or input from a mental health professional. The plan allows the person with the illness, in consultation with family members and mental health professionals, to designate who can decide if hospitalization or emergency care is necessary and what will be done in that case. This helps the family or other caregivers understand what will be done and allows the person with the illness to have input in the process in advance since he or she will not be able to communicate or think clearly during a time of crisis. The plan should include emergency phone numbers, a list of current medications the person is taking and their doses, the name of the current doctor and case worker, therapist, or counselor, insurance or related information, a plan for notifying pertinent healthcare professionals, and a list of family members or other caregivers who should be notified.

Because schizophrenia and other illnesses involving psychotic symptoms affect overall brain functioning, the person with psychotic symptoms often does not recognize symptoms as unusual and may refuse treatment. If symptoms are not too severe and the person refuses treatment, there may be nothing family members or friends can do but remain in contact and support the person. However, friends and family members need to define and defend their basic needs in dealing with the person with psychotic symptoms. Here are some suggestions for helping someone experiencing psychotic symptoms:

• Be yourself. This will help the person trust you and perhaps listen to your suggestions.

• Give yourself and the person emotional and physical space. Respect the person's physical space. Avoid touching the person without express permission, even to give comfort. If the person becomes hostile or aggressive, suggest a cooling off period, emphasizing that you plan to return to the issue at hand when everyone is calmer. Leave yourself an avenue of escape if the person is agitated.
• Calmly but firmly suggest that you take the person to see a doctor, therapist, case worker, or counselor for evaluation. Do not confront refusals or delusional material and do not argue, but continue to listen and to reiterate your suggestion. It may help to sit or stand beside the person while discussing this, rather than in a face-to-face posture.
• Go with the person to the doctor or mental health center to provide additional information about when the symptoms started, what medications the person is taking, and to answer any questions that may arise. In a crisis, the ill person may not be able to answer these questions clearly, so your input will become very valuable.
• If the person threatens or becomes violent, especially if there is a history of violence in the past, get help from the police or the Sheriff as necessary. Though hostility, threats and violence are very upsetting, it may be useful to remember that in many cases, these behaviors are a result of the illness and do not reflect the person's true feelings.

In very serious episodes of the illness, a person may need to be committed involuntarily to a hospital or other mental institution. There are different laws governing this process in different states in the U.S. The local mental health center, the local chapter of the Alliance for the Mentally Ill (AMI) or Mental Health Assocation, or a family doctor can provide information on the laws governing the process of involuntary commitment in that state or region. In case of an emergency, the police or Sheriff's office will also have such information, but the training and ability of law enforcement officials to handle persons with psychotic symptoms varies greatly, so it is advisable to consult other sources first when possible.

In North Carolina, in order to involuntarily commit a person, it must be clear that the person is mentally ill and a danger to self or others. "Danger to self or others" includes threats of suicide or suicidal gestures or plans, significant self-injury, threats of violence to others or actual behaviors that cause harm to others or to property, or a lack of self-care so serious and persistent that injury or disease is likely to result. In the presence of any of these behaviors in an emergency situation where intervention can not wait until later that day or within the next day or so, family members or friends can encourage the person to go to the nearest mental health center, hospital emergency room, or state psychiatric hospital. If the person refuses to go, the family or friends or anyone who has knowledge that the person meets the standards for inpatient commitment may petition the local magistrate. This will involve signing an affadavit stating the facts that indicate the presence of mental illness and danger to self or others. This affadavit must be filed in the magistrate's office, which is usually located in the local jail. If the magistrate determines there are reasonable grounds for inpatient commitment, a custody order will be issued, and a law enforcement officer will pick up and transport the person to a mental health center or hospital for examination. If the examining physician recommends inpatient care, the law enforcement officer will transport the person to a local psychiatric unit or the state psychiatric hospital where there will be an examination by a second physician, who may recommend involuntary comitment. The patient has a right to a court hearing within 10 days and the right to counsel (an attorney). The hearing is closed to the public, and the court records are kept confidential. If the judge does not decide that the person who was hospitalized meets standards for inpatient commitment, he will discharge the person from the hospital, though he may order outpatient commitment.

For more information about patients' rights, or if law enforcement officers or magistrates are unresponsive during psychiatric emergencies, contact the local chapter of the Alliance for the Mentally Ill or Mental Health Association.