Early psychosis warning signs

It can be frightening to notice a young person becoming withdrawn, confused or out of touch with reality. Understanding early signs can help families act with compassion and speed.

What's happening

Psychosis refers to a set of experiences where a person's thoughts and perceptions become disconnected from reality - this can include hearing or seeing things others don't, holding beliefs that aren't shared by others, or profound confusion in thinking. In young people, early or "first episode" psychosis often develops gradually, sometimes over months, and is frequently mistaken for typical teenage moodiness or stress at first. It is not caused by bad parenting or personal weakness, and a professional can assess what's really going on.

Signs to notice

• Increasing social withdrawal and isolation from friends and family
• A drop in school or work performance that seems out of character
• Unusual or suspicious beliefs, for example feeling watched, followed or plotted against
• Reporting hearing voices or seeing things others don't notice
• Disorganised speech or difficulty following a conversation
• Neglect of personal hygiene and self-care
• Disturbed sleep patterns and a flattened or unusual range of emotion
• Increased sensitivity, suspicion of loved ones, or new and unusual fears

What helps

• Take changes seriously rather than waiting to "see if it passes". Early intervention is strongly linked to better long-term outcomes.
• Approach the young person calmly and without judgement. Avoid arguing about whether their beliefs or experiences are "real" - instead, focus on how they're feeling.
• Encourage a full assessment with a doctor or mental health professional, who can rule out other causes like substance use, sleep deprivation or a medical condition.
• Keep communication open and reduce stress at home where possible - loud arguments or high-pressure environments can worsen symptoms.
• Involve the whole family in understanding the diagnosis and treatment plan if one is given, since family support is a strong protective factor.
• Be patient. Recovery is possible, and many young people go on to live full, meaningful lives with the right support.

When to reach out for help

Seek an urgent assessment if a young person shows any of the signs above, especially if they are distressed, unable to function day to day, or if there is any risk to their safety or the safety of others. Do not wait for a crisis to escalate before getting help.

Getting help in South Africa

Cleared Mind's EAP counsellors can help families find the right first step, including referral to psychiatric services. SADAG's Mental Health Line (011 234 4837) offers guidance and information on early psychosis services. A GP or clinic can also make an urgent referral to a psychiatrist. The sooner support begins, the better the outlook tends to be.

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If you or someone else is in immediate danger, reach out now. SADAG Suicide Crisis Helpline (24h): 0800 567 567 or SMS 31393. SAPS 10111, ambulance 10177, GBV Command Centre 0800 428 428.