Some psychotic conditions produce strange ideas which may result in unusual behaviour.
Sometimes people can feel paranoid and have a high level of anxiety about being pursued or watched. They can take steps to protect themselves (such as covering the windows with tinfoil). They may get very agitated with you if you don’t believe them. If you knew for certain that someone was outside with a weapon you would get very agitated too!
In this situation the most difficult question is “you do believe me don’t you?” Agreeing with the person may reinforce their ideas and not help them to distinguish what is real from what is not. Disagreeing results in conflict and heightened anxiety. The general recommendation is to say that you cannot agree with them but accept completely that they believe it. Some people choose to avoid even this response as it is a (gentle) way of saying “You are mistaken”. This response may be more acceptable as time passes or the situation calms. You may even be able to use humour in time but this has to feel appropriate.
The ideal situation is to be able to say “I think this idea is part of your MH issues, your mind
has made a mistake and there is no threat from anyone, it just feels like there is.”
Of course this is only possible if the person accepts that they have MH issues. This response
will only enrage people who don’t yet accept their MH status. It can feel like walking on eggshells but a calm reassurance and recognition of their distress alongside a gentle message that you don’t think they have any reason to be afraid can be very helpful in the long term.
Crucially, you can work with the feelings that these ideas produce. If the person is highly distressed or anxious, then ask them if anything helps with this. Some people feel safer under a duvet – perhaps it reduces stimulation and is calming. Perhaps you could distract them and offer an activity which could lead away from this train of thought? Try to build up a range of options that may help, such as favourite music or film, or a change of subject.
However, if they want tinfoil at the windows this may be necessary for a while. It is important that you acknowledge that what they are experiencing is utterly real to them. Hearing voices, for example, does cause activity in the region of the brain that processes speech so it is undoubtedly ‘real’.
Whenever possible avoid confrontation, challenging or arguments about these ideas. If they constantly repeat them then change the subject or tell them that they have explained this already, you have said all you are going to say and you really don’t want to keep going over it. It’s easy to just ‘turn off’ and nod absent-mindedly. You may be the main source of reliable information as to what’s real and what isn’t so it’s important to be consistent.
If the conversation gets incomprehensible, then it is worth reflecting that back by saying “I really can’t understand what you are saying right now”. Say you will come back to it later and then try to change the subject. You can just agree to differ, but it is helpful if you can to stay calm, unflustered and matter of fact.
If having visitors at home produces an increase in agitated delusional behaviour, then can you meet people elsewhere for a while? If they need to go back to their room or home or if they become anxious in a social situation, then discussing this and agreeing a code which means ‘I need to go – NOW’ may help them cope. If they get upset when the phone rings, then turn it off for a while or put it on silent? As time passes you may build up a set of agreed actions in certain circumstances and these can be reassuring if used consistently.