Understanding the impact of supporting someone with psychosis who is actively suicidal in the community

In individuals with psychosis, higher levelsof perceived family support areassociated with a reduction in positive psychotic symptoms, such as hallucinations, and a reduction in hospitalizations (Norman et al., 2005). However, it has been well established that supportinga relative with psychosis can be demanding and may contribute to a deterioration of family members' own physical and mental health (Lobban & Barrowclough, 2016). Qualitative studies of psychosis frequently document the breakdown of close personal relationships, including with family members (Mc-Carthy-Jones et al., 2013). This is pertinent in light of research highlighting how an absence of social support may be an important risk factor for suicide in those experiencing psychosis (Bolton, Gooding, Kapur, Barrowclough, & Tarrier, 2007), amongst whom the risk of suicide is estimated to be 12 times that of the general population (Dutta et al., 2010).Family members report difficulties interpreting their relatives' attempts to communicate suicidal thoughts, with barriers to understanding including the use of indirect language and difficulty judging the sincerity of intent (Owens et al., 2012). Family members also experience difficulties with interpreting warning signs in suicidal relatives and knowing when to contact mental health services (Owens et al., 2011).It is currently unknown how these challenges interact with psychotic symptoms. For example, people with psychosis who are suicidal may experience symptoms that make it difficult for family members to understand their distress, such as voices telling the individual to attempt suicide (Harkavy-Friedman et al., 2003).