Psychosis, agitation and risk to others

Some crisis contacts involve severe agitation, paranoia, command voices, confusion, unusual behaviour or threats to harm someone else. These calls can be frightening for patients, callers and staff and require calm escalation rather than debate or judgement.

Reception staff should not try to label a person as psychotic, intoxicated, manipulative or dangerous. The safe first-contact response is to record the caller's exact words, avoid confrontation, and activate the local route for urgent clinical, crisis, safeguarding or emergency ownership.

Listen or look for

• Command voices: hearing voices telling the person to harm themselves or someone else.
• Paranoia or extreme fear: belief that others are watching, poisoning, following or trying to harm them.
• Not making sense: severe confusion, disorganised speech, sudden change or inability to explain where they are.
• Severe agitation or aggression: shouting, threats, escalating behaviour or unsafe behaviour at the desk.
• Threats or fear of violence: risk to family, staff, children, neighbours or members of the public.

Respond without escalation of conflict

Use calm, simple language. Do not argue about whether a belief is true, challenge the person aggressively, or try to manage threats alone. If staff safety is at risk, follow the practice safety procedure as well as the clinical or crisis route.

If a third party reports threats, violence, domestic abuse or someone behaving dangerously, local processes should include emergency and safeguarding routes. The duty is to pass on the concern promptly, not to prove it at reception.

Staff safety

Threats, command voices, severe agitation and unsafe behaviour need urgent ownership; reception staff should not be left to contain the risk alone.