MindMap

Supporting Young People with Psychosis in School: How to Help Them Succeed 

Image of young woman and teacher talking with the text supporting young people with psychosis in school

For many young people in late adolescence and early adulthood, school is a top priority. Whether it’s finishing high school, learning a trade, or pursuing a college degree, education often takes center stage. But for students dealing with psychosis, navigating school can become a real challenge.

Psychotic disorders like schizophrenia are closely linked with higher dropout rates. In fact, two related mental health conditions—schizophrenia and schizophreniform disorder—are the most common reasons students drop out of high school (1). Among college students with first-episode psychosis, 82% take a leave of absence due to mental health struggles (2).

Educational attainment is tied to better health and overall outcomes. Since school participation is key to recovery for many young people, it’s crucial that providers, schools, and families work together to help students with psychosis reach their educational goals (3,4).

How Stress Impacts Students with Psychosis

Stress can both trigger and exacerbate symptoms of psychosis, and the stress students experience while in school is no exception. School-related stressors such as overstimulation in a busy classroom or the pressure of exams can worsen symptoms. Likewise, psychosis symptoms such as paranoia, auditory hallucinations, or a lack of motivation can make it hard for students to focus on their studies and do well socially.

Imagine trying to concentrate on a lecture while hearing voices whispering your name. Or feeling unsafe in a classroom because you’re convinced others are plotting to harm you. These challenges can lead to changes in behavior such as missed classes, social isolation, and difficulty completing work. Some students may even need to take time off to manage severe symptoms.

Why Advocacy is Essential for Success

Given the impact psychosis has on academic performance and vice versa, it’s essential that families and providers advocate for students with psychosis. Schools are often eager to support students once they understand their needs. Collaborating with school staff, families, and healthcare providers can create a supportive environment where students feel empowered to succeed.

Tips for Providers to Support Students with Psychosis

1. Communicate with the School

Always seek permission from the student or their guardian (if under 18) before involving the school. Schools are usually open to receiving guidance on how to better support students with psychosis. Collaboration helps ensure consistency between treatment and the educational environment.

2. Work with School Personnel

By sharing changes they may observe in a school setting, school personnel can work with providers to reinforce goals and strategies being worked on in treatment. The school social worker or psychologist is typically a great place to start. They understand mental health and can bridge the gap between the mental health and educational systems. With their help, you may be able to work with other important personnel such as professors and coaches to create a network of support.

3. Educate School Staff

Be prepared to provide information on what psychosis is and how it affects students. Explain symptoms like auditory hallucinations, paranoia, or disorganized thinking, and how school stress can worsen mental health.

4. Debunk Misconceptions

It’s important to dispel myths about psychosis. Clarify that a drop in academic performance isn’t due to laziness or lack of care, and that “psychosis” does not mean “psychopath” or “split-personality”. Most importantly they should know that the student is NOT inherently dangerous.

5. Share Helpful Strategies

Share information such as treatment goals, expected side effects of medications, triggers, and coping skills. Work with the school to develop accommodations that support the student’s needs. This could include extra time for tests, breaks during class, or allowing the student to use coping tools like fidget toys or music.

6. Provide Regular Feedback

Schools can offer valuable observations about a student’s progress. In turn, providers should share both concerning AND positive treatment updates with school staff to foster ongoing collaboration.

7. Address Safety Concerns

Notify the school of any relevant risk issues (for example, if a student is having an increase in thoughts of suicide, especially triggered by school stress). Collaborate on a safety plan, outlining when and how to seek help, whether from a school social worker or external crisis services.

8. Support 504 and IEP Plans

Offer to participate in any 504 or IEP planning meetings. If the student does not have formal accommodations in place, consider talking with the student, their family, and the school about whether one of these plans could help. If attending college, direct students to the disability services office for support with this documentation. Even if accommodations aren’t needed at the time, it’s helpful to have them in place.

Empowering Students to Take the Lead

Most importantly, always involve the student in the conversation. They know their needs better than anyone and can identify which aspects of school are most challenging. Elevating their voice builds trust and gives them the confidence to manage both school and their mental health.

By working together, schools, families, and providers can make a positive impact on the lives of students with psychosis. This support goes a long way in relieving stress, reducing symptoms, and promoting success towards their educational goals!

Author: Josina James, LCSW, STEP Learning Collaborative, Director of Social Work

Learn More

For further insights, check out the STEP Learning Collaborative Provider training on “Role of Coordination.” Sign up for upcoming Provider Trainings and Family & Community Workshops today. Providers may use our consultation service to discuss more about specific individual needs.

References

  1. Goulding S.M., Chien V.H., Compton M.T.: Prevalence and correlates of school drop-out prior to initial treatment of nonaffective psychosis: further evidence suggesting a need for supported education. Schizophr Res 2010; 116: pp. 228-233. 
  2. Shinn AK, Cawkwell PB, Bolton K, Healy BC, Karmacharya R, Yip AG, Öngür D, Pinder-Amaker S. Return to College After a First Episode of Psychosis. Schizophr Bull Open. 2020 Jan;1(1):sgaa041. doi: 10.1093/schizbullopen/sgaa041. Epub 2020 Aug 26. PMID: 32984820; PMCID: PMC7503481.
  3. Crossley, N. A., Alliende, L. M., Czepielewski, L. S., Aceituno, D., Castañeda, C. P., Diaz, C., Iruretagoyena, B., Mena, C., Mena, C., Ramírez-Mahaluf, J. P., Tepper, A., Vasquez, J., Fonseca, L., Machado, V., Hernández, C. E., Vargas-Upegui, C., Gomez-Cruz, G., Kobayashi-Romero, L. F., Moncada-Habib, T., Arango, C., Barch, D. M., Carter, C., Correll, C. U., Freimer, N. B., McGuire, P., Evans-Lacko, S., Undurraga, E., Bressan, R., Gama, C. S., Lopez-Jaramillo, C., de la Fuente-Sandoval, C., Gonzalez-Valderrama, A., Undurraga, J., & Gadelha, A. (2022). The enduring gap in educational attainment in schizophrenia according to the past 50 years of published research: A systematic review and meta-analysis. The Lancet Psychiatry, 9(7), 565–573. https://doi.org/10.1016/S2215-0366(22)00121-3  
  4. de Waal A, Dixon LB, Humensky JL. Association of participant preferences on work and school participation after a first episode of psychosis. Early Interv Psychiatry. 2018 Oct;12(5):959-963. doi: 10.1111/eip.12513. Epub 2017 Oct 20. PMID: 29052948; PMCID: PMC5910294.