NWPharmaTech CHR-P Research Programme

For young people and families

If you have been told you may be at risk of psychosis

A plain guide to what "clinical high risk" means, what an assessment involves, and how to get support. It is general information, not advice about you. It does not ask for any information about you.

Need help now? Urgent help by country

What it means

  • You have had experiences, such as unusual thoughts, sounds, or feeling that people are against you, that are milder or briefer than psychosis.
  • A specialist has found that these meet agreed criteria that go with a higher chance of developing psychosis than most people have.
  • You deserve support now, for the experiences themselves and for anything that comes with them, such as anxiety, low mood or problems sleeping.

What it does not mean

  • It is not a diagnosis of psychosis or schizophrenia.
  • It does not mean psychosis will happen. Most people in this group do not develop psychosis; an updated meta-analysis estimated that about one in four did within three years. Source: Salazar de Pablo et al. 2021
  • It does not mean you need medicine. In England, psychological therapy is the recommended first step. Source: NICE CG155

What a specialist assessment may involve

  1. A conversation, not a test. There is no blood test or scan for this. A clinician asks about your experiences, how often they happen, how long they have lasted and how much they affect you, often using a structured interview.
  2. Everyday life. Questions about school, college, work, friends, sleep, and use of alcohol or drugs.
  3. Family history. Whether close relatives have had mental health difficulties.
  4. Family involvement. With your agreement, someone close to you may be asked what they have noticed.
  5. What happens next. You may be offered support and regular check-ins, therapy, help with other difficulties, or a referral elsewhere. Sometimes the answer is that you do not meet the criteria, and that can change over time.

Assessment approaches are described in the research literature. Source: Fusar-Poli et al. 2013

Questions you might ask a clinician

  • What did the assessment find, and what does that mean for me?
  • What support or therapy can you offer, and how soon?
  • How often will we meet, and who do I contact between appointments?
  • What should I, or my family, look out for, and what should we do if things get worse?
  • Could anything else explain these experiences, such as stress, sleep, substances or another health condition?
  • Can someone help me talk to my school, college or employer?
  • Will my information be shared, and with whom?
  • Are there research studies I could consider, and how would taking part affect my care?

School, work and family life

You can ask for adjustments, such as extra time, a quiet space or a change to working hours, and you choose how much to share. In the UK:

  • If mental health difficulties have a substantial, long-term effect on daily life, the Equality Act 2010 may require schools, colleges, universities and employers to make reasonable adjustments.
  • Access to Work can help people in paid work, including through a Mental Health Support Service. gov.uk
  • Schools in England can provide special educational needs (SEN) support, including for social, emotional and mental health needs. gov.uk

For parents, carers and partners

  • Listen without arguing about the experiences; ask how they feel and what would help.
  • Keep routines, sleep and time together where you can.
  • Ask the care team how you can be involved, with the young person's agreement.
  • Look after your own wellbeing too; your GP can tell you about support for carers.

Where to get help

Services differ between countries and local areas. Not every early intervention service assesses people who may be at risk, so ask what your local service offers.

England
  • Start with your GP, who can refer to local mental health services.
  • NHS England guidance expects early intervention in psychosis (EIP) teams, which work with people aged 14 to 65, to offer care to people at risk of psychosis as well as to people with a first episode. How this works differs between areas, so ask your GP what your local team offers.
  • Under 18: children and young people's mental health services (CAMHS), usually after a referral from a GP, school or other professional.
Wales
  • Start with your GP. NHS Wales early intervention in psychosis services describe themselves as working with people who have a first episode of psychosis or who are at risk.
  • Referral is usually through a GP, community mental health team or CAMHS; some areas also accept referrals from families. Ask what your local service offers.
Scotland
  • Start with your GP. Early intervention services in Scotland are developing through a national programme focused on first-episode psychosis; whether your local service sees people at risk varies, so ask your GP.
Northern Ireland
  • Start with your GP, who can refer to local mental health services. Ask whether the local early intervention team sees people who may be at risk.
Ireland
  • Start with your GP. The HSE early intervention in psychosis programme is designed for people with a first episode of psychosis; ask your GP what support is available if you may be at risk.
United States
  • Start with a primary care provider or mental health professional.
  • SAMHSA's Early Serious Mental Illness Treatment Locator lists programmes for recent-onset serious mental illness. Some programmes also see people at clinical high risk; ask when you contact them.

Routes checked . Services change: always confirm with your GP or local service.

Research studies, including ours, are separate from your care. This page does not recruit for any study.