The nature of many psychotic symptoms (for instance paranoid ideas, thought disorder, distraction by hallucinations, negative symptoms) makes building confiding and trusting relationships very much harder.

Likewise, the poor concentration, or panic states that are often often associated with depression, or the anxious ruminations of OCD, etc, etc, interrupt the normal process for making secure bonds between patient and keyworker.

In some situations concentrating on QuickWins may be useful - ie. slowing down the drive to engage with Mental Health needs "head on".

Deploying Pharmacological interventions, which are demonstrably effective in controlling many symptoms of psychosis, at least to the point at which authentic engagement might begin, will be a high priority, but it is often medication that stirs the most trenchant opposition.

At worst, if the balance of risks and benefits suggests it, the team may be forced to consider whether and Assessment of whether it is appropriate to Use the Mental Health Act.