What do I do when someone else is having a psychotic episode

On the way home from work today, there was a lady going through what I assumed to be psychotic mania. She was having delusions of grandeur, proclaiming how beautiful she was and screaming at the guys on the trolley for wanting her. It was clear that she was no longer attached to reality; she was talking to her reflection claiming that her husband was going to divorce from his wife to marry her and dancing/singing all around the trolley. She alternated between hostility and an elevated mood. By the time I got off, I was still a little concerned. I decided to call and ask the transportation office what to do but my phone died right at that moment and it took me over an hour to get home. So, I’m curious. In situations like this, what am I supposed to do? Am I supposed to allow them to continue or alert authorities even though they don’t constitute an immediate danger to themselves and others? I honestly still feel guilty for not doing anything to help

Hi Freevantage,
Depends on where you live.

In the United States, there is nothing anyone can do to "help" someone in a mental health crisis until they pose a threat to themselves or others. If she was threatening the other passengers or to harm herself, that would be the appropriate time to call the police. But if she was feeling persecuted, and defending herself, let her be. You may make the situation worse if you try to intervene without experience or knowledge of this woman. In general, if you are not experienced interacting with a person, and do not know them, I would not recommend directly involving yourself with a person in a mental health crisis. It takes a special skill set, and training to be helpful.

When it is someone you know or love there is an effective strategy called LEAP developed by Dr. Amador. Listen, Empathize, Agree, and Partner. This strategy is the best strategy I know if you are in a situation with someone suffering from delusions and hallucinations. Trying to build trust to help is the key. I would not recommend you do anything if you didn't know the woman. The weight of the world is not on your shoulders. The woman you described was ill, and will likely gain access to care through the people in her life who know her. If you want to understand better how to empathize with what it is like to have a mental illness there are many books that describe mental illness through personal narratives, like the book I wrote. It may give you insight into what the experience is like.
Sunny

As for how to behave when someone is having a psychotic break and you're on the subway?

1. If they are acting out:
I'd recommend staying as you were. Don't turn your back. But don't make direct eye contact or stare. Direct eye contact may seem aggressive, where as turning your back may make the person feel isolated.
2. If it makes you uncomfortable:
Change subway cars at the next station, or wait for another train.
3. Be present:
Don't ignore the person, but don't pay special attention to them either. In New York I've seen people who are skilled at dealing with odd subway behavior. Keep to yourself. Keep your head down, eyes averted from the individual acting out if they start to pester / direct their attention to you. Cross your arms and legs. Do all the nonverbal cuing that you don't want to engage with them, without isolating them. If they start to ask questions that are based in delusions you can shake your head back and forth and keep a low profile, or if they are checking in about their surroundings, asking if you see what they see, or something like that, keep it real.

Sunny