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What is an At Risk Mental State (ARMS)?

At risk mental state (ARMS) is a term which is used by health professionals to describe young people, aged 14 – 35 years, who are experiencing perceptual changes that may be early, low level, signs of psychosis. It is unusual for psychosis to just happen. There are more likely to be some early signs weeks or months beforehand. So, Mental Health Services are now trying to work with young people when they are at risk. The idea is to delay the onset of psychosis, or even stop the experience of a first episode of psychosis altogether.

There are three groups of people who may be said to have an ARMS:

1. People with short-lived or milder symptoms of psychosis within the last 3 months.
2. People who have been functioning less well over the last 12 months. For example withdrawing from school, college or work or not being able to spend time with family or friends. On its own not functioning so well may be due to something else. But if you also have a brother or sister or a parent who has experienced psychosis this could mean you are having an ARMS.  
3. People who experience brief limited intermittent psychotic symptoms (BLIPs). These are psychotic level symptoms that have naturally stopped within 7 days.

They may start to have more unusual experiences; perhaps seeing things that other people don’t or hearing sounds which aren’t really there. These experiences may become frightening and distressing.

Who may have an ARMS?

Most often it is young people between the ages of 14 – 35 years who can have an at risk mental state. Research from young people who have had a first episode of psychosis suggests that they had a short period (3-6 months) of early psychotic experiences before they became more seriously unwell.

What causes someone to have an ARMS?

There is no one single cause. Generally people become at risk of psychosis due a mixture of stress factors and vulnerability. Like many mental health difficulties there are biological influences (genetics, chemicals in the brain), social influences (relationships, family) and psychological factors (beliefs about self and others). Currently, research suggests that about 1 in 3 people who are at risk may become more unwell in the future and experience a first episode of psychosis.

Other risk factors include:

• Higher levels of stress
• Feeling increasingly worried or anxious
• Major life events e.g. changing school, starting college, break up of a relationship, family problems, bereavement etc.
• Using substances e.g. cannabis, ecstasy, LSD, MCAT, amphetamine, cocaine.
• Childhood abuse or neglect.

What kind of experiences could someone have?

• Feeling tense, afraid and worried (anxious).
• Racing thoughts (too many at once, not able to focus on one thought at a time).
• Feeling more quiet and withdrawn
• Not socialising or seeing friends
• Feeling depressed, low, irritable and restless
• Feeling puzzled about strange experiences
• Having a reduced appetite and losing weight
• Having difficulty sleeping/broken sleep
• Becoming more self-conscious or nervous in public places

 Young People who are ARMS might have only one or two of these experiences but it is possible to have several of them at once and they can become confusing and distressing.

Why is it important to seek help for an ARMS?

For many people these experiences are short-lived. They are often a reaction to stress and will stop without any help or intervention by mental health services. However, for about 1 in 3 people, they may last for a longer period of time and could lead to a further, more serious, first episode of psychosis. If someone is reporting ARMS difficulties and would like some help, they can contact the Early Intervention Service. The Early Intervention Service will offer an assessment and support if needed. Alternatively, they can ask a family member to get in touch or go to see their GP.

What can services offer young people with an ARMS?

The risk of psychosis is linked to stress and vulnerability. So it is always best to get help sooner rather than later. This can stop the experiences from getting more distressing. The young person can get an explanation and information as to what is happening. They may be provided with self-help information, or signposted to another more appropriate service to help with their presenting difficulties. Other people will receive more targeted support from the Early Intervention Service for a 6 – 12 month period.