Hearing voices – What helps?

People with mental health issues, like me, can find life daunting, frightening and isolating. We can feel excluded, stigmatised and left behind, not only in education and employment, but also by health and social care services. 

I have experience of hearing voices, so I became a peer worker to not only face my own challenges but also to give hope to others. I wanted to help in their recovery and eventual discharge from hospital so that they can lead as normal a life as possible in the community. I have discovered that it can be extremely therapeutic to simply listen to people's experiences of psychosis in a non-judgemental way.

What happens in a peer support meeting

I usually start meetings by sharing something about my own experiences. In the first meeting I ran, I described a whispering voice that I hear which often says, "You're a swimmer, Ben" before going on to shout: "Boiling water!". Other voices I hear say things like: "Hot fire in your eyes!" and "On the bonfire with him!". Members of our group feedback that they really appreciated me sharing my own story. 

In sessions, we often ask people what the voice they hear says and what they feel can trigger it (often stress and anxiety). We also share coping strategies to reduce our stress which may include exercise, art and music and psychological therapies. Instead of denying the voice as a hallucination it is acknowledged with the voice hearer and we 'map' it (so it can be better understood and coped with by the voice hearer because we understand more about it). For example, mapping may include noting the voice's gender (is it male/female/other?) its age, if it whispers or shouts, if it is positive or negative in its tone, if it is one voice or many different ones, if it sounds advisory or commanding. We'll also share what the voice says.

Nurturing feelings of safety

Hearing voices sessions need to promote feelings of safety and it's important to establish connection right from the beginning. Matt (the director of patient experience) and I noticed the panic of staff and distress of people on the ward when the emergency alarms sounded, which were frequent and very loud. Discussing this in the hearing voices sessions gave us an opportunity to comfort and reassure and to think about ways we could soother ourselves when the alarms went off.

Staying curious

I learn so much from hearing voices sessions and it reminds me that no two experiences are the same. I recently had someone in a session with someone who hears both male and female voices that have a spiritual nature to them… this service user believes other people can see through his eyes. Because I have experienced hearing voices, I am able to stay curious instead of reacting nervously or acting shocked like some of my colleagues may struggle with. This service user said he was ignoring his voices and that talking with me had reassured him that his experiences are common among people with schizophrenia. 

I also had an intriguing hearing voices session recently with someone who hears voices that are like echoes. The voice would repeat the individual's thoughts and words but in a sinister, angry manner. Again, this was new information for me, and I stayed curious but calm. They reported that the voices were much worse after their lunch, so I made sure that I checked in with him after lunchtimes. This helped him to feel heard and cared for, which in turn reduced his feelings of anxiety.

Ask someone what they need

Hearing voices sessions also need to be progressive in steps to recovery. One person initially talked about his voices and thoughts that people want to kill and torture him and his family, so I listened non-judgementally and reassured him that this wasn't the case. Previously, he had felt ignored by staff, because, in his words, 'I say the same things again and again'. Just feeling heard helped him to feel calmer. We were then able to write notes for his ward review to formally request psychological/talking therapies, and some days later he was engaging with a psychologist and engaging in group therapy.

Really hear and connect with someone's pain

It is important to connect with and understand people's lived experience perspective of mental illness. This means not making assumptions about people's psychosis, hallucinations and delusions. It is not uncommon for example, for people to hear voices that they are going to hell; or to believe they are Jesus Christ or that they need to fight demons. What is special about our hearing voices sessions is that everyone shows compassion rather than shock. They empathise rather than pity, and they really hear someone's story.

I often share with the group what Winston Churchill said about his 'black dog' of depression: "If you're going through hell, keep going". I also usually add: "We won't let them get you!".

Working together to understand someone's trauma

Hearing voices sessions also need to be trauma informed, as they can sometimes involve very distressing and unsettling stories and experiences of mental illness. For example, I had a very disturbing session with a man who hears voices and sees dark figures, creatures and patterns coming out of the walls. The commanding voices tell him to kill people, or he will be killed, and to set fires and commit arson. The voices are so commanding that the man feels compelled to follow their instructions. Because of his voices, he also tried to harm himself considerably. For the first time in 30 years of work in mental health, I was initially a bit frightened by this person. After a few weeks, though, we felt better and safer together. We particularly connected with a shared interest in his Quaker faith, so we had many interesting and philosophical conversations on topics such as 'Do you believe there's love?' and 'Is there such a thing as a living hell?'. Slowly, we grew to understand each other better through similar experiences of hearing commanding voices to harm ourselves and others. We concluded that psychological therapies, particularly CBT, might help the individual resist the commanding voices. And indeed, he later went on to have some dialogical therapy.

I also spoke to someone who hears voices commanding him to spit out and vomit his food and liquids. This often occurs after medication has been dispensed, just after lunchtime. This lowers the level of antipsychotic medication, so he would become quite psychotic. He eventually disclosed in a hearing voices sessions that his mother would hit him as a child on the hand with a tin opener in the kitchen. When he heard a voice, he felt compelled to obey it in case of punishment. 

Be reassuring

It is crucial to adapt to what the service user may need. One service user described his vivid nightmares and voices, which seemed real, and his fears that he is going to hell. He gets little sleep. He also sees people: 'Marie', who is a sweet 15-year-old girl but does not age. She was sitting next to an older man, her father, on a bench nearby. He said that he feels betrayed and abandoned by friends. He asked me if his frightening experiences were real. Although I think they are real for the person experiencing them, I had to tread gently, be calm and compassionate and put him and his safety first. In other words, I could not impose my beliefs on him but had to listen to his beliefs and be reassuring. "They're not real", I said. "Promise?", the individual responded. "I promise", I reassured him. 

Signposting and inspiring hope

It is important to note that access to psychological therapies can be slow and arduous. There are long waiting lists for talking therapies. Peer support workers who conduct hearing voices sessions fill a much-needed gap and are an intermediate step that signposts people who might benefit from psychological therapies. For example, in two of my examples I signposted one individual to group psychological therapy and another to dialogical therapy.

According to Matt, the director of patient experience, my approach destigmatises hearing voices for people and helps them to feel less judged and have a greater sense of self-worth. The hearing voices sessions allows people to connect more authentically based on shared experiences and mentor people to move forward in their recovery. Helping people to feel in control of the voices in their head gives hope, and insight for all those involved. In Matt's view, they are not a common practice across other NHS providers in England, but perhaps they could be.

Peer work has given me hope too. There is reciprocity, connection and mutuality at a deep level that helps to inspire hope. By walking beside someone in their journey towards recovery, I also feel the benefit. It has improved my communication, confidence and self-esteem. It has lessened my feelings of stigma, and has given me a sense of purpose.

Recent feedback from a ward manager was: "You're inspirational. We need more peer support workers like you". This really touched me, but it is even more special when I get feedback from service users, telling me that I have given them hope. This means everything.

With thanks to Matthew Sisto, Director of Patient Experience at EPUT