The Deptford Hearing Voices Project (now the Deptford Hearing Voices Service DHVS) was originally run as one year pilot project from April 1996 to March 1997, funded by Deptford City Challenge, a limited liability company set up to supervise the effective use of urban regeneration funds made available by the government for investment in locations considered to be deprived inner city areas. Thereafter the project was then jointly supported Mental Health and Social Services. From April 1997 funding was provided on yearly basis by the Lewisham and Guys Mental Health NHS Trust while the project was given an office base by Lewisham Social Services in the Compass Centre Deptford. Since April 2001 The service has now been given permanent funding by the South London and Maudsley Mental Health NHS Trust. The service is now managed through Lewisham Mental Health (and Social) Services.  The service is intended to be complementary to existing mainstream statutory services.

The Deptford Hearing Voices Project is currently staffed by one person who provides the following services: (1) one to one support, (2) two facilitated support groups for ‘voice hearers’, (3) outreach support work to ‘voice hearers’ in various community centres and drops-ins and, finally, (4) education and information for groups of carers or workers as arranged.

The project does not assume that the medical model or even the social model are the only ways for 'voice hearer's from which to view their experiences of voices. The project's therapeutic work is based on the approaches researched by Prof. Marius Romme and Sandra Escher and also Ron Coleman and Mike Smith. The therapeutic work also incorporates some of Cognitive Behavioral Approaches research by Kingdon & Turkington (1995) and that of Hazel Nelson (1997). The project work uses an Integrative Counselling mode incorporating the methods from the above approaches. A huge amount of work is spent on developing a good counselling relationship and working alliance with the people using the services.

Developing sound working alliances with mental health workers and carers who might use the DHVS in various ways is considered to be of equal importance.

The project worker also assumes the best working relationships are those already established between the current clinician or worker and the client and that any referral made to the Hearing Voices Project is made because this is seen by the ‘voice hearer’ and the worker mutually as the most appropriate strategy. Prior to the need for such a referral it may be that the DHVS may be a practical resource to workers in terms of providing information and hand-outs on 'voices', along with any clinical advice seen to be useful by the clinician in their therapeutic work with ‘voice hearers’.

The DHVS adopts a neutral perspective on ‘voices’ and where they are seen to be coming from by each individual ‘voice hearer’. It is not assumed that ‘voice hearers’ see their voices as undesirable or something to be cured, unless this is explicitly stated by them, it may be that they just want to know more about them. Much of the emphasis of the work is to create a dignified conversation with the ‘voice hearer’ in order as previously stated to build up a constructive working partnership. Much of the initial conversation will take place during an intensive gathering of information through the use of a modified version of Professor Marius Romme’s questionnaire. It is also made clear to the ‘voice hearer’ that the project is directed at helping them know more about ‘voices’ and enabling them to manage or cope better with them, rather than curing them. The notes below give some idea of the content and style of the services so that it can be seen how these might be best used for those people with whom you work.

 

Use of the project by Service Users is on a self-referral basis only. Referral of ‘voice hearers’, by either workers or carers, is accepted on the understanding that the ‘voice hearer’ has been given a recommendation that they are free to accept or reject such a referral. Referral of the ‘voice hearer’ for individual work, or to any of the support groups, is either through direct contact or via telephone. Contact is not generally seen as confirmed until the ‘voice hearer’ makes consistent face to face contact with the project worker, even if this is irregular. All referral or contact information forms are completed by the project worker after the first direct contact is made with the ‘voice hearer’. Arrangements for referral can be made by phone to the Compass Centre on 0208 694 6519.

Emphasis placed on the self-referral aspect enables ‘voice hearers’ who might potentially use the service to see it as operating independently, or at least at arm’s length from statutory services framework. This independence emphasises the voluntary aspect of the service, so that the ‘voice hearer’ sees attendance as something they want for themselves as ‘consumers’.

The at arms length aspect of the Service still managerially retained within SLAM means that the information systems of the project are confidential and not available to other services unless the ‘voice hearer’ wishes such information to be disclosed though clearly all confidentially is subject to legal constraints with current managerial and funding arrangements. Permission is always sought from the ‘voice hearer’ if it is felt that some liaison between the project worker and another worker or agency would be appropriate. The only circumstance when the ‘voice hearer’s’ wishes might be overridden would be if the project worker were deeply concerned about the safety of the ‘voice hearer’. Should this be the opinion of the worker, they would first discuss their concern and reasons for making such contact (with other agencies) with the ‘voice hearer’.

The project worker offers support to individual ‘voice hearers’ who feel one-to-one sessions would suit them best. The session framework is based on a mix of question and answer, conversation and discussion. Support may consists of a variety of methods to help ‘voice hearers’ cope with their voices including coping enhancement through problem solving, use of diaries, counselling, and cognitive behavioural therapy. Experience has led to the worker believing that it is more appropriate to apply a mixture of strategies as indicated by the needs of each individual ‘voice hearer’, hence the emphasis on an 'Integrative' counselling approach. Formally designed sheets to methodically record strategies used and outcome are utilised as an aid to recognising what has been tried. These sheets are used to record current medication, or medication changes, determinants that may also affect what is happening with the ‘voice hearer’.

Consumer research shows that most ‘voice hearers’ value the Hearing Voices Service for the ‘sense of permission’ to speak frankly and at length about their voices, without feeling this will entail consequences. Consequences may be, for example, an increase in medication, or exposing themselves to an implied professional disbelief or dismissal. The latter feeling is the most profoundly recurrent theme that emerges from the project worker’s discussion with ‘voice hearers’.

The ‘Voice Hearer’s’ support group is a small facilitated support group attended by between three and seven ‘voice hearers’ with a steady trickle of new people coming in as current Users trickle out. Facilitaton of the group is shared between worker and user co-facilitators. Aside from their voices, ‘voice hearers’ have other non ordinary experiences or other unusual perceptions which they will also explore with others in the group. Its real to accept that not all individuals within the group will always feel able to relate to the experiences of others. The group focuses other issues relating to mental health such medication (medication side effects), communication issues and relationship with other workers, and carers and also on problems centred with living with long term illness and its social and economic effects.

At times the discussions centre on listening to audio or video cassettes of other voices hearers' experiences, on occasion discussions centre around mental health issues in general or the wider issues of life and society which also impact upon us all. The most important aspect of this group is that everyone participating knows each other to be a ‘voice hearer’ and so any conversation that takes place on the topic is with less embarrassment and without the need of explanation, as might occur with a mixed group which included non-‘voice hearers’.

Attendance to this mixed group of non-’voice hearers’ and ‘voice hearers’ averages from six to ten attendees, with numbers on occasion reaching up to 12 people. This group, also co-facilitated by a user co-facilitator in partnership with the project worker, is more diverse in the range of mental health topics discussed. The group starts with feedback from each member of the group on what has happened for them during the week.

The content of the feedback is often broadened in such a way as to include other members in the group in discussion. Later on, as time permits, the group may choose a topic to discuss, or a topic for the co-facilitators to present. The presentation often includes brain storming, exposition, question and answer as well as general discussion. The main purpose of this group is to increase awareness and knowledge on mental health issues and to or break down the differences between 'normal' and 'abnormal' cognition.

Facilitative style is best described as being disarming, gently challenging and inclusive so that no member feels ignored or excluded. Care is taken to ensure every group member's contribution is acknowledged.  People who do not feel up to sharing are made comfortable about 'passing' on the share round. This group may be particularly suitable for ‘voice hearers’ who may wish to familiarise themselves with, and participate in, a group but without a commitment to talk about their voices. New or undisclosed 'voice hearers' often find this a useful way of building up confidence in themselves starting up a conversation with the worker on this issue

‘Voice hearers’ attending the open forum may then decide to attend the ‘Voices’ Support Group, or even attend both groups. However, the worker’s experience is that few ‘voice hearers’ will attend both groups for any period of time.

The project worker undertakes outreach visits on a regular and rotared basis to various community centres in Deptford and New Cross. This enables the work to maintain the Project’s profile and accessibility to ‘voice hearers’ who might not otherwise use the Project. The Project is not strictly ring-fenced for the exclusive use of ‘voice hearers’, as encounters are often with people are not ‘voice hearers’, who nonetheless have self-identified problems relating to mental health. Such outreach work enables the worker to obtain a useful perspective on pattern of service usage, or non-usage, by people who have mental health problems and whether or not such problems are also linked to drug or alcohol use.

Regular visits by the worker to various community centres allows for familiarisation to potential consumers of the service to his presence, to form useful mutual helping alliances with other voluntary workers and to gather anecdotal information on existing consumers of the service. Appointment commitments are made with people using the service, and on the understanding that these will only take place when the person is so inclined and without any judgement being made on absences, either explained or unexplained.

The approach taken by the worker recognises and gives respect to the informality of people living in a manner and time scale which is not tied to regular employment, secure home environments or secure social support networks. People using the Hearing Voice Project in these community settings are less likely to be ‘voice hearers’ and, if using the service, will want the immediacy of their problems simply heard (rather than solved) or attended to in one ‘lump sum’ of time rather then to be tied to attending a series of sessions on one particular site.

They like to know that the worker has a professional background but do not want to be professionally treated and bound to an office or formal timetable of sessions. Many people using the Hearing Voices Project want the worker to be committed to ‘being there’ or being ‘available’ without feeling they need to be equally committed to attending. What they want is for the worker to ‘be there’ when needed, and the outreach project recognises this as the most useful aspect of the project. In this way the project is put on the same basis as other informal community resources which are around to be used when needed but which at the same time no one has to attend.

The type of resource the Project worker can be to other workers will depend on what the worker wants. The most common resource of the Hearing Voices Service is to provide a supplementary source of information about ‘voice’ phenomena or other unusual perceptions. This can be done through the distribution of pamphlets, other written references, individual presentations of the project in person or by phone or in seminar form to groups of workers and carers or to ‘voice hearers’ gathered together for that purpose. The worker can also provide ad hoc information advice if required and supervision on ‘voice hearers’ in the care of individual workers. Ad hoc calls can also be made to project worker during the day to their mobile phone number.

As noted earlier, the DHVS is staffed by one worker who operates as a one person business, essentially their own secretary, administrator, information and service sales department, clinician, researcher and volunteer supervisor. Allowances will need to be made for the fact that the service will only operate when the worker is present or available at the time. Delays in the worker responding are likely to occur for a variety of reasons: (1) they are absent on leave, study leave or sick, (2) they are in session or in a meeting when a telephone call comes through, (3) post is lost, the mobile phone or the message pager are not working. Allowing for the above factors the project worker is committed to making the project responsive and useful to most people at most times.

The project worker is committed to the ensuring the Hearing Voices Service makes a positive impact on ‘voice hearers’ using the service and to the range of community services at large and welcomes feedback on the quality or usefulness of its service. The DHVS also recognises knowledge on ‘voice hearing’ is constantly improving for voice hearers' and the whole range of workers and carers whose competency in this field may well make the need for this type of service less necessary in the fullness of time.

[A4 leaflet produced by John Robinson and Judith Wyles for the Deptford Hearing Voices Project ^(c)]