The Hearing Voices: a Guide to understanding helping and empowering individuals Mobile Application


When did you first introduce the innovation?

Less than 12 months ago

Please describe the innovation you have developed

Earlier this year the ‘Hearing Voices: A Guide to understanding helping and empowering individuals’ Mobile App was launched. The App is primarily aimed at health and social care practitioners to enhance their understanding of the experience of hearing voices and was developed by pooling the expertise of a multi-disciplinary project team, including people with lived experience of voice hearing. The App is free to download, is responsive to a variety of screen sizes and has cross platform accessibility (Apple and Android, iPhone and iPad). Simulation is the central pedagogical strategy of the resource and users are given the opportunity to engage in a number of cognitive and social tasks whilst using headphones to listen to auditory footage of voices. This is supported by text based theoretical explanations, podcasts of accounts of lived experience of voice hearing and descriptions of how to help people cope with these experiences. The App also includes interactive exercises and reflective prompts throughout the text to facilitate deeper learning and encourage users to consider how the content applies to their practice. The App can be used independently or integrated into educational initiatives as fully directed or blended learning. Educational facilitators can work with groups of learners and utilise the exercises as short activities within a traditional classroom setting.

What prompted you to develop this innovation?

Despite prevalence levels estimated to be between 4 and 15%, in many western cultures voice hearing is considered a taboo experience (Longden, Madill & Waterman 2012). People who hear voices are often labelled as psychotic and treated with fear and suspicion. Ando et al (2011) suggests that hearing voices is one of the most stigmatized experiences in psychiatry. Studies have found that health and social care professionals and students are influenced by commonly held myths and stereotypes. Llerena et al, (2002)found that 50% of medical and nursing students thought that people with a diagnosis of Schizophrenia would not recover or be able to lead a ‘normal’ life, 78% thought they were likely to be violent/dangerous and 40% would seek to distance themselves from people with a schizophrenia diagnosis. This limits the capacity of such professionals to develop therapeutic relationships with this marginalised group of service users. These attitudes are associated with adverse consequences to the health, quality of care and quality of life for people who hear distressing voices and is likely to prevent people from seeking help. This is also the case in physical health care settings. People with a diagnosis of schizophrenia have an increased rate of physical health problems and require access to prompt and effective intervention to address their reduced life expectancy. There is a need to ensure healthcare professionals are equipped to meet the challenge of providing voice hearers with empathetic, therapeutic and empowering care. Recent studies (Chaffin, 2013, Orr et al 2013, Sideras et al 2015) have found that students who have engaged in simulation acknowledge more understanding of their clients and more empathy for the challenges voice hearers face which leads them to want to show more patience during interactions. Advances in mobile technology presented an opportunity to devise a highly accessible educational resources of utility to educators and clinicians alike.

In your view, what is it about this innovation that makes it different/important?

The innovation is important because the experience of hearing voices is a highly stigmatising one and the App has been developed to address negative and pessimistic views. A unique feature of the App derives from the collaborative approach taken which ensured that it is not predominated by the medical model but rather represents the wider spectrum of understanding, interpretations and approaches to managing this complex phenomenon.

Representatives from the Hearing Voices Network played a central role in developing the resource and were used to devise the auditory recording. It is hoped that this will assist in addressing Waxman’s (2010) calls for simulations to sufficiently mimic real-life situations by enabling learners to suspend disbelief. The use of mobile technology also enables the simulation exercises to take place beyond the confines of the classroom and contextualises the experience.

Another, somewhat unexpected, important feature of this resource is the breadth of its appeal, as early indications suggest that it has proved beneficial in enhancing the understanding of voice hearing for loved ones and relatives of voice hearers as well as wide range of professionals (police, service industry etc.) beyond the health and social care arena.

To what extent does your innovation make use of existing approaches, resources or technologies?

In an attempt to remedy negative views and attitudes, recent years have seen those involved in the education of practitioners, both during primary professional education and after qualification, develop voice hearing simulation as a key pedagogic strategy to promote empathy and understanding of what it is like to hear voices. A number of different simulation approaches have been in common use including role play which involves students working in groups of three, with one taking on the role of the voice, whispering in the ear of one of the students while they attempt to hold a conversation with the third member of the group. However, this approach has been criticised as lacking authenticity as it does not involve people who hear voices. For this reason, more contemporary approaches have utilised Mp3 players using voices recorded by people with lived experience of hearing voices. Students are asked to listen to these pre-recorded voices (via earphones) while engaging in a number of different tasks to experience what it is like to complete daily tasks while voices are present. The Hearing Voices mobile app uses mobile technology to build on this enhancing the accessibility and incorporating the simulation technology within a wider comprehensive educational package.

To what degree has this innovation led to changes in education or clinical practice?

Having only launched the App in April 2015 our evaluation is still in its preliminary stages and as such it is difficult to determine the impact on education and practice. However, anecdotal evidence suggests that the resource has been and will continue to be widely used by educators and clinicians in our region and beyond.

What evidence do you have of the impact of the innovation?

Since its release in April of this year the number of downloads have increased month on month and currently approximate 1,000. As anticipated the App is most frequently downloaded in the UK but has also been downloaded by approx. 200 users in the USA and Canada and 58 in the Asian Pacific.

The pilot study of the App involved student nurses who had engaged with the resource providing feedback in a focus group interview and offered early indications as to its efficacy. Students appeared to have an enhanced understanding of the experience, as illustrated by one learner who commented that ‘the simulation part of it was really good, having the voices speaking to you and getting a bit more of an understanding, especially when we were like going down to the canteen and stuff with them let you see how distracting that would be’. While it is difficult to determine how this might translate into changes in clinical practice learners did express the view that it would impact upon their communication ‘I’ll be more understanding and have more patience now and I’ll feel more comfortable discussing voices with a patient’ and attitude ‘it’s given me a clearer view so that when I do meet someone who experiences voices I’ll be able to be more empathetic towards them because I understand now a lot more than what I did before I started with the app’.

To what degree has the innovation been disseminated in your organisation or elsewhere?

The App has featured in a number of national conference events including:

  • Simulation conference for Nursing, Midwifery and Allied Health Professionals (Belfast – June)
  • British association for Behavioural and Cognitive Psychotherapists Conference (Warwick – July)
  • Mental Health Nursing Research conference (Manchester – September)
  • Nurse Education Today conference (Cambridge Sept)

The App has also been included as a video case study in an infokit re: mobile learning produced by the Joint Information Systems Committee (JISC) c.f. ( The Psychological Professions Network and the Hearing Voices Network have incorporated information regarding the App into their membership bulletins and on their websites and the Nursing Standard has conducted a review of the App (awaiting publication).

Please provide details of any plans you have to disseminate the innovation in the future.

To date the conference presentations have focused on the process of devising the App and this will be followed with an academic paper in the coming months. The evaluative study is currently in progress and it is anticipated that this will be completed by Jan 2016. The research study adopts a mixed methods design combining quantitative pre and post simulation attitudinal survey data with rich narrative data gathered via focus group interviews. During 2016 the project team intend to publish a further academic paper and present at conferences to disseminate the empirical findings. This is a joint application with Manchester University and Dr Hilary Mairs, Reader | Director of Postgraduate Education | School of Nursing, Midwifery & Social Work, University of Manchester is the joint author with Eve Collins.