It is important to note that these simple techniques to help people cope do not represent a comprehensive therapeutic programme for people troubled by voices. Many mental health nurses will welcome this shift of emphasis from diagnosis-led treatment to a system of problem-solving for the individual patient. The view that voice-hearing is associated with a diagnosis of schizophrenia is becoming outdated, and a symptom-specific approach represents a profound change in mental health care. Hearing voices can be triggered by bereavement, trauma, depression and sexual abuse. Recent research has shown that voices are heard by many people who do not have mental health problems, and that hallucinations are considered normal experiences (Romme and Escher, 2000, Johns et al, 2002). Moreover, the literature that describes these techniques can be complex, written in an academic style and hard to access. A recent report highlighted that many mental health workers are unaware of the advances that have been made in understanding psychosis, and that training in psychological approaches is needed (British Psychological Society, 2000).Ĭoping strategies for people who hear voices do not appear to be routinely taught to nursing students, and the emphasis of postgraduate training in psychosocial interventions lies elsewhere. A second reason may be that nurses do not know about the strategies that could be used. One is that nurses are still afraid to talk openly to people about hearing voices it is as if they feel that doing so will open a Pandora’s box. If these simple coping strategies provide such a good opportunity to introduce people who hear voices to psychological treatment, why do mental health professionals not encourage the use of them? There may be two particular reasons. There is a clear evidence-base in psychological therapy for using symptom-specific interventions, as they routinely form part of CBT (Nelson, 1997), humanistic counselling (Knudson and Coyle, 1999) and approaches that are based on social psychiatry (Romme and Escher, 2000). The most common form of psychological treatment is cognitive behavioural therapy (CBT) (British Psychological Society, 2000), and NICE has recently decreed that anyone with persistent psychotic symptoms should be offered CBT (NICE, 2002). According to the National Institute for Clinical Excellence (NICE), psychological treatments for psychosis ‘should be an indispensable part of the treatment options available for service-users’ (NICE, 2002).
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