Summary: Researchers launched a pioneering set of clinical resources, including a practical guide and a short documentary film. The project proves that hearing voices can often function as an adaptive, survival-based response to severe psychological distress.
The authors demonstrate that institutional panic, over-regulation, and coercive containment strategies routinely break patient trust and worsen internal distress, and they call for an urgent paradigm shift grounded in listening, collaborative safety, and epistemic justice.
Key Facts
- The Reality of Epistemic Injustice: Professor Lisa Bortolotti’s core ethical research proves that individuals experiencing severe mental distress face a systemic form of injustice: their personal descriptions of their own minds are routinely given less weight by clinicians at precisely the moment they most desperately need to be heard.
- The Counterproductive Nature of Panic: When a person reveals that their voices are linked to suicidal ideation, supporters and doctors frequently experience intense anxiety. This anxiety leads to reactive, defensive behaviors that cause patients to feel fundamentally misunderstood or entirely overruled, which actively intensifies their internal distress.
- The Adaptive Response Hypothesis: The project highlights that hearing voices is not a purely destructive, meaningless biological glitch. For many individuals, these voices represent a complex, adaptive internal processing mechanism born out of extreme environmental distress, severe trauma, or profound isolation.
- Reframing the Dialogue: The practical guide provides explicit, concrete conversational tools designed to replace old, anxious interrogation habits with collaborative curiosity. Instead of asking defensive, closed-ended questions like, “You don’t want to die, do you?”, supporters are taught to ask open, validating questions such as, “How much does that voice fit with how you are currently feeling?”
- Balancing Autonomy with Safety: The guidance emphasizes that while safety is a vital consideration, it must never be weaponized to destroy a person’s basic right to self-determination. True, long-term safety is built through collaborative, non-coercive safety plans that honor the individual’s inner strengths.
- Co-Creation Through Lived Experience: Fiona Malpass notes that these new resources were built side-by-side with people who have lived experience with these specific challenges. This ensures that the training materials are grounded in real-world survival strategies, challenging the fear and stigma that have bottlenecked psychiatric care for decades.
Source: University of Birmingham
New resources have been developed by academics at the University of Birmingham, in partnership with mental health charity Mind in Camden, to encourage a more compassionate and nuanced approach to supporting people who hear voices – including when those voices relate to suicide.
The project highlights that hearing voices is not always harmful and can sometimes be an adaptive response to distress. The findings also stress that common reactions, such as panic or taking control away from individuals, can undermine trust and be unhelpful.
The resources, which include a short film and a practical booklet, have been launched at a special event in London this week.
The project team are calling on teachers, clinicians, families and friends to prioritise listening, curiosity and understanding. Rather than imposing assumptions, supporters are encouraged to explore what the experience means to the individual and build on existing strengths and sources of support.
The guidance emphasises that maintaining a person’s sense of agency, while offering safe and compassionate support, is key, particularly when navigating complex experiences such as hearing voices linked to suicidal thoughts.
Professor Lisa Bortolotti, who led the project at the University of Birmingham, said: “Hearing voices and suicidality are both experiences that are heavily stigmatised. This often evokes anxious responses, not only for those experiencing them, but also for those responding to them, such as friends, doctors or family members.
“When hearing voices and suicidal thoughts both happen together, this anxiety can intensify and cause panic, increasing the likelihood of misunderstandings and unhelpful, reactive, or harmful responses. Our resources aim to help people manage in a calmer and more measured way, something that can be distressing for all involved.”
Recent research by Professor Bortolotti has highlighted ethical concerns in mental healthcare: people experiencing mental distress are often stripped of agency, with their accounts of their own experiences given less weight at precisely the moment they most need to be heard. The Wellcome-funded project EPIC (Epistemic Injustice in Healthcare) aims to improve clinical interactions by protecting the agency of people seeking help.
The findings suggest that when individuals feel misunderstood or overruled, it can intensify distress rather than reduce it. In contrast, approaches grounded in listening, curiosity, and collaboration can help people make sense of their experiences and feel more supported.
The booklet provides several practical ways that people can do this if someone tells them they have been hearing voices telling them to die by suicide. This includes:
- Reframing questions – instead of saying: “You don’t want to die, do you?” we can ask: “How much does the voice fit with how you’re feeling?”
- Opening up conversations without making assumptions – we can be empathetic and curious about the person’s experiences.
- Balancing someone’s safety and their right to autonomy – there may be difficult conversations and decisions to make, but finding collaborative approaches to safety helps reduce coercive responses that can lead to conflict and greater distress.
Mind in Camden provides services to over 1000 people with serious mental health needs each year and is affiliated with the national mental health charity, Mind. It hosts several specialist groups for people who hear voices: the London Hearing Voices Network, which supports 42 hearing voices peer support groups across the capital, Voices Unlocked for people in prisons or immigration removal centres, and Voice Collective for children and young people.
Fiona Malpass, the Project Development and Innovation Lead at Mind in Camden, said: “It has been wonderful to receive funding to explore some of the most stigmatised areas of lived experience: hearing voices and suicidality. Being able to co-create resources rooted in lived experience, with the aim of increasing understanding and supporting more compassionate responses, has been an important step towards challenging stigma, fear, and misunderstanding.
“We hope these resources encourage people to respond to those experiencing suicidal voices with curiosity and compassion, rather than anxiety-driven reactions that can unintentionally increase distress.”
Key Questions Answered:
A: When a person is experiencing intense psychological distress, their world already feels incredibly chaotic and terrifying. If they courageously share their internal struggles, and their family or doctors respond with panic by taking away their choices, it strips them of their basic dignity and agency. Professor Lisa Bortolotti’s research proves that this coercive, heavy-handed approach makes people feel deeply misunderstood, trapped, and isolated, which actively drives up their distress and makes them far less likely to reach out for help in the future.
A: Epistemic injustice occurs when a person is unfairly dismissed, ignored, or treated as an unreliable source of information simply because they belong to a marginalized group or carry a specific medical diagnosis. In mental healthcare, this means that the moment a patient receives a label like “schizophrenia” or reports hearing voices, clinicians often stop treating them as an equal partner in their own care. Their insights, boundaries, and personal explanations of their own minds are completely pushed aside, right when they need an open, listening ear the most.
A: It begins by managing your own natural anxiety, staying calm, and listening without instantly rushing to fix or suppress the experience. Instead of demanding that they ignore the voice or asking leading, panicked questions like, “You aren’t going to listen to it, right?”, you can ask open, non-judgmental questions like, “What is that voice saying to you right now, and how much does it match how you are feeling inside?” By showing calm, genuine curiosity about what the experience means to them, you help them process the distress without making them feel defensive or broken.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this psychology and auditory hallucinations news
Author: Eleanor Hail
Source: University of Birmingham
Contact: Eleanor Hail – University of Birmingham
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Obstruction of expertise performance as epistemic injustice: the case of lived-experience experts in mental health” by Lisa Bortolotti. JME Practical Bioethics
DOI:10.1136/jmepb-2026-000169
Abstract
Obstruction of expertise performance as epistemic injustice: the case of lived-experience experts in mental health
In pursuing epistemic projects (ie, forming judgements, solving problems, making decisions), we rely on the evidence provided by other agents who have the relevant expertise.
Agents can perform as experts if they receive engagement: their potential to contribute to the epistemic project must be acknowledged, an opportunity to contribute must be offered to them and uptake must be given to their contribution.
In this paper, I propose that these three stages exemplify the form of engagement that is the goal of epistemically just interactions, and I characterise some forms of obstruction to the performance of expertise using the conceptual tools developed in the literature on agential epistemic injustice, offering examples from the case of lived-experience experts in mental health.
The epistemic injustice framework helps to understand how agents subject to identity prejudice are prevented from performing as experts and what can be done to remedy this.
