Summary: Researchers have released a new suite of clinical resources—a concise practical guide and a short documentary film—designed to improve how professionals, families, and communities respond when people report hearing voices, including voices that relate to suicide. The project shows that, for many, hearing voices can be an adaptive response to overwhelming psychological distress rather than a meaningless symptom.
The team argues that institutional panic, over-regulation, and coercive containment routinely damage trust and intensify internal distress. They call for an urgent shift toward approaches grounded in careful listening, collaborative safety planning, and recognition of lived experience.
Key Facts
- Epistemic injustice is real: Professor Lisa Bortolotti’s ethical research demonstrates that people in severe mental distress often face a systemic injustice: their first‑hand accounts of their own minds are frequently discounted by clinicians at the moment they most need to be taken seriously.
- Panic is counterproductive: When someone says their voices are linked to suicidal thoughts, those around them—friends, families, and clinicians—often react with intense anxiety. This can trigger defensive, controlling responses that leave the person feeling misunderstood, overruled, and more distressed.
- Hearing voices can be adaptive: The project highlights that voices are not always a meaningless biological malfunction. For many people, voices arise as a complex internal response to trauma, severe isolation, or other extreme environmental stressors and can serve an adaptive or communicative role.
- Practical conversational tools: The guide promotes simple, evidence-informed conversational techniques to replace anxious interrogation with collaborative curiosity. For example, instead of the closed, leading question “You don’t want to die, do you?” it recommends open, validating questions such as “How much does that voice fit with how you’re feeling right now?”
- Autonomy alongside safety: Safety is essential, but it must not be used to strip away a person’s right to make decisions about their life. Sustainable safety comes from non‑coercive, collaboratively developed plans that build on an individual’s strengths and supports.
- Co-created with lived experience: Fiona Malpass emphasises that the resources were developed in collaboration with people who have direct experience of hearing voices and suicidal distress. This ensures the materials reflect practical survival strategies and challenge longstanding stigma in mental healthcare.
Source: University of Birmingham
New resources from the University of Birmingham, created in partnership with the mental health charity Mind in Camden, promote a more compassionate, nuanced response to people who hear voices—including when those voices relate to suicidal thoughts.
These materials stress that hearing voices can sometimes be a meaningful adaptation to distress rather than inherently harmful. They also highlight how common emergency reactions—panic, immediate control, or forced containment—can erode trust and worsen a person’s internal experience.
The resources—a short film and a concise practical booklet—were launched at an event in London this week. The project team urges teachers, clinicians, families, and friends to prioritise listening, curiosity, and respectful inquiry. Instead of imposing assumptions, the guidance recommends exploring what the voice experience means to the person and identifying existing strengths and supports to build on.
Maintaining a person’s sense of agency while offering safe, compassionate support is central to the guidance, particularly when voices are connected to suicidal thinking.
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.”
Professor Bortolotti’s recent work on epistemic injustice in healthcare—part of the Wellcome-funded EPIC (Epistemic Injustice in Healthcare) project—highlights how people in distress are often stripped of agency when their accounts are discounted. The new resources aim to protect that agency and improve clinical and informal support interactions.
When people feel heard and treated as partners in care, their distress is more likely to be reduced. By contrast, feeling misunderstood or overruled can deepen isolation and make future help‑seeking less likely. The booklet offers practical steps for responders when someone reports hearing suicidal voices, including:
- Reframing questions: swap leading, defensive questions for open, validating ones—ask about how the voice relates to current feelings rather than immediately denying its reality.
- Opening conversation without assumptions: adopt empathy and curiosity to learn what the experience means to the person instead of trying to suppress it.
- Balancing safety and autonomy: engage in difficult discussions about risk while prioritising collaborative safety planning to reduce coercion and conflict.
Mind in Camden supports more than 1,000 people with complex mental health needs every year and runs specialist services for people who hear voices, including the London Hearing Voices Network, Voices Unlocked (for people in prisons or immigration removal centres), and Voice Collective for children and young people.
Fiona Malpass, Project Development and Innovation Lead at Mind in Camden, said: “Funding this work has allowed us to address two of the most stigmatised aspects of lived experience: hearing voices and suicidality. Co‑creating resources with people who have lived experience has been crucial for producing practical guidance that increases understanding and supports more compassionate responses. We hope these materials encourage curiosity and compassion instead of anxiety‑driven reactions that can unintentionally increase distress.”
Key Questions Answered:
A: For someone already experiencing chaotic, overwhelming distress, being heard is crucial. If they disclose suicidal voices and are met with panic or coercive interventions that remove choice, they can feel stripped of dignity and agency. Professor Bortolotti’s research shows that heavy‑handed responses often increase feelings of isolation and mistrust, which can raise distress and discourage future help‑seeking.
A: Epistemic injustice occurs when a person’s testimony or perspective is unfairly dismissed because of prejudice linked to their identity or diagnosis. In psychiatric settings this can mean clinicians stop treating a person as a credible source about their own experiences. As a result, patients’ insights, boundaries, and explanations are sidelined precisely when open listening is most needed.
A: Start by managing your own anxiety and staying calm. Listen without rushing to fix the problem. Avoid leading or panicked questions like “You aren’t going to listen to it, right?” Instead ask open, non‑judgmental questions such as “What is the voice saying to you now, and how much does it match what you are feeling?” Calm curiosity helps people process distress without feeling judged or broken.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- The journal paper was reviewed in full.
- Additional context was added by staff to aid understanding.
About this psychology and auditory hallucinations news
Author: Eleanor Hail
Source: University of Birmingham
Contact: Eleanor Hail – University of Birmingham
Image: Image 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
When we engage in epistemic work—forming judgments, solving problems, or making decisions—we rely on the evidence and expertise of others. An agent can function as an expert only if their contribution is acknowledged, they are given an opportunity to contribute, and their input is taken up.
This paper argues that those three stages represent the engagement required for epistemically just interactions. It identifies forms of obstruction that prevent people, especially lived‑experience experts in mental health, from performing as experts. Using concepts from agential epistemic injustice, the paper illustrates how identity prejudice can block expertise and suggests remedies to restore equitable participation.