Staff experience of delivering clinical care on acute psychiatric wards for service users who hear voices: a qualitative study

ABSTRACT

Background

Research indicates that clinical staff lack confidence in delivering clinical care for voice hearers. Understanding staff experience is therefore likely to benefit staff training.

Objective

To explore staff experience of delivering clinical care for voice hearers using qualitative methodology.

Method

A total of 18 multidisciplinary staff from five acute psychiatric wards participated in brief semi-structured interviews. Interviews were analysed using thematic analysis.

Results

Six themes were identified. Participants reported Challenges of Understanding Subjective Experience (N = 16) of hearing voices, Empathy for Distress (N = 14) caused by voices, Curiosity about Experience (N = 10) and wish to understand, Anxiety about Clinical Risk (N = 8), especially regarding command hallucinations, Lack of Clinical Confidence (N = 7) in how to respond, and Diversity of Voices (N = 6) experienced by voice hearers.

Conclusion

Staff have empathy for voice hearers’ distress but feel they lack subjective understanding of what it feels like to hear voices. Lack of understanding, perceived clinical risks, and diversity of voices may be associated with reported lack of clinical confidence. Staff training that promotes greater subjective understanding has the potential to improve therapeutic relationships, clinical confidence, and quality of care. Using simulation technologies and involving people with lived experience in staff training may be ways to improve subjective understanding.

KEYWORDS:

• Hearing voices
• inpatient wards
• psychosis
• qualitative research
• staff perceptions
• thematic analysis

Acknowledgments

We are grateful to all clinical staff who participated in this study.

Disclosure statement

The Authors have declared that there are no conflicts of interest in relation to the subject of this study.

Ethical approval

This study was approved by the South London and Maudsley NHS Foundation Trust.

Additional information

Funding

This study was supported by bench fees for a dissertation completed as part of an MSc in Mental Health Studies at Institute of Psychiatry, Psychology & Neuroscience, King’s College London. HLF was supported by a Mid-Career Fellowship from The British Academy [MD\170005].