printable pdf It is common for young people to hear voices under certain circumstances. For example, a high fever, problems with diet and hydration and experimenting with drugs might all lead to hearing voices. It is quite normal for all of us to occasionally hear sounds or voices around the time that we are falling asleep or waking up. This is the result of there being an overlap between dreaming and being awake and is normally nothing to worry about.
It is also common for younger children to report on conversations they are having with an imaginary friend. Relationships with imaginary friends become important to some children as a mechanism to support them through periods of uncertainty or simply when they are alone and want someone to play with or talk to, in the same way that they will talk to a teddy bear or doll.
There is some evidence suggesting that 2-3% of the adult population hear voices but only one in three ever become a psychiatric patient. Many people function well with their voices.
Hearing voices can sometimes occur as part of a coping mechanism in response to a traumatic event or severe emotional distress, for example, sudden bereavement or abuse.
Hearing voices as part of mental illness is less common and would only normally occur in older teenagers. On occasion, other senses can be involved such as seeing or smelling things that are not real. When mental illness is involved there will usually be other signs that the young person is troubled, for example:
- The young person might talk or laugh aloud as if having a conversation with an invisible person.
- They may become withdrawn and less inclined to mix socially.
- They may have difficulty in concentrating on studies or TV programmes, etc.
- They may lose interest in normal activities.
- Their thoughts and ideas may appear to be all mixed up and sound like nonsense.
- They may talk about or express unusual or even bizarre ideas that they are having which are not shared by any other people, for example, the feeling someone is directly inserting thoughts into their mind or they are being spied on by the Government. They will not be persuaded against these beliefs by facts and logical argument.
- Care in their appearance and self care may deteriorate.
- They may become lethargic and lose motivation or be agitated and overactive.
- It might be that hearing voices is not disclosed by the young person but others notice that they appear to be distracted or are acting out of character.
Young people who are hearing voices and are suspected of having serious mental health problems should be considered as vulnerable and may be a risk to themselves. Psychiatric advice should be sought as soon as possible and they will always be treated as a high priority by the local mental health specialists.
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- Remember that it is normal for young people to develop interest in unusual subjects and alternative culture and lifestyles as part of exploring and deciding on their own life values.
- Voices are not always distressing for the individual. They might find them to be a comfort or to be supportive during difficult situations.
- However, it is just as likely that the voices will cause serious distress for the young person and for those around them. It may be difficult for them to talk about their experiences because of the distressing and frightening content of the hallucinations or because of a fear that others will think they are insane.
- Voices can sometimes encourage people to harm themselves or others.
- A fear of ridicule, stigma and of not being believed can often cause a young person to try to cope with their problems alone.
- Other young people will probably have noticed changes in them and may be concerned or frightened by their behaviour or their strange thoughts and ideas.
- Mental illness that involves hearing voices is often made worse by stress such as exam pressure and work deadlines.
- Situations of high emotion like family conflict, arguments and shouting often have a detrimental effect on the well being of people who hear voices.
- It may be that the young person experienced a bereavement, trauma or abuse that might be provoking their current state of mind.
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It can be difficult to accept this type of behaviour if you have not encountered it before. Most people are apprehensive when they discover a young person is hearing voices because of fears of ‘madness’ and the stigma and prejudice surrounding mental illness. If you have not had much experience of people who hear voices, the uncertainty about how they will behave can lead to avoidance of them or the issue. Alternatively if you have had a difficult experience of someone with a mental illness in the past you may make unhelpful assumptions about how the situation will develop. It is important in responding helpfully that you are aware of your own feelings and thoughts so that your reaction is genuine to the needs of the young person.
For more information, see section on being aware of yourself and your own response.
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- Keep the young person safe and seek support and advice from colleagues and specialists.
- In the first instance, it is important to show the young person that you believe what they are telling you is real to them and that you would like to hear more about it.
- Talk and listen to the young person. You need to decide whether the ‘voice’ is causing distress or is likely to lead to self-harm or violence towards others as this requires urgent attention. The more information you can obtain, the clearer your understanding of the associated risks will be. However, you also need to be aware of the anxiety the young person may feel if forced to disclose information without feeling safe and secure (see counselling techniques).
- Sensitively discuss your concerns with other people who know them well because they may also be concerned and may be aware of useful information for example, about their level of risk to themselves/others or that they are already receiving support from specialists etc.
- Interventions which are used to help people who hear voices tend to be specialized and it is important to get them referred appropriately to the specialist, normally a psychiatrist or member of a specialist mental health team.
- It can also be useful to ask the young person how they normally cope with the voice as this might enable you to improve the environment for them until they can be seen by the specialist.
- You may want to ask whether there is anything that normally helps the voices to go away. It is possible that this can be supported within the environment the person is presently in. For example, music, television, reading, group conversation and sporting activity can be helpful to distract some individuals (see solution-focused techniques).
- It is useful to ask what can make the voices worse so that these triggers might be avoided. For example, loud noises, complete silence and whispering can act as triggers for some.
- It can be reassuring for the individual to know that you believe what they are telling you is real to them and you are keen to hear what the voice is telling them.
Things to avoid:
- Don’t ignore your concerns or their behaviour in the hope that it will go away. They may be in a state of confusion and distress. Early support/treatment will be useful and can reduce distress, risk and improve recovery.
- It is unwise to claim that you can hear the voice too as this will lead to issues around trust.
- It is not helpful to deny the existence of the voice to the individual as this conflict may lead to attempts to hide the ‘voice-hearing’ in your presence.
- Remember that it is a normal part of growing up for young people to think about and explore alternative ideas and life styles so don’t assume that all the unusual ideas, beliefs or behaviour the young person expresses are part of their mental health problem.
- Be understanding and respectful and try and reduce the stigma that they may be feeling by being tolerant and inclusive and by encouraging others to be the same
- Talk with others involved in supporting the young person because developing and coordinating their support network is very useful in aiding their recovery.
- Encourage them to follow the treatment and advice offered by specialists such as attending appointments, therapy and taking medication as prescribed.
- Encourage the young person to be involved in social activities.
- Encourage them to be involved in activities such as education or hobbies.
- Encourage them to take an interest in their appearance and self care.
- Encourage them to look after their health by taking exercise, eating a healthy diet and getting enough rest and relaxation.
- Protect them from situations where there is high emotion being expressed for example when people are arguing or shouting.
- Try and reduce the amount of stress the young person might be under.
- Help them develop strategies that make them feel less awkward in public for example using a mobile phone to disguise that they are talking to someone that nobody else can hear.
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- If the young person describes or appears to be hearing voices and they are not associated with falling asleep or waking up; a result of fever; or obviously part of a play activity.
- If the young person is already being treated by a specialist and you notice any significant change in them, for example, suicidal ideas/behaviour, an increase in their symptoms, deterioration in their self care or increase in their social isolation.
- If the signs of voice-hearing are new, even if it appears to be easily controlled, you should still discuss your concerns with a specialist. It is helpful to become aware of this condition early on as the chances of a better recovery tend to be greater.
Contact a mental health specialist urgently if, in extreme circumstances, an initial appraisal of risk suggests that someone could be harmed. An example of this would be if the young person is claiming that they need to self-harm or hurt someone else to satisfy their belief. This should be taken very seriously.
You should get in touch with your local health centre or hospital to obtain a contact number for the appropriate children and young people's mental health specialists.
Remember - you can contact your local mental health specialists for a number of reasons, for example:
- For advice on how to make a referral about a named child.
- For advice about whether or not to make a referral (it is normal practice to seek this advice without naming the child in the first instance).
- For advice about what to do (once again there should be no necessity to name the child).
By not naming the child you are protecting their right to confidentiality. This method of seeking advice also has the advantage that you do not need to get anyone’s consent in advance of your contact phone call.