Exploring the Lived Voice-Hearing Experiences of Men with a Learning Disability in Secure Units and Examining the Views of Forensic Nursing Staff About the Value of Shared Written Voice-Hearing Accounts

Making sense of voice-hearing is complex, with many explanatory frameworks. A recent paradigm shift to focus on the meaning of voice-hearing from the perspective of the voice-hearer has not yet included research with people with a learning disability who may have additional difficulties with the sense-making process. Voice-hearing is associated with a significant amount of stigma. Men with a learning disability in forensic settings who have complex histories including mental health issues, dangerous risky and offending behaviours, who also hear voices, are potentially one of the most stigmatised and feared groups of people.

This qualitative research examined the value of first-hand accounts of the voice-hearing experiences of men with a learning disability. Ten men from low and medium secure care settings for people with learning disabilities participated in a semi-structured interview about their voice-hearing experiences. These were analysed using interpretative phenomenological analysis in order to develop understanding of the men’s subjective experiences and sense-making processes. The second part of the study used semi-structured interviews and template analysis to explore the views of forensic nursing staff about the value of two of the voice-hearing accounts produced in the first part of the study for informing practice.

The findings of the first part of the study demonstrated that participants with a learning disability were able to articulate and share accounts of their voice-hearing. Exploring voice-hearing experiences revealed four master themes; ‘a real reality paradox: an active process to figure out the real and the unreal’, ‘powerful and controlling voice pulling the strings’, ‘an emotional journey: ups and downs’ and ‘trying to learn to live with the voices’. The second part of the study identified two overarching themes which characterised staff views of the voice-hearing accounts: ‘an individualised understanding: learning from voice-hearers’ and ‘a personalised and collaborative approach: enhancing care and support’. Together these themes suggested the value of the accounts for ‘understanding and working with people as unique individuals’.

This study has indicated that people with a learning disability mostly make sense of their experiences of voice-hearing in many similar ways to others but there are some interesting areas of divergence with their meaning-making. Forensic nursing staff and voice-hearers valued the written voice-hearing accounts highly. Implications for practice are discussed.