Scenario: I am worried I might say the wrong thing when supporting a person with a mental health condition

​The scenario

You are a disability support worker employed at a drop in centre to run music groups, cooking classes, trivia quizzes and other activities. Julia has just started coming to your centre to participate in activities. She is blind and has been diagnosed with schizophrenia. Julia has a lot to say and is quite open with people that she is a voice hearer. Julia has told you that her ability to hear voices is a gift. Julia has told you that she takes medication, but “thankfully it does not stop me hearing my voices.”

Today, Julia has approached you quite upset and says, “My voices have been silent for two days. I think I need to reduce my medication.” You respond, “That’s great, Julia! That means that your medication is working and taking away your schizophrenia! Don’t reduce your dose – you will become mentally ill again.”

Julia yells at you, “I miss my voices.” One of the activity participants says to you, “I think you got it wrong – she’s clearly still a psycho.” You just shrug your shoulders.

Tips for responding in the moment

• Be respectful.
• Julia experiences voice hearing as positive and it is not appropriate to speak about the loss of voices as a cause for optimism.
• Julia sees her voice hearing as a gift and it is not appropriate to talk about her voice hearing using the language of illness.
• Don’t provide information or advice that is outside your role, including assessment of Julia’s mental health or comments about medication or treatments. Help people to connect with appropriate specialists to get this advice.

What you could say:

• A better response to Julia would have been to say, “I’m sorry to hear that you are unhappy, Julia. I know that the voices that you hear are important to you. I can’t give you advice about your medication, but I can support you to get advice from a doctor if you are interested in that.”
• Always correct other people who speak in ways that are stigmatising, including other people who are participating in your service. You could say to the other participant “Calling someone a “psycho” is not okay, as it suggests someone is not worthy of respect. Julia deserves our respect and support, not insults.”

What approach you could take:

• Be guided by the language Julia uses about herself. She describes herself as a voice hearer and this is the language that you should use when talking about her experiences – not her diagnosis.
• Whilst you may be concerned that Julia could become unwell if she reduces her medication without consulting with her medical practitioner, it is important to respect Julia’s choices.
• At your next contact you could ask Julia what action she would like you to take in the future if you are concerned that she is becoming unwell, and discuss whether she has a Mental Health Wellness Plan that she might be prepared to share with you to assist you to support her the way she wants in the future.

Tips to help prepare for next time

• Learn more about what it means, for different people, to hear voices.
• Contact your supervisor and provide the details of what occurred to obtain advice on future contact.
• Follow your organisation’s guidelines and procedures regarding client safety.

Resources

Intervoice: The International Hearing Voices Network
This website hosts an interactive online community. It includes information on ways of overcoming the difficulties faced by people who hear voices and describes the more positive aspects of the experience.
Type: Web page
Estimated reading time: multiple resources
Produced by: Intervoice

Mental Health First Aid: Psychosis First Aid Guidelines
This guideline helps identify signs that psychosis is developing, and includes information on how to deal with delusions and communication difficulties.
Type: Guidelines (PDF)
Length: 3 pages
Produced by: Mental Health First Aid

The NDIS Code of Conduct – Summary for workers
The NDIS Code of Conduct Guidance for Workers provides guidance for workers in the NDIS about complying with the NDIS Code of Conduct. The guidance provides information and examples about what the Code of Conduct means in practice.
Produced by: NDIS Quality & Safeguards Commission