“Mieux Vivre Avec Les Voix” (Living Better with Voices)

Innovation summary

Hearing voices has along been a stigmatizing topic, leading those suffering to avoid speaking about their issues openly and subsequently leading to isolation and other dehabilitating circumstances. "Living Better with Voices" seeks to focus on this topic from a different angle by advocating for the acceptance of these experiences as real and meaningful, and encouraging the individual to ascertain control over his/her voice and his/her life.

The individualized, support and training program offers:

Knowledge about the voice-hearing phenomenon
Exercises that enable the individual to better understand his/her voices
Encouragement to use different types of strategies of adaptation
Eloquent testimonies of people who are dealing well with this phenomenon.

This program is also adapted to support families, community organizations and hospitals, seeking to create dialogue, working to de-stigmatize, and wanting to develop a support network for people who hear voices.

Impact summary

30 participants in "Living Better with Voices" program per year
"Living Better with Voices" training has been conducted in 55 public schools and community colleges, universities and at conferences attended by more than 3,000 participants

"Paying attention to voices and taking the time to listen to them is part of the solution. Voices have a rationale. We must develop the art of speaking with voices."

- Dr. Sandra Escher, one of the pioneers of research on the phenomenon of voices¹

Innovation details

Though Le Pavois was established in 1989, the “Living Better with Voices” program is a more recent initiative. The program was established in 2005, inspired by the international movement of voice hearers and recent research conducted at Laval University.

Structure of the Program

Individuals enrolled in the program meet weekly for two hours, where they develop a structure of personal thought, which is used to work with their voices. Through an individualized plan, and actions, exercises, strategies and sharing with people who are coping with their voices positively, participants learn about their voices, and how to make sense of, and regain control over, them.

The first hour of the meeting is devoted to sharing the experiences lived by participants during the past week, as related to the voices and the strategies used to create change. The second hour is devoted to content from the volume (e.g. adaptation stages, journal of voices, negotiating with the voices, and commitment for the week).

The objectives of these meetings are to:

Allow the participants to freely discuss their voices in a respectful context
Find alternative explanations to the phenomenon of voices than those related to symptoms of mental illness
Learn about research and experiments with people who hear voices in other countries
Know and apply different strategies and approaches to better cope with the voices
Develop a structure of personal thought that will facilitate adaptation to the phenomenon of voices
Seek empowerment over their voices and their life.

Trainings and Research

Awareness training, provided by the non-profit, is also available to community organizations, hospital centers and people in recovery (and their carers).

Le Pavois has also worked with Laval University to further research evidence on this topic. Research studies have been conducted to validate the program. The team has also written documents and a book on the topic.

Other Related Initiatives by Le Pavois

Le Pavois created the REVQuébécois (Quebec Voice Hearers Network) and is now supported by two other organizations (AQRP and ROBSM). The network aims to promote an approach to voice hearers which accepts, supports and integrates their experiences and their different perceptions as related to the voices. It mobilizes and supports emerging groups, creates awareness, exchange and development activities, provides information on its website, and liaises with national and international networks.

The program team has produced a DVD entitled "Living with the Voices" in which different people who hear voices educate us about their experiences and allows us to understand this human phenomenon.

Key drivers

Supportive Management Team

The support and confidence of Le Pavois management team

Willingness of Participants to Share Experiences

The openness of participants in sharing their experiences both during the program and in offering testimony in awareness training and implementation of the "Living Better with Voices" Program

Positive Research Results

The research results that increased credibility of the program

Engaged, Accepting, and Supportive Stakeholders

The openness of stakeholders in accepting respectfully the experiences of voice hearers

Recognition of the "Living Better with Voices" program by the Ministry of Health and Social Services (MSSS) and the Association of human rights groups (AGIDD)

Support from partners of the international network of voice hearers

Approach and Model Used

The recovery-oriented approach and the strengths model adopted at Le Pavois in the individualized support offered by recovery agents

Challenges

Lack of French Resources

Difficulty in finding French literature and resources pertaining to this topic as they do not exist

Initial Hesitance from Stakeholders

Demystifying concerns (fear of relapse, inherent danger, fear of worsening symptoms, severity of the problem), and biases of stakeholders, partners and other clients’ who do not hear voices.

Challenging Traditional Perceptions of Voices

Changing the perceptions in traditional psychiatry that consider voices as hallucinations, a symptom of mental illness in which the person is powerless, toward a perception of voices as a meaningful human phenomenon over which the person has power

Changing the paradigms of stakeholders, relatives and people who hear voices in relation to medication as the only tool to eliminate the voices, and the interventions focusing on suppression and denial of voices, and powerlessness about this experience.

Continuation

The team plans on implementing this program throughout the region of Quebec while developing alternative approaches to the needs expressed by people with a mental health issue. In addition the program team will continue to offer awareness trainings within the health and social services network, and among the population.

The Quebec Network of Voice Hearers will be further developed to extend the reach of this approach, which accepts the experiences of the person, gives it meaning, facilitates a break-up from the influence of voices and facilitates the individual’s development.

The organization will also seek funding to facilitate the further dissemination of information within the health and social services network as well as within society.

Evaluation methods

Four research projects were conducted in collaboration with Laval University and the International Community-University Mental Health and Citizenship Research Alliance (ARUCISMC).

The first study focused on evaluating how the goals of the program "Living Better with Voices" had been met, and assessing the degree of distress of the participants over the successive meetings, as well as the changes in the frequency, quantity and quality of voices: "The voice hearers: Evaluation of a training and support group."
The following two research projects focused on the effects of the group on participants: The voice hearers: Evaluation of the effects of group training and support, Part 1 and Part 2".
The last research study evaluated the effects of coaching by a recovery agent for each person attending the group meetings: "The effects of the approach offered at Le Pavois among voice hearers: The combination of group therapy and individualized strengths-based monitoring".

Qualitative and quantitative research studies have been completed to evaluate the effects of individual approaches with group therapy on the quality of life and social functions of voice hearers regularly visiting Le Pavois. Participants were assessed pre, mid-point and post-program. Individual interviews using previously validated and evidence-based tools assessed perceived changes by participants, and peripheral observation by an external party of participants during the group sessions, using observation checklists adapted and developed by Le Pavois.

Cost of implementation

Le Pavois has integrated this activity into regular programming without increasing the costs associated with the services. During the implementation of new groups elsewhere in Quebec, the same low-cost operating model is applied.

Three hour awareness training and 12-hour training for the implementation of a group of voice hearers, including implementation support are offered. Please contact the organization for the price associated with this service.

Impact details

At Le Pavois, on average about 30 persons who hear voices annually are enrolled in the program. The team works to facilitate their empowerment as it relates to their voices and their lives. Their quality of life improves and the influence of voices is reduced. For some, integration in employment or education is becoming a reality, new friendships are forged, and the pleasure of living increases through leisure activities. Everyone fulfills his dreams.

"Living Better with Voices" training was conducted in 55 public schools and community colleges, universities and at conferences attended by more than 3,000 participants. Following implementation training, 15 mental health organizations in different Quebec regions now offer this service and others are about to start offering it.

"Living Better with Voices" has been consulted by more than a hundred persons internationally. For example, training and support have been provided to the Centre for Community Psychiatry, associated with Budapest University, and a partnership has been formed for the tools to be translated into Hungarian to develop a group of voice hearers focusing on a recovery-oriented approach.

A book, based on psychoeducational activities, was produced to help form groups of voices hearers. It is also a valuable tool to support an individual approach, as well as accompanying stakeholders and friends. The books rests on a number of principles: voices are accepted as real; voices are full of meaning linked to the life of the person; everyone has the ability to capture the power of his/her voices; working with voices allows the person to expand his/her affirmation and accomplishment abilities.

References

Soucy B. (2013) Statements made in the first gathering of the francophone voice hearers networks. AQRP Le fil conducteur. 4(13)

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