Evaluating a Pilot ‘Hearing Voices Group’ for People With Learning Disabilities

Abstract

Aims

Adults with learning disabilities have traditionally been excluded from psychosis research studies and intervention trials because of their learning disabilities. There is a distinct lack of knowledge about adults with learning disabilities and their lived experience of psychosis including specific symptoms such as voice hearing. Interventions such as Hearing Voices Groups (HVG) have been developed without thorough understanding of what these experiences mean for this population, I found one pilot study ran by South London and Maudsley (SLAM) in 2018 (1)

• • Understand more about voice hearing experiences in people with a learning disability

• • Evaluate whether an adapted HVG is acceptable and affective in this patient group

• • To obtain feedback in order to improve the group for future practice

Methods

We set up a hearing voices group for people under the Bristol Community Learning Disability Team (CLDT) who experience hearing voices which causes them distress. The sessions for the group were inspired by ideas from the book “People with Intellectual Disabilities Hear Voices too” published by Psychologist Dr John Cheetham, which we adapted into accessible session plans. The group consisted of 6 service users and was facilitated by me and 3 mental health nurses and ran for 8 weeks on a weekly basis for 1 hour 30 mins. Each participant worked through an accessible handout which we then collated at the end to create a take home workbook of all the material covered throughout the group, as well as individual feedback from the group facilitators.

We used CORE-LD 30 and World Health Organisation Quality of Life (WHOQOL-8) tool pre-group and post-group which are both validated tools for use in people with a learning disability. We also conducted an adapted Maastricht's interview with each service user to understand more about their voice hearing experiences and a post group feedback questionnaire.

Results

All participants had a reduction in their CORE-LD score with lower scores indicating fewer distressing symptoms and lower risk to self, with an average reduction in score of 39%. Themes of why they thought they heard voices included: bereavement, bad neighbours, doing something bad in the past. When asked what the voices say, they were mostly negative insults towards the service user or telling them to harm themselves. Feedback post group included: more sessions/more time, learnt ways of coping with voices, helped to speak about the voices, felt safe and less alone, enjoyed sharing experiences, understand voices.

Conclusion

The NICE Guidelines 2017 Quality statement 4 states that we should be tailoring psychological interventions for people with learning disabilities. Previously there were specific interventions for people with a learning disability within the LD service. The evaluation of this group helps to support the effectiveness in adapting a well-established intervention and the value of offering this on a continued basis in the Bristol CLDT.