Page last updated at 23:03 GMT, Saturday, 18 April 2009 00:03 UK

The voices that help improve care

By Jane Elliott
Health reporter, BBC News

Janey Antoniou
Janey Antoniou coaches ambulance staff in dealing with mental illness

Janey Antoniou has schizophrenia. She regularly hears voices and has paranoid delusions.

But when the emergency services try to help her, or others like her, they can end up making things much worse.

In a bid to try and prevent misunderstandings, Janey, with the use of a tape filled with competing voices, has been coaching ambulance service staff on the world of schizophrenia.

"I see the world differently from other people. I have delusions which can lead me to do strange thing such as walking around London all night trying to get away from a Filipino army.

Hospital stays

"At the moment I am ending up in hospital once or twice a year and if I am stressed and uncomfortable it is more difficult to cope with the illness."

Hearing her talk about her illness, Phil Alexander, of the East of England Ambulance Trust, said he wanted her to explain to his staff the problems those with mental health problems can suffer.

I tell them that they can't turn down the cassette because I can't turn down my voices
Janey Antoniou

"She brings a Walkman with about seven voices on it talking at different volumes.

"One person wears the headphones, while another asks questions and a third observes.

"It gives the observer the opportunity to see what it is like for the person hearing the voices to try and have a conversation.

"We then get Janey to talk about mental health problems.

A patient with mental health problems
The tapes help people experience what it is like to hear voices

"We say if you have a broken leg and in pain you can see it, but unless someone tells you that a patient has mental health problems you have no way of knowing without trying to interpret what is happening.

"It gives them a little more empathy with patients."

He estimated that up to 9% of call-outs involved someone with a mental health problem.

Improving empathy

Janey, who has been schizophrenic for 23 years, says efforts like this do improve empathy.

"I talk about mental health problems to them and give them some personal advice such as moving away from the radio when they talk to me, because to me that is just another voice.

"I tell them that they can't turn down the cassette because I can't turn down my voices."

Ambulance man Chris Perry said his time with Janey had helped.

"It was brilliant, very good, and it gave us an understanding of what people go through when suffering from these disorders that has stayed with me ever since," he said.

"I am quite confident now asking what would have been tricky questions such as, 'Are you hearing voices?'"

He added: "There was a case where a patient's medication did not seem to be working as well as it should and he was hearing voices telling him to do things.

"It was quite a nasty area of the town and we were on edge but I approached him and, once we were sure we were safe, I thought back to the session and talked to him. He was quite open and talked about the problem.

"Before I would have tried to avoid all contact with the patient, which would have only alienated him more."

The idea has been so successful that it has been highlighted, by the NHS Institute for Innovation and Improvement, as one of the country's best examples of how a patient's experiences can be used to improve the health service.

Other schemes which have been praised by the institute include a renal unit that created a "wish wall", allowing patients to highlight problems or issues via Post-it notes, and a stroke team which has put toilet roll holders on both sides in all toilets to help patients who have lost the use of an arm.

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