Listening to the voices of youth mental health

Helen Coughlan is interviewing young people about ‘hearing voices’ and other unusual perceptual experiences in a bid to understand how and why these may be linked to mental health conditions.

Helen Coughlan
Helen Coughlan

If you heard voices in your head as a child, your experience was not that unusual – a recent study carried out at the Royal College of Surgeons in Ireland found that almost one in five of young adolescents surveyed had ‘auditory or other forms of hallucinations’.
For many of those young people, the voices go quiet with age. But some who hear voices go on to develop serious mental health conditions, such as psychosis. Do these kinds of experiences have meaning for young people and how can we know when the voices are trying to tell us something about an impending health issue?
These are key questions that social worker and RCSI researcher Helen Coughlan is exploring through interviews with young people about their experiences.
Making sense of delusions
'I’m interested in how young people who report unusual perceptual experiences, like hallucinations and delusions, themselves describe those experiences and make sense of them', explains Coughlan, a Clinical Research Fellow at RCSI. 
'I also want to explore the relationship between adverse life events, mental health difficulties, traumas and the persistence of those experiences over time'.
Coughlan is following up with young people who took part in the ‘Adolescent Brain Development’ [] study at RCSI to find out about their experiences. 'Only a tiny proportion of people who have unusual perceptual experiences are ever going to transition to a really poor outcome, but if we can find links to why that happens then perhaps we can identify others earlier on and help them', she explains. 
The human dimension
Coughlan is well used to being a team player - she played volleyball for Ireland and enjoys choral singing  – and her experience as a social worker brings something new to the team at RCSI. 
'I am a social scientist in a research field that is dominated by quantitative data and large datasets', she explains. 'But I am really lucky because I think there is a growing appetite for exploring the more subjective experience of the person. Human beings are complicated and we really need to look at how people respond to and interpret their environment and experiences'.
Social work was Coughlan’s top choice for study – she got her degree at Trinity and soon discovered a love of community work and psychotherapy, spending time in Canada and Ireland and working with the Deaf community, Our Lady’s Hospice, Headstrong and St John of God Hospital. She combined clinical work with lecturing at Trinity and SJOG and was an author on the International Declaration on Youth Mental Health [] in 2011.
Youth mental health  
'There is a big move to try and do more research in youth mental health', explains Coughlan.
'At the moment adult services cover ages 18 to 90, but 18 is a totally arbitrary cut-off point. Also, mid-adolescence into early 20s is a peak period of risk for mental health so to clump all adults together in the 18-90 group for mental health services is ignoring the evidence'.
The Declaration led to a meeting with the Minister with responsibility for mental health. 'We argued the need to target young people in the mental health services, and that the policies should be data driven', recalls Coughlan.
That work also introduced her to Prof Mary Cannon from RCSI, a primary investigator on the Adolescent Brain Development study, and through a HRB Fellowship Coughlan joined the research group.
Getting to work with people as part of the research is an 'enormous privilege', says Coughlan, and the combination of clinical and research experience gives her a nuanced view of mental health.
Ultimately, she hopes that her findings will have an impact on policy, practice and, above all, people. 'It’s great to have high-impact papers as an outcome of research but we shouldn’t over-emphasise that - the people who are reading journals are not always the practitioners working with young people on the ground. When a person is sitting in your office and you are listening, that is the greatest impact you can have for the person at that time'.
Co-ordinate the efforts
Coughlan would also like to see more cohesion and strategy in mental health research and services in Ireland. 'We have lots of people stepping up and telling their stories and that shows there are clearly issues, but we lack evidence-based policies or strategies,” she says. “In cancer Ireland has been more strategic and clever and savvy and people worked together, but in mental health people are competing to have their voices heard'.
Ideally, she would like to see services in Ireland direct age-appropriate support for people across the continuum of mental health, and she hopes that her research will help move that forward. 'You don’t become a social worker without wanting to make the world a better place', she says. 'The merit here is the link between research data and service provision – I want to influence policy and practice'.

Helen was in a conversation with science writer and journalist Dr Claire O'Connell.