It was the cacophony of voices that caused Ian Hopkirk finally to snap. Distressed, he was forced to leave the room to compose himself. The police constable had a friend with schizophrenia, but had never realised what it must be like.
The simulation exercise made the 30-year-old officer think for the first time how terrifying it must be to have schizophrenia and to undergo questioning by the police. His dramatic revelation was precisely what a groundbreaking scheme in Kent was trying to achieve. In a series of seminars over the past two years, police and schoolchildren have had their prejudices towards mental illness challenged - and their outlooks broadened.
The workshops, run by mental health professionals, carers and people with mental health problems, were set up to challenge the stigma and discrimination that still hamper people with mental illness. Despite commitments by ministers four years ago to stamp out discrimination, research suggests that stereotypes surrounding illnesses such as schizophrenia - commonly and wrongly caricatured as split personality still persist.
Debunking such myths was the aim of the Kent experiment, the first of its kind in Britain. Six hundred 14-year-olds and 200 police officers were involved in the project, an evaluation of which is published today in the British Journal of Psychiatry.
The workshops stressed four main messages: people can recover from mental illness; violence is not a symptom; one in four people experience mental health problems at some point in their lives; and everyone has emotional/mental health needs.
Leaflets giving the facts about mental illness were handed out during the workshops, which also included the exercise on hearing voices and a talk by people with mental health problems about their experiences.
For Hopkirk (not his real name), the moment of realisation came during a reconstruction of the questioning of a person with a history of schizophrenia who was suspected of shoplifting. The officer was chosen to be the suspect and was told to sit at a table, between two colleagues who, playing the voices, were asked to read different scripts. On the opposite side of the table were two other officers who began to question him about the alleged theft.
The experience left him upset and bewildered, according to Vanessa Pinfold, a research coordinator, who is based at the Institute of Psychiatry in south London. "Police officers are used to filtering out noise, but this really gave a feel of what it's like to have different thought processes," says Pinfold, who conducted the research as part of a joint-working initiative with mental health charity Rethink.
The research team evaluated the training provided by two voluntary mental health awareness groups in Kent, based in Sevenoaks and Maidstone. To her surprise, Pinfold found that as many as one in four police officers admitted they would treat future suspects with mental health problems differently as a result of the role play. This figure increased to more than 40% after officers listened to people recount their experiences of mental illness, according to the study - the first to examine what makes mental health awareness training successful.
Evidence of a more positive approach has already been picked up by local mental health service-users, including those involved in the project. Miki Brunt, 32, helped run some of the workshops for police and teenagers. Police were unaware of her mental health problems until she spoke about her experience of manic depression, also known as bi-polar disorder.
"Quite often there was a reaction of: 'You don't look like someone with a mental health problem'," says Brunt, a former stockbroker, who was diagnosed three years ago. "Officers seemed to have this vision of people banging their head on walls. I would tell the police that sometimes people with mental health problems are scary to look at, but usually we are more scared than scary."
Brunt, who first became ill eight years ago, said going into a police station used to be "talking to a brick wall". That has now changed. "Now there are officers mental health service-users can talk to. One police officer even told me he had had two weeks off because of stress. In the past, he would have said flu."
The results have impressed Pinfold, who says training will continue with police and other local organisations which have staff likely to come into contact with people with mental health problems. It was hoped that staff from the benefits agency would attend the workshops but, according to Pinfold, managers pulled out at the last minute.
For the police, the training certainly has been an eye-opener. One person closely involved in the research was John Boyden, a community officer in Maidstone. He wants to see the messages from the workshops built into future basic training of police recruits.
"There is no doubt that all of the officers have improved their outlook and how they approach people with mental health problems," says Boyden, who attended the training courses and is a member of a mental health awareness group. Police officers have to make quick decisions, he points out, and it is all too easy to categorise people. But the workshops showed that mental health problems covered a wide range of illnesses and how disparaging it was to use terms such as "nutter".
"It was very brave of service-users to stand in front of police officers and talk about their health and social problems," says Boyden. "What came across was that society is more a danger to them than they are to society. The officers learned that it is not enough to say that someone is ill, but to ask why and whether the services were doing enough for that person. They now know how to get help."
Police who took part in the workshops have been frank about the impact on them. One noted: "I felt far more confident dealing with the subject; a more sympathetic approach." Another said the workshops "helped me to understand people's feelings and give them advice". He added: "I felt I was more patient and listened to them."
A different approach has been taken in schools, where talking about stress and how to deal with it has formed a key part of the workshops. Facts about mental illness have been presented to teenagers, who said they had regarded people with mental health problems as "thick" and "violent".
"We stayed away from schizophrenia because we felt it was too complicated a concept for young people to take on board," says Jackie Brewer, who oversaw the workshops in five schools. She is now extending the programme to other schools in Kent. "If you leave children a message without them having a clear understanding, there is a danger you can do more harm than good. Instead, we placed an emphasis on emotional health, and trying to give each pupil an understanding of their own needs and how they might change over time.
"Hopefully this will help them cope better with exam pressures, and major life events such as bereavement in later life. We also want them to take home the message that you can recover from mental illness and that one in four of us is likely to have mental health problems at some point in our lives."
Pinfold says the project shows how stigma can be tackled if people with mental health problems - "the real experts" - work alongside professionals in the community. Boyden puts it another way. "We've had measures to combat racism and homophobia in the police," he says. "We need the same kind of initiative to combat the stigma surrounding mental illness."
