School-based ECHOES programme shows promise for young people hearing distressing voices

Young people who hear distressing voices may find meaningful support through a brief intervention delivered in their own schools, according to a new qualitative study published in Child and Adolescent Psychiatry and Mental Health. The ECHOES study, conducted in secondary schools in Southeast England, explored whether a short psychoeducation and coping strategies programme could be feasibly and acceptably delivered by Mental Health Support Teams to students who hear voices.

The need for such an intervention is grounded in a striking gap in current provision. According to the researchers, hearing voices is a relatively common experience among school-age children but can be very distressing, and in the UK voice hearing is often stigmatised. There are recognised connections between voice hearing and risks to wellbeing and self-harm, yet no established psychological interventions exist that are specifically designed to support young people who hear distressing voices. Many face long waits for specialist support from child and adolescent mental health services.

The study itself was an uncontrolled feasibility study, meaning it assessed whether the intervention could be delivered in practice rather than testing effectiveness against a control group. Qualitative accounts were gathered from 96 participants across four stakeholder groups: school students, so-called Plus-1s (parents and caregivers), school staff, and the Mental Health Support Team practitioners who delivered the sessions. Data were collected throughout the study through interviews, focus groups, feedback forms and reflective accounts, and analysed using the Framework Method to examine acceptability, perceived impact and implementation experiences.

The findings paint a cautiously encouraging picture. Young people described the intervention as meaningful and supportive, particularly in helping them understand their voice-hearing experiences, develop coping strategies and regain a sense of control. The researchers report that the psychoeducation component acted as a catalyst for meaning-making and narrative change, with some participants describing shifts in how they related to their voices.

Engagement, however, was not effortless. The study found that taking part required emotional investment from the young people, and acceptability was shaped by the school context itself. Academic pressures and concerns about visibility and stigma influenced how comfortable students felt engaging with the programme, highlighting the practical realities of delivering mental health support within a busy secondary school environment.

Across all four participant groups, the analysis identified flexibility, autonomy and relational delivery as key facilitators of engagement. At the same time, a perceived rigid structure in the intervention and abrupt endings limited the benefit for some participants, suggesting that the shape and pacing of the programme matter as much as its content.

The authors conclude that ECHOES is a feasible and broadly acceptable early intervention for young people who hear distressing voices when delivered flexibly within school settings. But they are clear that refinement is needed: the intervention requires greater individualisation, therapeutic materials that are age-appropriate across a wide range of developmental stages, better support for the practitioners delivering the sessions, and improved pacing of endings and follow-up.

Importantly, the study does not establish that ECHOES improves clinical outcomes. As an uncontrolled feasibility study with qualitative data, it demonstrates that the intervention can be delivered and was broadly acceptable to those involved, not that it is effective. The researchers state that further evaluation through a randomised controlled trial is warranted to assess effectiveness and sustainability, a necessary next step before any claims about benefit can be made.

The work is registered as trial ISRCTN16395888 and was published open access on 21 October 2026. For now, its contribution lies in mapping what students, families, school staff and practitioners actually experience when mental health support moves into the classroom, offering a detailed implementation picture to guide the larger trials that will determine whether school-based support for young voice-hearers can become standard practice.

Subject of Research: A qualitative feasibility study of the ECHOES school-based psychoeducation intervention for young people who hear distressing voices

Article Title: Understanding the experiences of young people, parents, caregivers, school staff and practitioners engaged in ECHOES: a school-based intervention for distressing voices

Article References: Parry, S., Ashment, H., Bibby-Jones, A. M., Dixon, C., John, M., Malpass, F., Naito, A., Nicholls, J., Orchard, F., & Hayward, M. (2026). Understanding the experiences of young people, parents, caregivers, school staff and practitioners engaged in ECHOES: a school-based intervention for distressing voices. Child and Adolescent Psychiatry and Mental Health. https://doi.org/10.1186/s13034-026-01171-9

Image Credits: AI Generated

DOI: 10.1186/s13034-026-01171-9

Keywords: ECHOES intervention, voice hearing, school-based mental health, psychoeducation, Mental Health Support Teams, feasibility study, qualitative research, adolescent mental health, coping strategies, stigma, Southeast England, randomised controlled trial