A speech bubble on a colourful background reading: "I've been feeling ... Can we talk?".

Open up on #TimetoTalk Day 2023

Today is Time to Talk Day, a day dedicated to breaking the silence around mental health. It’s a reminder that it’s important to check in on our mental health and the mental health of those around us. But let’s not limit these conversations to just one day a year. Let’s make it a daily practice to check in with ourselves and each other.

We’re taking this opportunity to remind everyone that it’s okay to not be okay and encourage you to reach out for support if you need it. Here are some general tips for maintaining good mental health.

  1. Take care of your physical health by eating well, getting enough sleep and exercising regularly.

  2. Connect with others, this could be through face-to-face conversations, phone calls or virtual chats.

  3. Practice mindfulness and relaxation techniques such as meditation or yoga. There are some great options online including Yoga with Adriene and the Calm app.

  4. Set realistic goals and work towards achieving them.

  5. Remember that it’s okay to ask for help.

Listening tips

Although it is Time to Talk Day, it’s also important to consider the people who listen and offer support.

At different times in life we may need to talk, at others, we may take on the role of listener and supporter. Both sides of this equation can be challenging and rewarding in different ways. Listening can feel draining or can impact your own wellbeing, but it can also help you feel connected and positive about your impact on others.

However, sometimes it can be hard to know how to reach out and talk to a someone who may be struggling with their mental health. Here are some tips to keep in mind:

  1. Be direct and honest. Let your friend know that you’re there for them and that you are worried about their well-being.

  2. Actively listen. Give your friend the space to share their thoughts and feelings, without judgement.

  3. Validate their feelings. Let them know that it’s okay to feel the way they do and remind them that they are not alone.

  4. Offer support. Let your friend know that there are people and resources available to help them (see resource list below).

  5. Encourage them to speak to a professional. Sometimes talking to a therapist or counsellor can be the best way to get them the help they need.

There are many charities out there who provide support and resources for people facing mental health issues. Some of these include:

  • Mind: Offers advice and support for better mental health.

  • Samaritans: Provides confidential emotional support to anyone in distress or finding it hard to cope. Samaritans are available to speak to 24 hours a day, all year long. Call them on 116 123 (free from any phone).

  • Rethink Mental Illness: Works to improve the lives of people affected by severe mental illness. Call them on 0808 801 0525 (between 9:30am and 4pm, Monday-Friday). If you want to webchat instead, visit this link between 10am and 1pm, Monday-Friday.

  • SANEline: If you are supporting someone with mental health problems or going through a mental health problem yourself, call SANEline on 0300 304 7000 (lines are open between 4:30pm and 10:30pm everyday).

  • Campaign against living miserably (CALM). Call the team on 0800 58 58 58 between 5pm and midnight, the lines are open every day. If you’d rather not speak on the phone, CALM have their own webchat service.

  • Your GP: Don’t forget, your mental health is just as important as your physical health.

If you, or someone you know is struggling with mental health, reach out to these charities, other support organisations or friends and family for help. Remember, talking about mental health is not a sign of weakness, it’s a sign of strength. It’s Time to Talk.

Time to Talk at court

Communicourt specialises in facilitating communication for individuals going through court proceedings. We see first-hand the very high levels of stress that court users can experience, and the toll legal proceedings can take on people’s mental health. In turn, this can negatively impact upon communication. 

From communicating with court users with mental health difficulties at some of the most difficult moments of their lives, our intermediaries are skilled in supporting people to talk at difficult moments.

Here are some lessons we’ve learned about really listening at court…

  1. Build rapport and create a safe and comfortable environment to enable effective communication.

  2. Allow time for clear communication and actively encourage court users to express themselves.

  3. Be aware of emotional dysregulation and provide support in a non-judgemental and empathetic way. Consider whether the individual needs a break and ask about strategies which can help them at difficult moments (whether that’s taking a walk, listening to music, doing a mindful activity or speaking to a supportive loved one).

  4. Ensure court users understand the legal proceedings and the court process.

  5. Empower court users to take control of their own mental wellbeing. Provide them with the resources (e.g., stress balls or fidget objects) they need to cope with the stress and uncertainty of a court case.

At Communicourt, we see first-hand how mental health difficulties can impact an individual’s ability to navigate the legal system. To find out more about the intermediary role, explore our website or visit The Access Brief (a free library of resources for legal professionals working with clients who have communication difficulties, including mental health difficulties).

On The Access Brief, you will find free downloadable guides on topics including supporting emotional regulation, assisting clients who have a range of diagnoses and what it’s like to work with an intermediary at all stages of family and criminal proceedings.

Intermediary assistance and EUPD

How does Emotionally Unstable Personality Disorder (EUPD) impact court users involved in legal proceedings? And how can an intermediary assist? Communicourt intermediary, Rhianna McGreevy, takes a closer look at this diagnosis and strategies to improve access to justice.

Emotionally Unstable Personality Disorder [EUPD] (also known as Borderline Personality Disorder [BPD]), is a complex and misunderstood condition. Individuals who carry this diagnosis may experience longstanding pervasive difficulties in relating to others and themselves. The difficulties that individuals with EUPD experience will usually be apparent in multiple situations across their personal and professional lives.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies 10 personality disorders, which are subdivided into three ‘clusters’. These clusters group the disorders in terms of their defining characteristics. EUPD is one of four personality disorders in Cluster B, all of which are defined by their “dramatic, emotional or erratic” nature.

What causes EUPD?

It is hard to determine what causes EUPD, but studies have suggested that it is likely a combination of genetic and environmental factors. The heritability of EUPD is estimated to be around 46%. However, while genetic pre-disposition may increase your likelihood of diagnosis, there are many other factors that contribute to someone’s overall risk of developing EUPD. The individual, their environment and their personal circumstances are all extremely influential.

It is common for people with EUPD to have experienced a significant trauma. Common environmental factors that have been experienced by people with EUPD include being the victim of sexual, physical, or emotional abuse, or the experience of adverse childhood experiences (ACEs) which can include growing up in a neglectful environment, growing up in fear, or living in the shadow of a relative with poor mental health or substance abuse issues.

Stigma and labels

EUPD is heavily stigmatised as a condition, and individuals with the diagnosis are often deeply and profoundly misunderstood. Using the word ‘disordered’ to describe an individual’s personality can denote a sense that there is something wrong with the very essence of who they are. The individual with EUPD may find that others do not view their behaviour in the context of their diagnosis, but rather see the individual as being wilfully and deliberately unreasonable or selfish.

This simplifies a very complex subjective experience and disregards the deeply rooted causes of EUPD. Our brains are constantly trying to adapt and survive, and personality disorders are often developed in response to difficult circumstances. Emotionally unstable personality disorder, and the thoughts, feelings and behaviours that accompany it, are more helpfully viewed as the brain trying to adapt in order to survive the abandonment, abuse, or neglect it has experienced in the past, and to protect the self from experiencing similar traumas in the future.

Symptoms of EUPD

Individuals with EUPD often live with an intense fear of abandonment. They may carry a deep-rooted belief that they are inherently ‘bad’, and that others are ‘good’. They may also be hypersensitive to the possibility of rejection. If they feel as though there is a threat of being abandoned, whether this threat is real or imagined, this can cause them to spiral into self-destructive patterns.

The emotions that accompany rejection or abandonment can be incredibly painful for individuals with EUPD to process, and the resultant behaviours may explode outwards in the form of lashing out at others or sabotaging interpersonal relationships. Individuals may also internalise rejection as confirmation of their essential ‘badness’, or ‘worthlessness’, and this may manifest as feelings of deep self-loathing, disassociation from the self, or even self-harm and suicide. Between 3% and 10% of people diagnosed with EUPD take their own lives, a figure that is 50 times higher than the suicide rate in the general population.

Relationship difficulties

Photo by Kelly Sikkema on Unsplash

Another common feature of EUPD is unstable and tumultuous personal relationships. There may be intense and abrupt changes in how they perceive and relate to those closest to them. A person with EUPD may have unrealistic perceptions of others, lurching between seeing someone as an idealised version of themselves who can do no wrong, to an enemy who is vindictive and cruel. The emotional inner life of individuals with EUPD is very complex and intense, which means that they can find it difficult to understand other people’s perspectives. This can be unpredictable and difficult to deal with and consequentially makes it very difficult for people with EUPD to sustain long-term, healthy interpersonal relationships. Their personal lives may be characterised by patterns of instability and volatility.

Relationship to self

In the same way that individuals with EUPD may struggle to relate to others, they can equally have difficulty relating to their own sense of self. They may behave impulsively, suddenly shifting their identity, career, outlook or plans. They may be self-destructive or reckless and engage risky behaviour, such as substance abuse, gambling or self-harm.

Emotional regulation

Individuals with EUPD are highly sensitive, and can experience intense emotional shifts, which may be triggered by relatively small stimuli. Analogously, if a person had experienced a serious injury to their leg, it would only take the slightest of impacts for the wound to be re-opened, and for the intense pain to return. Similarly with EUPD, what may seem a minor incident to others, can result in an all-consuming and apparently disproportionate emotional response. In particular, individuals with EUPD may have difficulty managing conflict in relationships and regulating their anger. They may have outbursts which escalate out of control. They may find it difficult to calm down and self-soothe, and their anger may eventually collapse inwards into feelings of shame and guilt, which intensifies their negative self-view.


Photo by Randy Jacob on Unsplash

EUPD is often characterised by chronic feelings of emptiness. This may manifest as a feeling of numbness and an unsettling sense of disconnection, both with others and with the self. In these periods of emptiness, people with EUPD may appear restless and seek external distraction. In times of extreme emotional distress, this sense of disconnection may deepen into a state of de-personalisation or de-realization. This is a temporary state of extreme dissociation, where the individual detaches from reality completely. The individual may feel as though they are not a real person or that they don’t exist at all.


Photo by Tamanna Rumee on Unsplash

In addition to the specific challenges of EUPD, the diagnosis has a high rate of comorbidity, which means that individuals with EUPD often live simultaneously with other mental health issues. The most common comorbid diagnoses with EUPD are depression, anxiety and substance abuse. This adds a separate and distinct layer of challenge for the individual, which could further impact their ability to manage the challenges of their diagnosis.

EUPD in court proceedings

Living with emotionally unstable personality disorder can be intense and challenging at the best of times. These difficulties are only heightened in the court environment, which can be relentless, stressful, and highly emotional. Without adequate support, there may be a significant negative impact upon individuals with EUPD who have to attend court. The experience may have destructive consequences for their emotional wellbeing, and their ability to fairly participate in the court process may be impacted as a result.

Emotional management

Intermediaries can offer a level of assistance and support to individuals with EUPD which may improve their experience of court and increase their ability to participate. Intermediaries are not advocates, support workers or mental health professionals, and we are employed solely to assist the understanding and participation of the individual. However, there are circumstances in which intermediary assistance can positively affect emotional management. For example, if an individual is becoming distressed in court proceedings because they are struggling to understand what is happening, the support of an intermediary to understand what is being discussed may prevent them from becoming emotionally dysregulated.

Clear, consistent communication

When working with service users with EUPD, it is crucial that good communication is modelled by professionals. The most effective communicators will present information in an accessible way, with patience, dedication, and transparency as central principles. Anything less than this may leave the service user feeling left in the dark and confused. For individuals with complex emotional needs, clear and consistent communication is especially important. For example, language may be routinely used in court with which the service user is unfamiliar, or time constraints may mean that there is not an adequate chance within each hearing to process information. The service user may not be informed about the purpose of a specific hearing, or they may not have any concept of what to expect from the court day. For individuals with complex emotional needs, situations like these may leave them feeling left behind, unimportant or disregarded. This could be triggering for the individual and may cause them to spiral into an adverse emotional response.

The intermediary role, as a dedicated communication specialist who is ultimately impartial, can help to mitigate some of the risk of a negative experience for a service user with EUPD. In court, the intermediary will endeavour to make sure that the service user is fully informed about what is being discussed at all stages of proceedings, by using simplified explanations and visual aids. The intermediary can also create a court timetable, to manage expectations about what is happening within the court day. The intermediary can ensure that the service user has a clear sense of the purpose of each hearing, and that they feel included in the conversations which concern them. An intermediary’s presence can help to bridge the gap between the complex legal discussions that take place at court, and the unique emotional needs of a service user with EUPD.

Rapport building

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Intermediaries are adept at building rapport, and this is central to a constructive working relationship with any service user, but particularly one who has a diagnosis of EUPD. Working closely with someone with this diagnosis can be an unpredictable experience, and the difficulties that individuals with EUPD have with emotional regulation will only be exacerbated in an emotional court environment. When rapport is established, this is a foundation of trust from which effective strategies can be implemented, and support offered in moments of dysregulation. For example, the intermediary can assist the service user by implementing grounding exercises, such as deep breathing. They could also offer the use of anxiety aids, such as fiddle objects, to assist the service user to remain calm. The intermediary can offer a level of emotional support to the service user if things reach a crisis point.


It is important, however, for clear emotional boundaries to be in place at all times. The balance needs to be appropriate, and the impartial role of the intermediary uncompromised. The intermediary must not be inflexible, if they are too rigid and stringent with their emotional energy, they may appear defensive or cold. Conversely, if the intermediary does not establish healthy personal limits, they may find themselves taking on the emotions of others, which may interfere with their ability to provide appropriate support.


If an intermediary is able to build a strong rapport and working relationship with a service user who has EUPD, they may be able to anticipate the triggers which cause negative reactions and prevent them from occurring before things spiral out of control. The service user may function better at a particular time of day, or in a particular setting. The intermediary can make recommendations to the court based on this, for example, suggesting that hearings take place in the afternoon, or suggesting the service user attends from a familiar environment, such as their solicitor’s office. The service user may find it harder to regulate their emotions if they are fatigued, uncomfortable or hungry. Although this may sound relatively simple, these factors can have significant consequences and are easily avoided. The intermediary can monitor the service user’s wellbeing and alert the court to take breaks as needed. The service user may be triggered by coming into contact with specific individuals, and special measures, such as screens, can be used to prevent individuals from encountering other parties in proceedings.

Giving evidence

Often individuals with EUPD will find it difficult to remain calm when they feel they are being ‘attacked’. Whilst court is undeniably a tense environment, and giving evidence is doubtless a stressful experience, the intermediary can make recommendations to help make this process less fraught. For example, when giving evidence, it may assist the service user if they are asked questions in a neutral tone, as they may respond poorly to an adversarial approach. The service user may be more likely to give their best evidence if questions are pooled, and asked by one advocate, as this limits the number of people the service user will have to interact with and may remove an element of anxiety about the process. The service user may be assisted by frequent breaks whilst giving evidence, to manage the increased pressure on their communication skills, and the likelihood that they may become dysregulated if they have to confront difficult and distressing topics during questioning.

EUPD is a complex condition which is extremely challenging for those it impacts. The emotional turmoil that individuals with this diagnosis may experience can be a significant barrier to their understanding and participation in court. There is no simple remedy for the challenges that this diagnosis poses, but the assistance of an intermediary can offer dedicated support and strategies to assist individuals with EUPD throughout proceedings.

Communicourt resources

Learn more about mental health and communication difficulties on The Access Brief, a growing library of downloadable resources for legal professionals, developed by intermediaires. The collection includes guides to Attention Deficit Hyperactivity Disorder, Post-Traumatic Stress Disorder, creating visual aids to support clients with communication needs, writing easy read documents and more!

To learn more about ‘Hidden Disabilities’ like EUPD, tune into series 2 of our Accessing Justice Podcast. In this series, we talk to experts about conditions which affect communication, but may be overlooked at court, from stammering and trauma, to ADHD.

Logo of the Accessing Justice podcast (text with an icon of the scales of justice)
Man sitting outside with his head in his hands

How does stress impact court communication?

International Stress Awareness Week is a chance to explore ways to recognise, manage and reduce stress. Stress is a normal part of life but, in some cases, it can have a profoundly negative impact, resulting in feelings of hopelessness and an inability to cope. Although acute manifestations of stress can be a prompt which forces us to look more closely at the causes of stress in our lives, stress at any level should not be ignored, as its effects can be low-level but cumulative.

This post will outline what stress actually is, how it can affect individuals, how it can impact communication and how it can be managed in the courtroom to minimise its impact on court users.

Stress at court

There are no two ways about it – court is stressful. It’s often an unfamiliar and strange environment, where difficult topics with serious consequences are discussed and emotions understandably run high. To ensure effective participation, it is essential that defendants, respondents, appellants and other court users understand their case and are able to articulate their position. Unfortunately, stress often significantly impacts a person’s ability to communicate.

Our role, as intermediaries, is to provide communication support for court users who have identified communication needs, but it is important to remember that stress can negatively affect anyone’s communication skills. For court users with existing communication difficulties, however, the impact of stress can be magnified and could further hinder their ability to communicate effectively during proceedings.

What is stress?

Stress is how we react to something that is currently happening, it often makes us feel ‘under pressure’ and usually occurs when we feel we cannot control a situation. It can lead someone to feel anxious, irritable, confused or overwhelmed.

Stress can manifest itself through physical symptoms such as muscle tightness, rapid breathing, a flushed face and an increased heart rate. But it can also affect mental health and someone’s ability to communicate, as they may have racing thoughts making it difficult to process information and stay focused.

How does stress affect communication?

When we experience heightened stress, there is likely to be a negative impact on our communication skills. Many people have a ‘rabbit in the headlight’ type experience which can lead to confusion. Someone who is stressed may become frustrated more easily and, when emotions are heightened, an individual may find it challenging to communicate, both in terms of expressing themselves and in terms of their understanding.

People respond to stress in different ways; some people may decide to disengage from communication when feeling high levels of stress. This can create a barrier between the individual and the help and support they may have otherwise benefitted from. In a legal setting, someone feeling stressed may stop engaging with their solicitor or may even not turn up to court. When feeling stressed, people may have a ‘fight’, ‘flight’, ‘freeze’ or ‘faun’ response (learn more about these presentations here) and it’s important to remember that everyone will respond to stress differently. Additionally, if someone is feeling stressed, they are more likely to miss information as their ability to concentrate will be affected. If someone has not taken in and retained information, they may struggle to communicate, as they may not have understood the key points of the discussion.

Managing stress in the courtroom

The courtroom is a stressful environment and therefore effective communication can be challenging to achieve. However, in this setting, clear communication is vital.  It is important that everyone has the opportunity to explain their side of the story and understand the position and evidence of others involved in the case.   

In the courtroom, there will be some stress-inducing factors which simply can’t be alleviated. However, it’s important to identify the things that are within the court’s control, which can be addressed.

There are a number of ways to try to reduce stress within the formal court environment:

  1. Introductions
    Introductions can go a long way to helping someone feel more at ease. A court user is often met with lots of new faces on their first day at a trial or hearing. In many cases, they have never even met their barrister face-to-face before. It is helpful when a representative from each party (e.g., the prosecution barrister or counsel for the Local Authority) introduces themselves to the court user prior to the case commencing. This helps the individual to feel more comfortable and also helps their understanding once in court, as they know who is speaking on behalf of whom.

  2. Familiarisation visits
    A quick visit to the courtroom to have a look around, see where everyone will be sitting and get a general ‘feel’ for the room can really help an individual feel less stressed before their trial or hearing begins.

  3. Fidget objects
    Fidget objects are great tools to help someone stay focused and calm, even in times of stress. This could be anything from a tangle toy, stress ball or even a pen and paper to doodle with. An intermediary can provide an appropriate tool to aid emotional regulation and ability to attend to the proceedings.

  4. Book a conference room
    Courts are busy places, often it can be hard to find a quiet space to take a breather and gather thoughts. If a conference room can be booked within the court building, this can help reduce the stress of searching for a space to have a private discussion. It can additionally provide a place to rest before returning to the courtroom, the court user may want to do some puzzles or listen to music to ‘take a break’ from thinking about emotive topics. Additionally, it can be useful to have a room booked to avoid bumping into other parties in the case, which can significantly increase stress in certain cases.

  5. Practice in the witness box
    Giving evidence is often the part of proceedings which court users are most stressed about – and understandably so. They are expected to stand in court, in front of strangers, and answer questions for a significant period of time (days in some cases).

    A defendant in a criminal court must choose whether they wish to answer questions. If they are feeling immense stress, a flight or fight response may be triggered. The stress associated with giving evidence in court may lead someone to avoid giving evidence, despite the negative impact it could have for their case. Stress-minimising steps should be taken, where needed, to help court users feel able to make the appropriate decision for their case.

    Practicing in the witness box and answering neutral questions such as, “What did you have for breakfast?” can go a long way towards helping someone feel more at ease. This is also a great time to practice reading the oath and get used to the setting in which they will later give evidence. When it comes to the real deal, they will know where to stand, what the view of the court will look like and be ready to take the oath. These steps can mean the process doesn’t feel quite so unusual and daunting.

  6. Video-link or screens
    A video-link in court allows people to give evidence from a remote location. They will appear on-screen in the courtroom. A camera in the court will allow them to see the other parties. A video-link can help someone feel less stressed as they are somewhat shielded from the intense pressure of the courtroom.

    Some people also ask to use screens around the witness box to prevent them from having to see other parties whilst giving evidence. Stress can affect the quantity and quality of communication and therefore, making sure court users feel as comfortable as possible whilst giving evidence ensures they can give their best evidence – which is of benefit both to themselves and the court.

  7. Allow processing time  
    Lots of detailed information can be discussed in a short space of time in the courtroom, often using specialised vocabulary and complex grammar. It can be hard to keep up with the pace and maintain focus. It is important that court users have plenty of time to process legal discussions, evidence and questions put to them. They should be reminded that, if they don’t understand a question, it is not their fault, and they should ask for the barrister or judge to repeat the question in a different way. They should also be told that they can ask for a break if and when they require one, have water whenever they want and take time to consider their answer before responding. It is always helpful if those in the courtroom speak at a slower pace than usual to support one’s ability to digest the information being discussed.

  8. Regular breaks
    Taking breaks is important to allow an opportunity to emotionally reregulate and manage stress. Breaks allow a person to rest, which can support their attention and emotional state when they return to the courtroom. Breaks throughout the court day can support someone’s wellbeing and increase their ability to focus on the proceedings. They can also help court users to consolidate the evidence, as when someone takes a break, they are having a chance to review and discuss the information (with appropriate people), helping them to better retain the content of proceedings. It’s also the perfect time for legal representatives to answer any questions the court user may have had, which could not be answered within the courtroom.

  9. An intermediary
    Intermediaries can facilitate communication between court users and the court. Intermediaries will use their expertise in communication to explore an individual’s communication strengths and difficulties, then suggest ways to assist their communication during proceedings, if needed. It is important to note, however, that an intermediary will only be recommended or allocated in cases where the court user has an existing communication difficulty.

    If someone is feeling stressed, they are likely to struggle to concentrate, this may mean they miss key information. An intermediary will whisper to the court user during hearings to ensure they understand what is being said. An intermediary may also make simple notes for the individual and re-cap the key evidence in breaks with the court user and their legal team.

    Just the presence of an intermediary can help the court user feel less stressed, as they have someone to sit next to them in court and answer questions they may have throughout the day. An intermediary will monitor their stress levels and call for breaks (when necessary) and provide recommendations to the court about how to best assist.

  10. Listen
    Talk to the court user. They may have their own strategies which they use in day-to-day life which help them manage stress. Everyone has their own ways of coping, and it may be that the court user already has some good tools they use to help them de-stress. Have an open conversation about what would be beneficial and see if they have any ideas of their own.

Stress has a big impact on communication. Communication difficulties with understanding and/or expressing oneself can have serious implications during court proceedings. Mitigating the impact of stress, where possible, is an important step towards improving understanding and assisting court users to participate in their trial or hearing effectively.

  • Get involved with Stress Awareness Week using the hashtag #StressAwarenessWeek from 7th-13th November 2022.
  • Learn more about coping with stress from Rethink Mental Illness

Article Image by Ben White on Unsplash

Schizophrenia: myths, stigma and prejudice

Elizabeth is one of our intermediaries and she has written a post to explore how the condition is misunderstood.

We provide communication support for defendants in criminal courts and respondents in family proceedings. We all have a strong passion for equality and fairness and every day we work with individuals that have a wide range of diagnoses. One of which is schizophrenia.

Mental health remains a hugely complex and misunderstood topic. Do the general public truly and fully understand schizophrenia, or are we surrounded by myths, stigmas and prejudices?

What we need know about schizophrenia?


  • In England, approximately one adult in every 100 will live with a diagnosis of schizophrenia
  • Schizophrenia affects 20 million people worldwide but is not as common as many other mental disorders
  • About 20% of people with schizophrenia attempt suicide
  • Approximately 5 or 6 percent of people with schizophrenia die by suicide

The statistics may acknowledge that schizophrenia is less common than other mental disorders however the prevalence still shocked me as being higher than expected.

The NHS defines schizophrenia as a severe long-term mental health condition that causes a range of different psychological symptoms. Doctors often describe schizophrenia as a type of psychosis. This means the person may not always be able to distinguish their own thoughts and ideas from reality.

What are the common symptoms?

Things that might start happening include:

  • Delusions – unusual beliefs not based on reality
  • Hallucinations – hearing or seeing things that do not exist outside of the mind
  • Disorganised speech
  • Difficulty making decisions
  • Difficulty concentrating
  • Movement disorders

Things that might stop happening:

  • Showing interest in everyday activities
  • Caring about your personal hygiene
  • Wanting to avoid people, including friends
  • Difficulties remembering things

Schizophrenia also shares traits with other mental health disorders including depression, anxiety, OCD, panic disorder, PTSD, substance use disorders and personality disorders. So, we must bear in mind that people can be suffering in multiple ways.

Is schizophrenia misunderstood?

Whilst researching I realised there is lots of incorrect information floating around which is distorting people’s knowledge and understanding, and the media, TV shows, and films often use stereotypes.  


  • Schizophrenia causes someone to be violent
  • People with schizophrenia have a split personality
  • They can’t hold a job down
  • There is a dramatic change of character
  • Schizophrenia makes people lazy
  • Schizophrenia requires long term hospitalisation
  • It is caused by bad parenting
  • If your parent has schizophrenia, then you will have it too
  • People with schizophrenia aren’t intelligent
  • You can never recover from it

These statements are all false. People think schizophrenia is about having a split personality or multiple personalities, or someone behaving irrationally. This all highlights that not everybody understands the true complexity of this diagnosis.   

What is it really like to live with schizophrenia?

People need support with mental health conditions, not prejudice. We should not judge situations, feelings or lives of those that we have never experienced or that we cannot comprehend. If we do not take the time to be educated, or to ask questions, then we won’t understand.

So, what is it really like to live with schizophrenia? These quotes are from real life stories and accounts of people who live with schizophrenia every day of their lives.

“Cognitive symptoms make it hard to pay attention and hard to focus”

“Your brain is just racing, it can’t stop”       

“My first symptom of schizophrenia was pretty much just zooming out, thinking I was in a different place. Then it turned into kind of voices in my head”

“I get plagued by thoughts that are just so repetitive in my head and they just go around over and over again, when really you just want them to be nice and quiet and silent”

“It can be lonely, the paranoia, the fear, the voices. Everything that goes along with it”

“I started seeing things, and hearing voices. I didn’t want to get dressed or even get out of bed. I didn’t understand what was going on”

“Schizophrenia is different for everyone”

“Everything was getting bigger, smaller, louder, quieter; my ability to process information coming in through my senses started breaking down”

“Hallucinations are often auditory but can be accompanied by odours, visions, and tastes”

How does schizophrenia affect communication?

We know that hallucinations and delusions are commonly associated with schizophrenia, but this neurological disorder can also affect communication skills in many ways such as, disorganised speech, trouble expressing emotions, slower processing speed and working memory deficits.

More specifically:

Alogia refers to a lack of speech by the inability to put thoughts together. For example, someone may pause for a long time between words.

Disorganised thinking in speech leads individuals to lose their trail of thought during a conversation, become tangential jumping from topic to topic, give answers to unrelated questions, speak continuously providing irrelevant details, or even speech becoming completely jumbled.

Affect refers to a restricted range of expressed emotions. People with affective flattening show relatively immobile and unresponsive facial expressions, little body language or movement and poor eye contact.

Schizophrenia can also create disturbances in receptive language and understanding the messages of others.

Any one of us may be speaking to someone who displays these symptoms, yet not have any idea that they are diagnosed with schizophrenia. It is an invisible condition and so there are no obvious or physical signs to let us know.

How do intermediaries help?

We are professionally trained to assist people with communication difficulties. We use a whole range of strategies and techniques to help people understand and participate throughout life changing court proceedings. Ensuring that their voice is heard. No matter what difficulties they possess. We also keep learning and educating ourselves so we can adapt our work to meet the needs of individuals with diagnosis such as schizophrenia.

Whilst Communicourt intermediaries have undergone extensive training, and obtained degrees, our intermediaries possess more than that. We are calm and patient. We know when to listen. We know when to intervene. We do not judge. We are able to pick up on signs and cues, that others perhaps cannot. Lastly, we love the job we do.

Case study 1: an intermediary assessed a man diagnosed with paranoid schizophrenia

Mr X alluded to experiencing paranoid thoughts throughout the assessment.

I can’t sit and stand in front of people, I don’t like people looking at me, I hate it. I always feel like that, everywhere I go I think people are looking at me, it’s why I just stay in all day”.

He added that he thinks people are “planning things” when they look at him.

I asked him if he currently experiences auditory or visual hallucinations. He reported, “I’ve heard voices before. It’s more when I’m by myself” and “… most of the time I just hear someone calling my name, so I look around to see where it’s coming from”.

He reported emotional management difficulties related to his diagnosis, for example, he expressed his mistrust of people and his worries about being in the busy court room for his trial.

I recommended to the court that Mr X attended his trial, accompanied by me, via a live video-link, in a separate room to the main court room. Mr X reported anxieties relating to his diagnosis of schizophrenia and having to sit in the main court room, due to the amount of people present in court and his beliefs that everyone will be staring at him. If he is unable to manage his emotions in the court room, it will likely have a detrimental impact on his ability to attend to the evidence.

If Mr X was not permitted to attend his whole trial via a video-link, I recommended consideration should be given to the use of one if he was to give evidence.

My other recommendations included:

Introduce each new topic of conversation to assist Mr X’s engagement, understanding and concentration. Mr X appeared to relax into the assessment process when I clearly outlined topics and tasks and told him what to expect.

Maintain a neutral tone while questioning Mr X. Avoid asking questions in an adversarial manner. This may assist Mr X to manage and regulate his emotions during cross-examination. He responded well to questions during the assessment, where the tone of questioning was informal and non-confrontational.

Breaks are also likely to assist Mr X to manage his emotions. I would monitor Mr X’s emotional state and draw the judge’s attention to any difficulties he is having, or if he needs any additional breaks.

Case study 2, an intermediary worked with a woman during family court proceedings

As soon as I started to work with Ms X, I picked up on various symptoms that she was presenting with.

For example –

Delusions – Ms X often did not trust who the professions were and what their role was. For example, she believed the local authority’s barrister was the clerk. Ms X could not shift her disbeliefs.

Trouble concentrating – Ms X struggled to focus on the evidence being heard in court and during conferences when checking her understanding, she did not retain the correct or relevant information.

I recommended that the court should do informal introductions. All professionals individually introduced themselves to Ms X in a relaxed environment outside of the court room. This was to help Ms X understand who acted on behalf of who and what their role was.

My other recommendations included:

Visual stimuli. I recommended Ms X should be positioned so that she could clearly see each lawyer or witness as they were speaking which successfully aided her focus and concentration. 

Promote trust. To alleviate any feelings of mistrust, I recommended all professionals avoided engaging in general ‘chit chat’ with each other whilst in the court room to clearly demonstrate clear boundaries of the opposing teams. I also advised all professionals to speak openly about the proceedings in front of Ms X, which stopped Ms X from thinking that information was being hidden from her. Both recommendations promoted better engagement from Ms X and ability to effectively participate in the hearing.

National schizophrenia awareness day is a chance to think about all those people who live with this misunderstood condition. Rethink Mental Illness shines a spotlight on the condition and the dedicated work to improve the quality of life for people living with schizophrenia and their carers. Find out more.