Hearing Voices that are Distressing' (HVD) simulation workshop for regional (and rural) health and mental health workers practising in the health sector using a clinical trial (CT) leveraging from the regional Teletrial cluster model (National Australian Teletrial Program -ATP-SA) to build a higher level of evidence for lived experience (LE) added-value in simulation methods used for education and training for workers (and students).

The UniSA Department of Rural Health, in partnership with Flinders University Department of Rural Health and Keepwell Australia® New Zealand, will deliver a series of Hearing Voices that are Distressing (HVD) simulation workshops across sites in rural, regional, and remote South Australia (locations Whyalla, Victor Harbor, Berri, Port Augusta, Port Pirie, Port Lincoln, Mount Gambier). The half-day workshops are delivered in-person, and are based on Arana Pearson's (Keepwell Australia® New Zealand) authorised adaptation of Dr Patricia Deegan's Hearing Distressing Voices Simulation. HVD simulation workshops are divided into four parts: 1) a video introduction from Arana Pearson sharing his own story of voice-hearing, 2) a 45-minute theoretical lecture on current research and techniques that can be used to give voice-hearers power over their voices, and 3) a 35-45-minute simulation experience, and 4) a 30-minute debrief session with guided reflection. Workshops will be co-facilitated by rural mental health academics and a person with a lived experience of hearing distressing voices. Three co-facilitators will deliver each workshop, the composition of which will either be 2x rural mental health academics with a lived experience co-facilitator (intervention group) or 3x rural mental health academics (standard delivery). All facilitators have prior experience delivering the workshop. Each workshop will include the same content, however workshops delivered to the intervention group will also include a lived experience co-facilitator sharing their story of hearing distressing voices and responding to participant questions. Delivery sites will be randomized by an independent allocator, using computer-generated assignment, to determine which sites will receive the HVD simulation workshops delivered with a lived experience co-facilitator (intervention group, n=3 sites) and which will not (standard delivery, n=3 sites). Participants will be blinded to the site allocation; however, facilitators will be informed of the type of delivery each site will receive in order to prepare adequately. To ensure intervention fidelity, all workshops will be delivered by 3x co-facilitators. All co-facilitators are trained and experienced in delivering the workshop. Sites allocated to the standard delivery arm will be delivered by the same co-facilitators, and vice versa. All workshops will include the same simulation experience, involving the same recording of distressing voices (delivered via MP3 players) and activities (i.e., undertaking a mental state assessment and engaging in cognitive or group-based activities). The same question prompts will be used in the guided reflection for both study arms. Co-facilitators will be asked to keep a reflective journal and record the amount of time spent on each component of the workshop at each delivery site.