by McCollum Consultants, With Commentary by Dananni Lewis.
World Mental Health Day, marked on 10 October, offers an opportunity to reflect on the experiences of people living with mental health difficulties and the importance of compassionate, person-centred care. Listening to someone’s concerns, recognising their individual needs and helping them feel heard are essential parts of that care.
At McCollum Consultants, our mental health experts bring clinical experience to the independent assessment of care in medico-legal cases. To mark the day Dananni Lewis, one of our mental health nursing experts reflects below on the difference between hearing and listening, and why paying attention to both words and silence matters in clinical practice and the review of care.
An Expert’s Reflection: The Difference Between Hearing and Listening
“It’s World Mental Health Day today, and I’ve been reflecting on a distinction that defines both mental health nursing and the world of medico-legal reporting: the difference between hearing and listening.
Hearing is passive. It is simply taking in words without catching the tone, the hesitation, or the subtle shift in body language behind them.
The Zen master Thich Nhat Hanh wrote about “deep listening” and listening with the sole purpose of helping another person empty their heart. True listening requires full presence. It means putting the person before yourself and tuning into what isn’t being said.
Years ago, I cared for a service user who wouldn’t speak due to severe depression and a profound fear of not being heard. Shift after shift, his clinical notes simply recorded him as “non-communicative.” One doctor described him as mute. Instead of forcing conversation, I just sat in his room. We exchanged no words, I was simply present.
Eventually, I advanced to reading to him from the daily newspaper and his favorite magazines. Slowly, because I was actively watching rather than just waiting for words, I noticed the non-verbal shifts; fleeting moments of eye contact and a progressively relaxed posture. After a month of this shared space, he finally spoke his first words to me, “Thank you,” followed by a suppressed smile. It was as if a physical weight had been lifted from his shoulders. Within two months, he was engaging with staff and his family.
For clinicians, active listening even to silence prevents catastrophic outcomes. For healthcare professionals, active listening is our most vital diagnostic tool, it is the difference between intervening in a crisis and writing a post-incident report.
In my work as an expert witness reviewing high-value psychiatric claims, I repeatedly see how this clinical distinction becomes the focal point of High Court litigation.
Barristers and solicitors know exactly what this looks like when forensically dissecting medical records. It looks like weeks of entries stating a patient was “withdrawn,” or “uncooperative” right up until a catastrophic event occurs. The patient’s words or their silence were technically heard and dutifully logged. But the underlying dynamic risk, the subtle deterioration that demands urgent escalation, was never truly listened to. By the time those records are scrutinised in a courtroom, that missed opportunity often carries an immense, irreversible human cost.
This World Mental Health Day, my challenge to both my clinical colleagues on the wards and the legal professionals navigating these complex claims is simple: let us move beyond the passive act of hearing. True listening is the most fundamental standard of care we owe to every vulnerable person.”