Albert Garcia started hearing voices 12 years ago. He was 47.
There was a lot going on in his life: He had separated from his wife and lost contact with his four grandchildren. His older brother, someone he looked up to and who had protected him from an abusive father, was dying.
"I went to sleep on my brother's couch, woke up, and the first thing I heard was 'Albert, I'm going to be your worst [obscenity] nightmare.'"
The voices haven't stopped since. There is a crowd of them. They're loud, they talk over each other and they physically pull, push or tug at Garcia, now 60.
"A lot of screaming. I couldn't even concentrate on what to do next, where to sit, who to look at," he said. "Even though I wanted to leave my brother's apartment, I had a hard time concentrating on just finding the door to get out."
He has to pause several times when he's in conversation, trying to separate the voices yelling vulgarities or calling him names from his own thoughts and what he's about to say next.
"It's so real because they know everything. Every deep, dark secret," Garcia said. "They know every feeling and emotion. It's as if they're going through that to mock you."
He's taken medication and has seen mental health professionals. But he said it wasn't until he was able to find coping mechanisms to help him separate his own voice from the voices in his head, that he was able to function again.
Garcia founded the Minnesota chapter of the Hearing Voices Network in 2013. It's a group of people with similar symptoms, who meet weekly to discuss strategies and coping mechanisms. The approach is meant to complement medicine traditionally prescribed to people with mental illness.
For three years, Garcia has traveled across the state to give talks about what he does, how the group works and how it can help people with schizoaffective disorder. The condition causes auditory and visual hallucinations, depression, delusions and mood swings.
Every Wednesday morning, Garcia meets a group of about eight people at People Incorporated in Minneapolis, a nonprofit organization that provides community-integrated support for people with mental illness.
The people sitting around the table are experiencing a range of life events. Some are homeless, others struggling with chemical dependency. Two were recently incarcerated. They're all struggling with various types of mental illness, but one symptom they all have in common: Hearing voices.
One of the women in the group says the voices she hears make her feel worthless. MPR News has agreed not share names of the group's members because of the stigma they face.
"My voices make me do things to harm myself," she said. She goes on to say she feels unwanted by family and friends, that she's bothering them by asking for help.
"I know that's the voices talking," she said. "But that's how they intimidate me, by not reaching out for help."
Garcia and his supporters say the group-based approach of the Hearing Voices Network is invaluable for people who hear voices every day, all the time. Inside the group, participants say they don't feel the same kind of fear they often experience when they're talking to someone who doesn't have similar symptoms. They're able to share with honesty and learn coping skills from each other.
But right now, Garcia's group is the only Hearing Voices Network chapter in Minnesota.
Garcia is one of the state's 385 certified peer support specialists. They're people who struggle with mental illness themselves, but also counsel others who experience similar symptoms.
There's a shortage of mental health services in Minnesota, and as a result, many patients end up in emergency rooms or jails. Alternative therapies — like Garcia's group — could provide some relief. Legislation passed in 2007 includes the work of certified peer specialists in a host of mental health services eligible for coverage under the Medical Assistance program.
But it's still a new approach. Experts say that newness, paired with the stigma that follows people who hear voices, may hold people back from joining or forming such groups.
Piper Meyer, executive director of the Minnesota Center for Chemical and Mental Health at the University of Minnesota, said hearing voices groups took off outside of the United States a few years ago. It wasn't until recently that they began to take hold here.
"For a long time, cognitive behavioral approaches weren't being applied to people with psychosis," Meyer said. "Typically, people think that if you are experiencing psychosis, that medication is the only option you have."
The state's first certified peer specialist training class graduated just 14 in 2009. Although the program has grown to nearly 400, it's still not large enough to meet the high demand of Minnesotans struggling with mental illness. According to the state Department of Human Services, 155,000 adults received publicly funded mental health services in 2014.
The state surveyed mental health providers in February, and found that more than half of those who did not employ peer specialists had found it difficult to find individuals qualified for the work. Some said they didn't understand how peer specialists could add to their services. Others said they couldn't sustain them financially.
A legislative report released that same month recommends the state expand the service and encourages providers and nonprofits to "examine the possibility of hiring those with prior criminal history."
"This is a very complex situation," said Diane Ferreira, a mental health professional in St. Paul who worked with Garcia at People Incorporated. "It's very complex to work with people that are attempting to function and still at the same time they are fighting with those symptoms. It's a matter of building a rapport and consistency."
Albert Garcia was able to get a second chance at living a normal life despite a criminal history, chemical dependency and the voices in his head. He led a training session in Duluth last weekend to teach staff who work with homeless people and people with mental illness about how to treat them, based on his own experience.
It's one of the regular trips he makes, across the state, that he says helps reduce the stigma around hearing voices.
"I wish I would've had somebody to walk with me, maybe even hold my hand, going through the anxiety I was going through," he said. "Just to show me like a kid: 'You know what, take two steps, you will be OK, I'm here.'"