Are You Aware?

Did you know that this is Mental Health Awareness Week? This year’s focus is on the impact of physical activity and exercise on mental health and well-being. However, it has made me ask myself what I am doing as a Speech and Language Therapist to raise awareness about mental health. Not amongst the teams and services I work with week in week out, but amongst the general public and the community services we all use.

Raising awareness is important but it isn’t as easy as it sounds. How do we persuade people that they want their awareness raised? How do we make our message sufficiently interesting and relevant to ensure people listen to what we have to say? And how do busy clinicians undertake awareness raising activities without taking valuable time away from the individuals to whom they have a duty of care? Is it a justified use of my clinical time to undertake activities that raise public awareness of mental health and communication difficulties?

Individuals and communities that are more aware, more understanding and more willing to include everyone are an important step in combating the stigma and social exclusion associated with mental health problems. But on a practical level how do we achieve this? And who should be raising awareness?

This is a blog of questions rather than answers. So over to you, tell me, what do you think?

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Therapy Through the Looking Glass

I recently completed an Adult Mental Health placement where Susan was my Clinical Educator.  She asked me if I would be interested in writing up a reflection of my placement as her first guest blog.  My first thought was “Oh no, another writing assignment to top off my already busy workload”.  My second thought was “blogging – how trendy!” And so I agreed to take on the task granted there was no deadline.
 
My experience was as fascinating as it was eye-opening and the best way to describe it is through analogy.

Picture a well set table including a table cloth, plates, cutlery and glasses.  The table cloth represents the medical model that forms the basis of Speech and Language Therapists’ practice in the majority of care settings. The items on the table cloth represent the clients we work with, the other health professionals and support staff, our skills and knowledge base, tools and assessments, and so on. Now imagine that cloth being whipped away from the table while all the items remain standing.  At first you are awed by the trick and feel surprised at how all the objects managed to stay standing without being thrown to the ground.  You then begin to wonder how it happened, and you feel confused as you would assume that some items would have fallen over. 

This may seem confusing and hard to follow, but that’s the point.  Mental Health is an emerging area in Speech and Language Therapy, and providing services in this area is confusing for someone who has only thus far been exposed to the ever-dominating medical model of communication disorders.  I saw that medical mind set and approach being pulled away in front of my eyes, yet everything else was left standing just as it should be.
 
Mental Health is very different from the other clinical areas Speech and Language Therapists traditionally work in but it is not difficult working in this area; it just requires lots of adjustment. We also need to see past the overshadowing stigma. The service users I met on placement were the friendliest bunch of people who had been dealt a bad set of cards in the game of life.  They opened my eyes and made this placement a truly special one.  As Susan said, “You have all the skills and knowledge it takes to work in this field…all you need to do is simply apply them with confidence”.

Look To The Future

A quick question for my fellow healthcare professionals out there.  Do you regularly volunteer to take students and look forward to them coming? Or do you regularly volunteer reasons why it is not appropriate for you to have a student?  In my experience you will probably fall into one camp or the other.

I am fortunate to be part of a team that is passionate about the role we play in the clinical education of Speech and Language Therapists.  We encourage a continuous cycle of students through our department and see this as an opportunity for not only students and therapists, but also for our clients and for our profession. This enthusiasm and drive has just been recognised in the 2013 Advancing Healthcare Awards where we won this year’s award for Supporting the Future Workforce.

I often hear people say that they can’t take students because they are too busy or because their department is short staffed. This troubles me because it appears to reflect a perception that students are extra work rather than another pair of hands (not to mention another brain) which can actually lighten the load on hard pressed professionals. Having a student means that I have someone else who is putting time and effort into preparing for the clients we will be seeing that day and all that they ask of me in return is direction, feedback and support – that sounds like a fair exchange to me.

Others protest that their caseload is too specialised or too complex for a student placement. Are they suggesting that those who work in areas of high specialism are not using core, transferable skills or drawing upon theoretical frameworks which apply to other areas of clinical practice? I do hope not. Those of us working in areas of complex need provide students with a unique opportunity to see how their core training and knowledge base can be applied in a wide variety of roles and settings.

My caseload is busy, specialised and complex, and students love it! And just to prove it, I am excited to announce that my first guest blog (which will be published next week) will be by Laura who is currently studying at Queen Margaret University in Edinburgh and recently completed a mental health clinical placement with our Speech and Language Therapy service.

What’s in a Name?

I feel that I have been surrounded by conversations about psychiatric diagnosis lately. The recent publication of DSM5 has raised some great concerns on this topic. An article in last month’s Guardian prompted strong reactions from some. And in the context of my own professional practice, I have spent a long time in conversations with colleagues about a complex individual with a raft of possible diagnoses – none of which seem to sit quite comfortably.

I have been aware for some time now that I appear to hold contradictory views on diagnostic labelling.  On one hand, I am passionate about accurate differential diagnosis to ensure each person I see gets the most appropriate intervention.  On the other hand, I have always advocated that the power is in the description rather than the label.  What exactly do this person’s difficulties look like? And how do they impact on his or her daily life?  Further, I take real exception to people referring to individuals by their diagnosis as if it defines them – terms like epileptic or schizophrenic get me really annoyed!

I have met several individuals and families over the years who are desperately seeking a diagnosis because they feel that a label will give them an explanation, a future direction and access to services.  However, I have also worked with individuals who have been inaccurately diagnosed and this label has had a negative impact on their life, often due to the assumptions that people have made about them based on that diagnosis. And I know a significant number of people who would have their needs best met by a certain service but are denied access because of the presence or absence of a diagnostic label.

I have been wondering if one of the reasons this is such a contentious issue is our attempt to treat the mental and physical aspects of a person in the same manner. Being diagnosed with diabetes, for example, will explain the physical symptoms a person is experiencing, however, is this true for mental health problems? Does a diagnosis of depression explain why you feel the way you do, or does it just label what you already know? Is this the same or different from the impact of getting a physical diagnosis? This is something that I will continue to mull over, possibly for years to come. However, it is my firm belief that what people really value is the feeling that the difficulties they are experiencing are understood by someone; that they are being taken seriously, and I am not convinced we always need to label something to be able to do this.

A Tweet in the Life

I saw an interesting use of twitter recently. NHS Highland use their account (@NHSHWhoWeAre) to showcase services by having members of staff tweet about their working lives for a week. The “week in the life” that caught my eye was by the Caithness & Sutherland Speech & Language Therapy Team. I was interested to read about the diversity of roles members of the team undertook so, in a similar vein, I have decided to blog about my own clinical week “twitter-style” – each entry 140 characters or less!

Tuesday

Working on research proposal this morning: my first attempt at a qualitative study. Great support from NHST and SDHI – hope I get funding.

Two multi-disciplinary sessions this afternoon – first with Dietitian and second with Clinical Psychologist. Teamwork in CMHT is essential.

Joint initial assessment with Dietitian – teenager with suspected ASD and a long standing food phobia. Sharing knowledge and resources.

Working with Psychologist supporting young man with Asperger’s – blunt communication style having significant impact on family relationships.

Wednesday

Met with Social Worker from Early Years Service this morning – having difficulty communicating with young mum with post-natal depression.

Lunch meeting to organise Phase 2 of Communication Champions training with Richmond Fellowship. More staff want to do training – RESULT!

Visit to client with PTSD – mute for 10 yrs. Been using iPad to communicate for 3 months: family relationships and confidence improving.

Thursday

Quick visit to some Communication Champions first thing to provide guidance on support plan for resident with complex communication issues.

Meeting with young woman new to CMHT – CPN and Psychologist want a second opinion re: Asperger’s Syndrome. Difficult differential diagnosis.

Start afternoon with home visit. Client with Bipolar Disorder has language difficulties following ECT. Conversation flowing more easily now.

Off to local library for afternoon clinic: clients love this city centre venue – library staff even provide tea, coffee and biscuits for us.

Friday

Getting ready for a long clinic this morning – 9:30 to 1:30 – looks like lunch will be optional again!

Client with schizophrenia referred with very poor speech. Change of antipsychotic medication and speech much improved. Happy I’m not needed.

Assessing young woman with Asperger’s: confused because information doesn’t seem to apply – direct her towards resources for women with AS.

Seeing client with PTSD and low self-esteem. Dissatisfaction with voice contributing to problems: working to improve acceptability.

Client with history of alcohol dependency and anxiety reports sudden expressive language difficulties. Minor impairment having major impact.

Finish day meeting with student nurse who wants to learn about Asperger’s Syndrome – mutual love of The Big Bang Theory useful for examples.

And that was the week (or the tweet) that was.

Out with the Old, In with the New

I find it hard to believe that it is now halfway through January as I am writing my first blog of 2013.  I have had a very therapeutic break over Christmas and New Year.  I made sure that I surrounded myself with the people who help me keep perspective, who make me laugh and who make a difference in my life.  I have taken time to reflect on my own priorities, on who I am and what I’m really about; both personally and professionally.  And I have made a positive choice to address my major personality flaw.

I would like to introduce you to my superhero alter ego.  Do you know her?  The girl who seems unaware of how many hours are actually in a day.  Who resembles a human tornado as she passes through the office.  Who places unrealistic expectations on herself and can often be found literally or metaphorically tearing her hair out.  I know her very well.

In 2013 I resolve to accept that I am not a superhero – not least of all because I really cannot carry off the pants over the tights look!  I cannot do it all by myself, and more importantly nobody expects me to except me.  I am good at coming up with ideas and trying something new, and can generally persuade others to come on the journey with me so long as I stop for long enough to actually involve them.

So my desire for 2013 is to see this Mental Health SLT blog evolve from a place to document my own thoughts and experiences into a forum for anyone who wishes to blog about Speech and Language Therapy in Mental Health.  So watch out if I work with you already – you’re probably on my list!

But Why?

I love students. No seriously I do. My role as a clinical educator for student Speech and Language Therapists from Queen Margaret University is one of the favourite parts of my job. I love students because they ask questions. They create a situation where I am required to provide clear, rational and evidence-based reasoning for my clinical decisions. And on that basis my favourite question is WHY?

Laura is a post-graduate student who has just completed a placement with me in Tayside. She has graciously agreed to write a guest blog on her thoughts and experiences of Speech and Language Therapy in Mental Health which will feature when her academic and personal calendar allow, but until that time I wanted to share with you one of the big WHYs of Laura’s placement.

But WHY are we working with him? This isn’t Speech and Language Therapy.

Many Speech and Language Therapists work to a pretty high degree in professional isolation. By that I mean that they either work just with their client and/or that person’s parent/ spouse/ carer, or they have a well defined role within a multi-disciplinary team to tackle the communication aspects of a client’s disorder. I say this from a perspective of personal experience as I have worked as a member of many teams where teamwork is merely making sure we share information and don’t book people in for appointments at the same time! Unlike the fields of Physical Disability or Stroke Rehabilitation, in Mental Health the majority of work carried out by all team members is entirely verbally mediated. So what happens when an individual has communication difficulties that create barriers to therapeutic interaction? In this situation, the team member who can communicate most effectively with that person is most likely to affect positive change and that person may be the Speech and Language Therapist.

Laura is right; I am not doing specific communication skills development work with this client at this point in time – I have in the past and I am sure I will in the future. What I am doing is using my understanding of his subtle and complex communication difficulties to adapt and deliver a psychological based intervention that other members of the team have found it impossible to engage him in effectively. This is an intervention that will benefit his mental wellbeing and keep him positively engaged with the Community Mental Health Team; and that is what being part of a team really means to me.