The Dark Art of Speech and Language Therapy

This month marks 2 years since I started my blog and although I don’t post so often these days interest doesn’t seem to have dwindled if the number of hits each week is anything to go by. Although overall I am enjoying this journey, there are times when the sheer size of the job can feel quite overwhelming. The range of valuable roles that a Speech and Language Therapist can play in the context of adult mental health is what keeps this job interesting and challenging all at the same time.

I seldom take the time these days to reflect on the breadth of roles I undertake on a day to day basis but I have a had recent cause to consider exactly that. I was asked last week what my “elevator pitch” for my service would be. If I had 10 seconds to sell myself (in a professional context obviously) what would I say?

Mental health and communication are very closely linked. The way a person communicates can tell us a lot about their mental health or even diagnosis, and conversely a person’s ability to communicate can significantly impact on their mental wellbeing. Equally, mental health workers’ ability to make appropriate adaptations to the way they communicate according to each individual’s need can make or break important therapeutic relationships.

Speech and Language Therapy has been described to me as being a bit of a “dark art” as people aren’t entirely sure what we do, and I believe that is because communication is the foundation of everything we do, not only in mental health, but in life. A Speech and Language Therapy assessment can make sure you get the right treatment by gathering information that leads to the right diagnosis. A Speech and Language Therapist can work alongside your Occupational Therapist to help you get a job. A Speech and Language Therapist can work with you to increase your self-esteem and confidence by improving your communication skills or addressing a specific speech or language difficulty you experience. The list goes on.

So what would my “elevator pitch” be?

Communication is a fundamental human right and forms the basis of all our interactions and relationships. Mental health services need Speech and Language Therapists because without the support we can offer there will be people whom services fail by not adequately addressing their communication needs. Without specialist knowledge from Speech and Language Therapists the risk of individuals becoming stuck in a downward spiral of poor communication and poor mental health increases. Services need Speech and Language Therapists because without effective communication what do we have?

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.