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?
World Autism Awareness Day on 2nd April marked the start of a month of activities aiming to develop understanding of autism and Asperger Syndrome. So I have decided to dedicate this month’s blog to talking about the work I do as a Speech and Language Therapist with and for people with autism spectrum conditions.
One of the things that often surprises people is that I work with autistic adults. Autism is something children have isn’t it? Certainly many internet searches and much media coverage could lead to you this conclusion, but strangely enough autistic children grow into autistic adults, and for many people, particularly with Asperger Syndrome, it is not until adulthood that the diagnostic process begins. This doesn’t mean that they have somehow acquired autism, but rather that it is not until adulthood that their differences start to interfere with living a “normal” life. Quirks are no longer considered “a phase he is going through”. Academic promise does not necessarily translate into vocational success. The shy girl who was praised for keeping her room immaculate is now told she has anxiety problems and OCD. You get the picture.
The autistic adults I meet are accessing mental health services, so on that basis they are usually struggling with their mental wellbeing. Most often this is the result of living either with an undiagnosed autism spectrum condition, or with a poor understanding of the diagnosis they have received earlier in life. As a result, these individuals have not learned why they act, think and communicate in the ways they do, and have failed to develop a positive sense of self. They can feel that they are the only person who experiences these challenges, and have no or few strategies to deal with the confusing and complicated world around them.
As a Speech and Language Therapist I play an important role within our Community Mental Health Teams for not only diagnosing autism spectrum conditions in adults, but also in providing support after that diagnosis and promoting improved mental wellbeing. One of the most exciting developments I am currently involved with is a post-diagnostic group aiming not only to educate but also empower, and to create a supportive social network of people with Asperger Syndrome in a local area. It is early days yet with this pilot project but the feedback from participants so far is good and relationships are beginning to develop. Ultimately, people living with autism spectrum conditions will learn the most from other autistic people because they will always know more about how it really feels and what really works, but if I can play a part in helping people make those connections then I can be proud of doing my job well.
A change of topic from my 3 best things this week as I have not been doing my normal clinical work. Instead have been attending a course on Sensory Integration and I would like to share my thoughts on what I have learned with you.
What do you think of as a sensory based difficulty? It is far more than a hearing or visual loss. Our understanding of the sensory aspects of the world in which we function tends towards the more traditional senses of sight, hearing, taste and smell but we seldom consider the significance of information we gain from touch and movement.
Sensory issues are being increasingly recognised as being a core part of Autism Spectrum Conditions and these is very well described by Cynthia Kim in her blog Musings of an Aspie, but I wonder how many other individuals who access Mental Health services experience sensory processing and integration difficulties.
The reason I say this is that I now have a very different understanding and perspective on the link between our sensory processing and emotional state. Our brains receive and start to process sensory information in the same areas that control our emotional and physiological responses. An unexpected loud noise will initially elicit a “flight or fight” reflexive response from us but it will subside if we don’t actually need to act to protect ourselves. But how would you feel and function if your neurological system could not integrate this sensory information sufficiently to allow you to return to your normal level of arousal within a short period of time? Or if this level of high arousal was elicited by activities that others did not find stressful such as the movement of riding on a bus or the feeling of the label on the T-shirt you are wearing? And what would it do to your ability to use your higher cognitive skills and therefore your thinking patterns?
This is a very simplistic summary of how sensory integration difficulties could impact on our mental health and well-being but a good place to start. By using “sensory glasses” to consider human behaviour and interpreting what we observe in relation to neurological processing of this information, sensory integration seems to me to offer an exciting new perspective on the way we can provide meaningful support people who experience mental health difficulties.
This week’s 3 best things have a learning theme.
1. Second Time Lucky – While I usually work with a person because their mental health problems are causing communication difficulties, I also occasionally work with people who have lost their communication skills and as a result of this loss are experiencing problems with their mental health. Harriet* had a brain haemorrhage several years ago which resulted in a significant loss of her communication skills. This loss had a profound impact on Harriet’s sense of self and her social role, and she became depressed which in turn had a significant impact on her ability to engage in rehabilitation. Many mainstream therapy services may not be able to adapt their input to address the mental health components of an individual’s rehabilitation journey and for Harriet, the perceived inability to engage resulted in her being discharged. A change in approach that has acknowledged the mental health component of Harriet’s difficulties has allowed her to re-engage with Speech and Language Therapy and she is starting to make progress again.
2. Train the Trainer – Each year NHS Education for Scotland offer funding for Allied Health Professionals to undertake training or experiential learning to progress their career and improve the services they provide. This week I learned that I have secured funding to become a Talking Mats Accredited Trainer. This will allow me to offer training in this extremely useful communication approach in my local area and I am so excited about the ways in which this will improve communication practice in our mental health services.
3. Family Ties – Our relationships with family and close friends are key in supporting our mental wellbeing, but for the people with communication difficulties these often impact on interactions with these important people. An individual’s communication barriers are only half the story though; the other person’s understanding of these difficulties and how to cope with them are just as important. This week I have had the opportunity to do some very rewarding work with a number of families; supporting understanding, increasing skills and ensuring these important relationships are maintained.
* Harriet is a pseudonym to protect client confidentiality.
My 3 best things about being a mental health SLT this week appear to have a nurturing theme – conversations that nurture understanding, nurturing the learning of others, and nurturing skills and self-reliance…
1. Talk to Me – When a client walks in to clinic distressed and is able to walk out calmer and with a sense of direction and achievement I know what I do is worthwhile. There are times when we need to talk through our difficulties in order to sort things out and to feel better but this is much more difficult if you also have a communication difficulty. When you cannot find the words to express how you feel or explain why you are feeling that way, others find it that much harder to help you find the right solution. When you cannot organise information in a meaningful way you can feel that others are not listening to you or even find that you get yourself even more confused than before. John* arrived for his appointment this week in a very flustered state. He had been feeling overwhelmed in recent weeks and this was impacting on his ability to discuss his worries with his family and friends. By creating a structure around the conversation and providing appropriate feedback, John was able to organise his thoughts and we were able to work through his problems, and he left his appointment much happier and calmer than before.
2. Look to the Future – As part of my job I am involved in the clinical education of student Speech and Language Therapists from Queen Margaret University. My current student is approaching the end of her placement and it makes me so happy to watch her confidence grow and her skills develop. This is one of the very few adult mental health placements available in Scotland currently and it is wonderful to be involved in developing clinical interest and skills for this client group in our emerging workforce.
3. First Steps – Our new group for clients who have recently been diagnosed with Asperger Syndrome started this week. The purpose of the group is to provide information about Asperger Syndrome; helping these individuals to have better understanding about the ways in which they communicate, think and act differently from others, to develop coping strategies, and to establish relationships and gain support from peers who are “the same as me”. First sessions are difficult for everyone – especially people with Asperger Syndrome – but by creating an Asperger friendly environment and pacing information and demands correctly our group was a great success.
John* is a pseudonym to protect client confidentiality
It’s been a good long while since I last blogged. This has been partially due to being extremely short on time recently, but also because I had slightly lost direction and was unsure what stories I still had to tell. However, it seems that despite my recent silence, interest in my blog has remained with almost 600 “hits” since my last post. This has reminded me why I started this blog…
…there are still very few Speech & Language Therapists working in the field of adult mental health [so] The purpose of mentalhealthslt is to share my experiences not only with other Speech & Language Therapists but with anyone who works in or has an interest in mental health.
So it’s about time I got back to doing just that!
One of the things I regularly do with people is help them to focus on positive situations and work to their strengths rather than dwelling on negatives and difficulties. A friend of mine also writes a blog which is titled “Rachel’s Three Beautiful Things” which does exactly what is says on the tin. Rachel writes about three beautiful things that happened to her that day – an idea I love. So I am going to borrow the concept (which she also borrowed so I don’t think she will mind) for the next wee while to help get this blog back on track.
By highlighting the three best things each week about being a Speech and Language Therapist working in mental health services, and hopefully encouraging other colleagues to do the same, I believe that I can continue with my mission to spread awareness and develop understanding of the unique and valuable role we play.
So here goes. Here are here the 3 best things about this week…
1. The Sweet Sound of Success – About 18 months ago I met a lady called Sarah* who had become mute following a significant psychological trauma. She had not uttered a word for over 10 years and had become completely socially isolated and reliant on her family for even basic tasks. This week marked my final session with a now very talkative Sarah* who is living her life to the full having rediscovered herself and her role as wife, mother and grandmother.
2. Group Fever – There are a significant number of people with Asperger Syndrome who access mental health services. Many have very little understanding of their diagnosis and can find it difficult to participate in mainstream groups run by the community mental health teams. From next week I am running a group along with an Occupational Therapist and a Support Worker specifically to meet the needs of these clients. We had our final planning meeting this week and everyone is so positive, excited and enthusiastic – it’s infectious!!
3. All for One – This week I have been working in partnership with a broad range of people including a University Disability Advisor, staff in the local library, family members, nurses and psychologists to name but a few. These partnerships help me to ensure that my clients get the best possible service from me and from others, and being able to do that is one of the best things about my job.
*Sarah is a pseudonym to protect client confidentiality
Apologies for my recent silence – October has been a busy but very productive month for raising the profile of Speech and Language Therapy in mental health settings.
The month started off with 2 conferences in Edinburgh for Allied Health Professionals from across Scotland, the UK and the world. I was pleased to have a poster accepted for the Scottish conference and honoured to be asked to present a workshop at the International conference. My topic for both was person-centred care and I shared the outcomes and learning from the staff training and support programme I have been piloting with a team of local social care staff.
I am proud to say that my poster won joint first prize as voted for by delegates attending the conference, and even prouder that my workshop was attended by the CEO and Chair of Royal College of Speech and Language Therapists!
Our outcomes are so important but sometimes it can be difficult to measure what is truly important. As Albert Einstein is reported to have said, “Not everything that can be counted counts, and not everything that counts can be counted”. In an age where we are driven to seek the evidence to underpin our practice where can we find the evidence about what really counts for the people in our care?
With this in mind, the RCSLT Mental Health Clinical Excellence Network met in London, Glasgow and Limerick (embracing video-conferencing technology) to discuss “What works for SLTs in Mental Health?”. We had a packed day of presentations from therapists working in the field; sharing information, approaches and tools that have really made a difference for the people they support. While far from the scientific “gold standard” of research evidence, this sharing of anecdotal experience does start the process of unpicking what really counts in the work that we do.
In my work supporting good communication between people with mental health problems and social care staff I have not improved any one person’s speech, language or conversational skills as could be measured on a standardised assessment. However, what we have achieved are significant improvements in people’s quality of life in terms of their participation, independence, involvement, relationships and mental wellbeing – and that, in my opinion, is what really counts.