Contribution of Speech & Language Therapists

Why SLTs have a role in mental health services

Speech and language therapists (SLTs) are dedicated to the needs of people with communication support needs (or impairments) and eating, drinking and swallowing difficulties (dysphagia).  SLTs contribution is central to multidisciplinary teamwork.  SLTs who in a multi-disciplinary mental health team often carry out generic as well as specialist work.

Stockport Mental Health Services and the University of Manchester have established a joint project which enables a significant proportion of first year speech and language therapy students to undertake a placement in older people’s mental health specifically to engage in ‘life story work’ with people with advanced dementia and challenging behaviour.  Alongside this has been a project whereby the MDT changed the assessment tool used.  The life story work is part of a person centred approach – with very good feedback from carers involved.                                                         

Contact: laura.brierley@nhs.net,

A high number of people accessing mental health services in the community or in acute settings (hospital) are known to be present with significant communication support needs and / or dysphagia as a consequence of their mental health difficulties. 

• The incidence of speech and language problems in people receiving mental health services is substantially higher than the general population (Bryan et al, 1991) (RCP, 2004).
  
• 78% of screened patients with mental health problems had communication problems ranging from severe receptive and expressive dysphasia (comprehension / expressive language problems), dysfluency (stammering / stuttering,) voice and articulation problems and dysarthria (phonation / resonance problems)  (Emerson and Enderby, 1998)
  
• 62% of children in psychiatrist populations had speech problems (Goodyer, 2000).
  
• While medication is reported to impact directly on swallowing and feeding ability, problems with eating, drinking and swallowing are recognized as an integral part of the dementing process, particularly in later stages (Bach DB, Pouget et al, 1989).

Speech and language therapy activity, value and impact on mental health services

1. Detailed assessment and review of clients’ communication skills and needs.  This contributes to MDT diagnosis, differential diagnosis and provides models for intervention based on assessment findings. 
   
2. Development and provision of communication programmes.  Communication programmes developed by SLTs commonly have two distinct elements:
   
   i) Direct one to one / group therapy: This helps the individual achieve greater insight into their communication difficulties and enables them to develop new or regain “lost” communication skills, enhancing motivation and confidence.   Such interventions enable the individual to access all forms of “talking” interpersonal therapies, other verbally mediated interventions and therapeutic programmes e.g. anger management, assertiveness training and educational programmes.
   
   ii) Indirect therapy: Advising and training staff, MDT colleagues and carers about how to best interpret, respond to and support a person’s communication needs and to determine a person’s present wishes and feelings.  This is important since many of the therapeutic interventions used in mental health are verbal.  SLTs work with families and carers, focusing on the transfer and maintenance of appropriate management strategies, which are valuable in helping to address and reduce carer stress and burden.  SLTs input may be significant with regard to issues of capacity and consent.
   
3. Assessment of eating, drinking and swallowing difficulties, involving observation, formal assessment, discussions with carers and others and often videofluroscopic examinations (a radiographic technique to visualise the pharyngeal stage of swallowing).  Poor or incorrect management of dysphagia frequently results in malnutrition, dehydration, pneumonia, choking or a combination of these features.  SLTs also provide advice and training to carers and the MDT, with ongoing monitoring and evaluation of the eating and drinking programme altering the aspects as a person’s functioning improves or deteriorates.  This input directly influences quality of life for both the individual and their carer.
   
4. Development and provision of safe eating, drinking and swallowing programmes, often in collaboration with other members of the dysphagia team.  This input enhances overall quality of life for the service user, promoting safe practice and pleasant, social mealtimes.

Web Links:

RCSLT website,

RCSLT position paper: SLT provision for people with dementia,

RCSLT communicating quality guidelines 3 (2006),

RCSLT clinical guidelines (2005),

RCSLT model of professional practice and clinical competencies (2003),

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