Communication and Mental Illness

Theoretical and Practical Approaches

Jenny France, Sarah Kramer

• Publisher: Jessica Kingsley Publishers
• Year: 2001
• ISBN:
  9781846422737
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

`This is a unique book that addresses an interesting aspect of work in mental health settings.' - Mental Health OT

Communication and Mental Illness is a comprehensive and practical textbook written by a multidisciplinary group of experts in the field of mental health which will be of interest to all those interested in improving their understanding of individuals with mental illness. The book is divided into three parts. The first of these offers both student and experienced clinicians in the mental health field an improved theoretical knowledge of the methods of communication commonly adopted by individuals with a variety of diagnoses of mental illness. It also provides practical suggestions of how this information can improve the individual professional's management of patients. Part Two looks at how information about communication in mental illness can influence service provision, ending with suggestions for future policy and practice. Communication and Mental Illness concludes with a final part describing the state of current research into different facets of communication and mental illness, offering an insight into the variety of research methodology and points of interest to those involved in the field.

PART I

Background

CHAPTER 1

Disorders of Communication and Mental Illness

Jenny France

Speech, language and/or hearing can be impaired in individuals with a diagnosis of mental illness. Difficulties in these areas can result in the reduced intelligibility of messages, or in deficient listening skills. This imposes limitations on the communication of thoughts and feelings. It frequently also engenders messages of intolerance, ridicule and rejection by society. This can encourage feelings of isolation, hostility and anger in those affected, which are frequently accompanied by feelings of low self-esteem, a lack of self-confidence, and worthlessness and uselessness (France 1996).

This book has been planned to fulfil a dual purpose. One, that of providing information to those multidisciplinary professionals who work in mental health and have little awareness and/or appreciation of the prevalence of various forms of communication breakdown in people with mental illness and therefore the place that speech and language therapy might play in helping to alleviate these problems. Two, to provide a text to support qualified clinical speech and language therapists, undergraduate and postgraduate speech and language therapy (SLT) students in gaining an understanding of aspects of mental health, mental illness and related communication disorders and difficulties. This would seem particularly important due to the frequently limited awareness by those involved in mental health services of the role of SLT. The contribution to the multidisciplinary team and to the services for mentally ill patients made by occupational therapists, psychologists, and art and music therapists, for example, would appear to be more widely known. Perhaps this is in part the result of the limited provision of SLT services within the mental health setting both historically and geographically.

Until the late 1960s, most SLTs working in psychiatry were extremely isolated, working in different locations and with varied client groups, whilst also working only part-time. Broadmoor Hospital was one of the first authorities to take the step of appointing a full-time SLT. Prior to that time patients were referred for therapy only if they developed specific communication disorders independent of their diagnosis as mentally ill, for example for hysterical aphonia, or as a result of a cerebro-vascular accident.

The exploration of the speech and language of people with a diagnosis of mental illness began to develop alongside the advent of major developments in the study of linguistics. The SLT’s knowledge and skills in areas including psychology, neurology, linguistics and speech and language pathology suggest the appropriateness of SLT in monitoring the effects of new forms of pharmaceutical treatment, in improving prognoses and offering a wider range of treatments.

SLTs would endorse Hume and Pullen’s (1994) view that no one profession has all the skills necessary for the assessment, treatment and rehabilitation of mentally ill people, just as no one treatment has been found to be fully effective in all cases. It would seem important to draw attention to the contribution of SLT as many professionals working in mental health areas are unaware of, and lack knowledge of, such services, specialisms and skills.

The national special interest group (SIG) was founded in the early 1980s, and this brought together many therapists around the country for purposes of support and training, helping the development of the specialism and encouraging the setting up of new services, whilst acting in an advisory capacity and maintaining links with the Royal College of Speech and Language Therapists (RCSLT) and other bodies such as the Royal College of Psychiatrists (RCP). Thus, the SIG is active in supporting SLT services which are already established and those which are just being set up.

Where services are already in place, demonstrating, describing, teaching and convincing other professionals of the value of a SLT service, there will only be the usual working problems. The difficulties of setting up a new service in areas where little if anything is known of the advantages of the service are fraught with problems, not only those of achieving funding for a post but in order to gain a hearing to present the idea of this service (see Chapters 4 and 5). Many SLTs in the past have carried out surveys of the needs of mentally ill patients, in both hospital and community settings, and have described the extent of the communication problems, the type of service that might be best suited to the patients, and how this service could be delivered. Commonly this has resulted in a consensus that the patients’ needs were not being fully met – however, frequently funds have not been available to develop further services. Thus, attempts to continue to develop and expand services presents daunting and exhausting difficulties, with the communication breakdown experienced by so many mentally sick people still often misunderstood, misinterpreted and mismanaged. Hence the need to create opportunities to share knowledge and information about SLT not only with psychiatrists, but also with other mental health professionals.

The particular SLT service for people with a diagnosis of mental illness will vary according to the particular patient population and the setting in which the service is delivered. Wherever possible it is viewed within the context of a multidisciplinary approach where it aims to assist patients in leading as full and valued lives as possible. The service provided must be sufficiently flexible to meet individual needs, and be delivered across a range of mental health settings for all, or some, of the major mental illness diagnostic groups, the service being prioritised according to need (France and Muir 1997). Of course, its role within the treatment package being offered must be appreciated by members of the multidisciplinary team.

At the Winter Meeting of the Royal College of Psychiatrists in 1997, Dr John Cox, Dean of the College, took a great interest in a symposium presented by a small group of speech and language therapists on the place of SLT in Mental Health. Dr Cox initiated discussion as to how best to educate psychiatrists on the role of SLT to ensure that the service was better understood, valued and used. It was suggested that during the psychiatrists’ early training would assist in their recognition of SLT and so aid support for developing services. Also when the SLT is working in co-operation with other members of the multidisciplinary team opportunities can be created to extend information either through specifically designed staff training sessions or as an example in treatment, whether individually or in co-operation with other members of the team.

The prime concern of SLT services in mental health settings is the communication skills of the individual patient, whilst recognising the relationship of these skills with other aspects of the individual and his/her environment. France and Muir (1997) suggest that SLT treatment should begin at the point of communication breakdown (Cox’s quote). The provision of SLT assessment and therapy is within the context of the multidisciplinary team and it is recognised that many other team members have contributions to make in evaluating and treating environmental, attentional and perceptual needs and deficits. However, in skills related to speech and language function, it is the SLT whose training provides specialist knowledge and skills relating to their neuropathology and psychopathology. This improves the adequacy of descriptions of the disorder, assisting in the achievement of a differential diagnosis. Chapter 9 on Neuropsychology will develop this topic further.

Another major contribution by the SLT to the team is that of describing, assessing and managing specific features of functional communication, including specific treatment programmes. In Chapter 19 on communication and social skills training, Henton and Sideras elaborate in some detail on the methods and techniques. These include structured programmes in which various aspects of communication are experienced and practised, with elaboration of different details relating to the pragmatic aspects of communication.

The specialised training of SLTs also enables them to have developed the listening and reflective skills required for many aspects of work in mental health. This is frequently followed by further training in areas such as counselling, personal construct psychotherapy and neurolinguistic programming, so that these additional skills are applied to the management of communication disorders, as seen in Chapters 25 and 26. Work initially includes a focus on re-establishing and developing the individual patient’s communication and linguistic skills with a common aim for the patient to progress sufficiently to benefit from other verbally mediated treatments. After the development of a successful working relationship with the high level of understanding regarding the person’s communication that has been achieved, continued direct/indirect involvement of the SLT in the provision of other treatment modules is generally beneficial. The emphasis is on helping the person to maintain and/or restore his/her communication skills as far as possible, whilst also improving the individual’s sense of personhood and self-worth (Dalton 1994).

The SLT has an additional role as an intermediary. This is twofold. Frequently, patients have great difficulty understanding the language used by mental health professionals, which includes jargon. They often misunderstand what we perceive as a clear message, and how often do we check we have been understood? It is quite likely to be the SLT’s responsibility to translate and/or clarify information shared with the patient by other professionals. Additionally, breakdowns in communication are not always patient-orientated! It would appear that the SLT is particularly adept at identifying when confusion or apparent misunderstandings occur and this provides the opportunity to interject to ensure that the message has been given, received and understood by all.

Sharing information with fellow professionals and with relatives and carers, who might well benefit from having clearly written and verbal explanations of the complexities of communication, is a skill which should not be underestimated. It can help avoid misunderstandings and avert intensification of relationship breakdown between the family, the patient and the therapist and ensure that all have the same information and the same understanding of that information.

Chapters 2–5 aim to help fill in the background information on mental disorders and their related speech, language and communication problems, and therefore will be of use to students and those new to the idea of SLT in mental health.

Mental disorder

The problem raised by the term ‘mental disorder’ has, according to the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV 1994), been much clearer than its solution, and, unfortunately, the term persists in the present volume as no appropriate substitute has been found. No definition adequately specifies precise boundaries for the concept of mental disorder, and like many other concepts in medical science, this lacks a consistent operational definition that covers all situations. Each of the mental disorders have been conceptualised as a clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom.

In the Pocket Guide to the Classification of Mental and Behavioural Disorders (Cooper 1994), the Foreword begins by informing us that mental and behavioural disorders are frequent, can be grave in their consequences and cause suffering to hundreds of millions of people, worldwide. The care these people receive – or should receive – depends on better education of health workers and the general public and on commitments of governments to the development of services to the mentally ill and their communities.

Both the DSM-IV and the ICD-10 are systems which are thought to be complementary, and to be more similar with each revision. The DSM-IV is widely used in the USA whilst the ICD-10 is widely used in the UK. However, both systems are familiar to those in the field, and easy to understand, remember and use by members of the multidisciplinary team.

Also relevant to definitions of mental disorder is the Mental Health Act of 1983. This defines mental disorder as ‘mental illness, arrested or incomplete development of the mind, psychopathic disorder and any other disorder or disability of the mind’. The Act has four categories, of which mental illness is by far the largest. The second group is psychopathic disorder, which is defined as a persistent disorder or disability of the mind which results in abnormally aggressive or seriously irresponsible misconduct and is therefore viewed solely in terms of its being antisocial behaviour (see Chapters 5 and 12). The inclusion of this in mental health legislation still raises much controversy. The third and fourth categories are mental impairment and severe mental impairment discussed in Chapter 20.

Mental illness

To understand the causes of mental illness, and even to define mental illness s...

Table of contents

• Cover Page
• Of Related Interest
• Title Page
• Copyright
• Contents
• Acknowledgements
• Foreword
• Part I : Background
• Part II : Management of Mental Health Services
• Part III : The Way Forward
• Appendix
• The Contributors
• Index