More than words

In the following article, written by Ellice Wood, Highly Specialist Speech and Language Therapist at St Andrew’s Healthcare, Ellice discusses how building understanding, empathy and emotional resilience can break down barriers in communication, demonstrating the profound impact of Speech and Language Therapy on mental health and social integration.

In mental healthcare, the importance of Speech and Language Therapy (SLT) is still relatively unrecognised, but this is slowly improving, with more people learning about the benefits that SLT can bring to patient recovery.

To highlight the integral role that SLT can contribute to a person’s recovery journey we wanted to share some insight directly from one of our patients, Kevin*, who made remarkable progress in his SLT sessions at St Andrew’s.

Kevin* supported us to create this article and he wanted to share his own thoughts and reflections on how the SLT therapeutic programme improved his interactions with others and the value he found in developing positive emotional literacy.

Kevin came to St Andrew’s from prison with complex mental health needs after experiencing trauma and adverse childhood experiences at a young age.

On paper, people like Kevin, with no additional diagnosis such as Autism, Learning Disability or Brain Injury, can easily be dismissed as not needing SLT input - ‘doesn’t need SLT, he can talk just fine’ was a verdict given - and his challenges with communication and social interaction had not been addressed until he was admitted to St Andrew’s where he was triaged for SLT assessment.

On admission our team identified some potential factors in Kevin’s presentation that indicated that he may be experiencing difficulties with communication and social interaction, these were;

• His involvement in the criminal justice system before the age of 25 (1)
• Kevin’s difficulties in building relationships with peers
• His disenfranchisement with education and leaving college early

Kevin’s communication:

Kevin worked with members of the SLT team to explore and assess his communication strengths and needs. The most important areas he felt he struggled with, were recognising, labelling and interpreting other people’s body language and facial expressions to understand how they were feeling.

This also included recognising and understanding sarcasm and non-literal language, for example he would interpret “let’s get cracking” as someone asking for a fight, rather than the intended meaning, of ‘let’s get going!’.

Assessments showed that Kevin also had difficulties with understanding and retaining complex language and producing a narrative.

These are essential skills for navigating both the criminal justice system and a secure hospital setting, allowing people to effectively access mental health treatments, attend important meetings and engage in debriefs after risk incidents. 

So how did this impact him? 

During his time working with SLT, Kevin reflected on how the communication difficulties that we were targeting in therapy had been present and impacting on him throughout the majority of his life.

He shared many anecdotes from growing up, and in sessions, was able to view these with a different lens and understand what had happened and how people may have been feeling.

At school, Kevin was labelled as someone that “disrupted the classroom” and who “daydreamed until they said my name”, he therefore frequently found himself ending up in isolation. Kevin struggled to understand why other children felt the way they did and why they may have responded differently than him, to the same situation.

Kevin described himself as “seeming very arrogant and I didn’t care about others’ emotions, because I struggled to understand them”. Kevin realises now, that he often did not look at people’s faces which further impacted his ability to identify how other people were feeling.

He described to us how, “it didn’t help situations that I didn’t understand what their faces were supposed to be doing most of the time anyway, I just thought they were pulling weird faces all of the time”. 

Kevin shared that he used to get into a lot of fights, “there’s a few situations I can think of now, where I would start a fight, and in the process of hitting someone, they’d say ‘what’s your problem, I was joking!”. Kevin could now reflect that there had been a miscommunication and how the other person may have been feeling in the situation.

These difficulties in social interactions contributed to Kevin feeling wary around new people and he would often find himself “overthinking social situations for days after they had happened, just trying to make sense of them”. The social anxiety Kevin felt unfortunately meant he would often rely on drug use to help him feel more at ease when socialising.

When Kevin found himself in prison, his communication difficulties continued, on top of his worsening mental health.

Kevin continued to experience misunderstandings with people, escalating into verbal and physical conflicts. This resulted in him spending large amounts of time in his cell avoiding people, and with his mental health deteriorating, he reports that he also became ‘mute’ and did not speak with, or trust, anyone.

Kevin’s mental health continued to decline, resulting in admission to hospital, where he received support and made very positive progress with his mental health.

During his time in hospital, his communication difficulties made it difficult to attend his care meetings and ward rounds, due to not understanding the complex language being used.

When trying to build relationships with peers, Kevin described being “unable to fully listen to people for longer than a couple of minutes” as he struggled to ‘empathise’ with them and understand their stories.

What did we do?

When Kevin was first approached about SLT, he thought it was “going to be about my speech”. This is a common misconception, when in fact, it only makes up a small part of what we do.

Kevin engaged in weekly 1:1 SLT sessions with an SLT Assistant, working on emotional recognition in others, which developed into emotional awareness in himself. He subsequently built upon his emotional vocabulary and learnt more about recognising and responding to sarcasm.

Using video, pictures and role play, Kevin spent time learning how to look for clues in social interactions, to understand what people may be really meaning. 

During his time at St. Andrews, SLT also worked to support Kevin back to accessing his care planning meetings and ward rounds. This was done using visual resources to gather his thoughts and opinions before attending the meeting, which supported him to feel less pressured and on the spot.

He also created a list of dos and don’ts for professionals in the meeting, to make the environment feel more accessible and accommodating for him. Examples of this included telling him who was in the meeting before he joined, taking a fidget toy in with him and briefing people to not look at him when he initially walked into the room.

Kevin’s team followed this guidance and it was effective in helping him to access his meetings and share his views meaningfully. This intervention was noted by the ward psychology and medical team as being helpful for the team and successful in re-engaging Kevin.

What is Kevin’s communication like now?

We asked Kevin how he felt his communication had changed since working with SLT at St Andrew's and he shared this insight;

“When it comes to noticing people’s emotions, I feel I’ve got a lot better at it, I’m able to see things I didn’t really notice before. I think my communication has changed because I am able to identify different facial language/key features when talking and, for me, the biggest difference is that I’ve learnt to understand sarcasm and what to watch out for.”

Kevin is noticeably using humorous sarcasm more frequently, however he has noted that that he does still struggle to spot when people are using sarcasm to be mean. Kevin’s awareness of the complexities of emotions has improved, “I learnt why it’s so difficult to read emotions of others who may be wearing a mask, or talking over the phone and how emotions can overlap, mix or change in an instant.”

In discussion, we asked Kevin whether he felt it would have been beneficial to have SLT support with emotional literacy at an earlier age, he agreed that it could have helped him with understanding people around him and made things a bit easier.

However, with 76,000 children currently on the waiting list for SLT and 17 per cent of SLT posts vacant across England (2), it is likely that many people like Kevin will not receive the support they need at an early age and this may profoundly impact their educational attainment, their emotional wellbeing and mental health. 

How has SLT helped him progress?

Overall, Kevin feels he is now less wary around new people and more comfortable in social settings, without the use of drugs to help facilitate this. When asked how he felt his SLT sessions had helped him, Kevin said;

 “I can use what I now know to manage and cope with situations better than I used to, and to understand others. I am able to accept that it is natural to have emotions. It’s helped me to become more empathetic”.

Kevin shared some final thoughts on SLT:

“I would recommend SLT to other patients because it helps to better understand yourself and others around you. A problem shared is a problem halved, it has helped me to better communicate my problems. I’d advise anyone who does SLT to be open and honest, as this can help staff know how to support you. SLT staff are kind, don’t judge or discriminate and are genuinely there to help”. 

If you would like to find out more about Speech and Language therapies at St Andrew’s you can contact Ellice Wood, Highly Specialist Speech and Language Therapist, directly on eawood@stah.org

In addition, to find out more about how SLT triage interventions are improving outcomes for patients in our PICU and acute services please click HERE

St Andrew’s Healthcare is a charity that, for 185 years, has supported people with complex mental health needs. To find out more about their specialist inpatient and community mental healthcare services visit: St Andrew's Healthcare

*please note that we have changed the name of the person in this interview to protect patient confidentiality

*Ref 1 It is known that over 60 per cent of Youth Offenders experience communication difficulties. 

Bryan K, Freer J, Furlong C. Language and communication difficulties in juvenile offenders. International Journal of Language and Communication Disorders 2007; 42, 505-520.

*Ref 2 76,000 children in England waiting for speech and language therapy | The Independent