Uniquely Challenging Working as an SLT Assistant in

Uniquely Challenging Working as an SLT Assistant in Forensic Mental Health Fiona Williamson Rampton Hospital

Introduction My Background History ¢ Employed in Dec 2000 ¢ Full time contracted 35 hrs pw ¢ First (& only) SLT Assistant employed at Rampton Hospital ¢ Only SLT Assistant working in the High Secure Hospitals in England (as far as we know) ¢ Initially employed on Assistant pay scale ¢ Following successful re-grading now TI 2 (A 4 C Band 4)

Introduction cont’d Working environment Large Victorian building in a rural setting Security constraints Client group ¢ Patients with a primary diagnoses of either Mental Illness, Personality Disorder or Learning Disability ¢ Secondary diagnoses such as Asperger’s Syndrome ¢ Often limited educational attainment ¢ Exacerbating factors such as effects of medication, institutionalised behaviour, lack of volition etc

The Speech & Language Therapy Team SLT Team Manager Lead SLT Women’s services Lead SLT Personality Disorder Vacant Lead SLT Learning Disability Senior SLT x 2 Senior SLT Me!

Roles & Responsibilities ¢ To provide supportive clinical work, 1: 1 or groups to identified patients. SLT package of care devised by SLT but delivered independently ¢ ¢ Develop activities to meet defined intervention needs Source and prepare resources to support therapeutic interventions as required and requested by SLT team ¢ Write reports for identified patients under guidance of supervising Therapist ¢ Plan and manage own timetable, negotiating with Head SLT re workload ¢ Participate in regular supervision with supervising Therapists and Head of SLT

Opportunities of working at Rampton Hospital ¢ Opportunities to co work with other professions- in past have co facilitated groups with Occupational Therapists and Nurses ¢ Opportunity to utilise a wide range of therapeutic interventions, for example Personal Construct Psychology ¢ Provides you with a clear insight of the effect communication difficulties have on an individual and the relationship between communication and level of risk

Opportunities of working at Rampton Hospital ¢ Involvement in all aspects of patients care ¢ Ability to follow patient through their treatment pathway during time spent at Rampton ¢ Opportunity to work with a diverse range of communication difficulties ¢ Opportunity to work with patients across all directorates, i. e. Learning Disability, Personality Disorder, Mental Health & Women ¢ Involvement in patients rehabilitation trips and transfer to Medium Secure Units

What are the Challenges? Activity Before I go onto talk about the challenges I’ve faced, what are the challenges you face in your roles? Activity 1: • Break into groups of 5 • What are the ‘challenges’ you face? • Feedback to the main group 10 minutes

Challenges of working within this setting ¢ Limited understanding/ lack of awareness of SLT Assistant role ¢ Limited understanding of benefits/purpose of SLT for this client group within own profession and others ¢ Dysphagia can ‘overshadow’ other aspects of our roles ¢ Lack of appropriate training courses both in house and external ¢ At times feel isolated & without peer support

Challenges of working within this setting – client focused ¢ Issues re perception of SLT ¢ Expectations of ‘curing’ ¢ Often intervention is about maintaining skills rather than developing ¢ Variability in presentation ¢ Difficulties with engagement ¢ Relapses in mental health ¢ Co-morbidity issues e. g. drug misuse

Challenges of working within this setting – client focused ¢ Patients often utilise sessions to discuss issues ¢ Can at times be emotionally draining ¢ Need to ensure remain focused on SLT intervention & aims ¢ Areas aren’t conducive to therapy ¢ Security policies and risk issues can prohibit ideas you may have for intervention & resources

How I’ve overcome/dealt with challenges Kept smiling & a good sense of humour! ¢ Regular clinical and managerial supervision ¢ Thinking ‘outside the box’ for training courses -even though not directly relevant, ¢ identify aspects that can be transferred to your client group

Possible solutions -Activity 2 ¢ Looking at your ‘theme’, what ideas or strategies can your group identify to overcome those challenges? ¢ Feedback to the main group 15 minutes

Close and Any Questions? I am more than happy for people to contact me if they have any queries or would like further information: fiona. williamson@nottshc. nhs. uk