Role of SLT on a CAMHS Team Flashcards
what is a camhs team
What is a CAMHS Team
The Child and Adolescent Mental Health Service (CAMHS) is a specialist service for people under 18 with moderate to severe mental health difficulties. Mental health as defined by the American Psychological Association is effective functioning in daily activities resulting in: productive activities (such as work, school or caregiving), healthy relationships, and the ability to adapt to change and cope with adversity. The WHO (2014) asserts that “mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life”. Mental illness is defined by the American Psychological Association as a collective term for all diagnosable mental disorders - health conditions involving significant changes in thinking, emotion and/or behaviour or distress and/or problems functioning in social, work or family activities. Some examples of these mental health disorders which commonly present to CAMHS are anxiety disorders, mood disorders, eating disorders, psychosis, obsessive compulsive disorder and social and behavioural disorders among others.
social-emotional and behavioural disorders
Social-Emotional and Behavioural Disorders (SEBDs) refers to a wide range of emotional and behavioural difficulties presenting in childhood, described in terms of externalising and internalising behaviours. An externalising behaviour refers to impulsive, overactive and aggressive behaviour (Law & Plunkett, 2009). This aggression may be turned towards objects, the self, or others. It is highly concerning and associated with long-term problems including school dropout and delinquency. Internalising behaviour refers to shy, anxious or withdrawn behaviour (Law & Plunkett, 2009).
langauge and psychiatry
In order to understand why an SLT belongs on a CAMHS team, we must first understand the intrinsic relationship between language and mental health. According to a study carried out by Hollo et al, (2014) an estimated 81% of young people with mental health difficulties presented with at least mild speech, language or communication needs which had previously gone unrecognised. According to the RCSLT (2020) there are three different types of language and mental health interactions. The first of these is the presence of SLCN prior to availing of mental health services, which as demonstrated by the statistic above, is extremely prevalent. The second is a SLCN intrinsic to the mental health disorder - which is to say a SLCN caused by the mental health disorder. There are plenty of examples of this, some as described by Speech Pathology Australia include: depression resulting in decreased prosodic variation, decreased social awareness and interaction, and impaired attention, concentration and information processing. Another example of this is anxiety causing voice problems due to muscle tension, dysfluencies, checking behaviours disrupting conversations and selective mutism. The third interaction described by the RCSLT is SLCN contributing to the mental health disorder. For example, SLCN can contribute to social isolation and loneliness which are known risk factors for anxiety disorders; personality development can be affected - self-esteem, self-image and aspirations are often shaped by social interactions; frustration caused by an inability to communicate effectively can result in behavioural concerns, and finally reduced-self advocacy due to a lack of verbal ability to express thoughts and emotions can result in mental health difficulties as well. Of course, many children and young people may fall into more than one of these categories. For example, an adolescent with DLD may experience social isolation resulting in an anxiety disorder which then exacerbates their SLCN. Overall, the relationship between SLCN and mental health is ‘complex, multidimensional and transactional’ (Tannock 1996). It is for this reason that all children and young people who attend CAMHS or mental health services in general should be referred to an SLT for an assessment. Unfortunately, this does not always happen.
underdetection of SLCN in MH
There is plenty of research to suggest that the population of young people with SLCN in addition to their mental health needs is misunderstood and underidentified, which cna have implications for diagnosis and treatment of their mental health concerns (Hanock et al., 2023). There are many reasons for this. The child’s communication difficulties may be masked by areas of strength such as good social skills, or may be misinterpreted as poor motivation or attitude in the case of poor eye contact, closed body language and monosyllabic responses. Additionally, there is a lack of awareness of communication difficulties among other healthcare professionals. A study carried out by Panrow (2009), surveyed SLTs about working with children with SEBD found that those SLTs experienced barriers from other professionals, most of these barriers revolved around other professionals not understanding the links between language and behavioural difficulties. “you don’t need to see him, behaviour is the problem”.
role of slt
Now that we have a good understanding of how mental health difficulties and SLCN can interact, we can fully describe how important the role of the SLT is on a CAMHS team. Some responsibilities that fall to the SLT include carrying out communication or swallowing assessments and establishing communication needs. SLTs also help the patient engage with other interventions by helping them understand their diagnosis, providing important information such as safety and discharge plans to the patient in an accessible format, and adapting other interventions for them. One example of this is talking therapy. In addition to medication, talking therapy is one of the most common and important methods of mental health intervention - however, for a person with a SLCN it may be incredibly difficult to engage with thereby putting their recovery at risk. An SLT can assist with this, by providing both parties with strategies to enable more effective communication. In summary, an SLT has a unique ability to identify and integrate knowledge of the nature, assessment and impact of SLCN in the context of the young person’s overall mental health presentation to ensure they are provided with the most appropriate supports and interventions.
mdt
Within a CAMHS team there are many members of the MDT. These include an SLT, psychologist, psychiatrist, social worker, play therapist, occupational therapist, mental health nurse, and art therapist. The MDT work in different capacities depending on the patient’s needs. They have weekly meetings to discuss case load, sometimes they may have joint appointments with the patient for example, SLT and the psychiatrist being present at the same session. They also produce integrated care plans which provide an overview of the young person’s presentation, goals for their care as identified by and agreed with the young person and their parent/guardian, and an outline of the specific MDT interventions the young person may be engaging with.
5 p’s
When assessing the young person to develop a summary of their presenting concerns it is important to follow the 5 P’s model (McNeil et al., 2012). The first of these is the presenting problem, which describes the patient’s current concerns and provides a space for them to express their goals for engaging with MH services, some examples of a presenting problem include an inability to maintain employment, schooling, erratic friendships, physical complications from self-harm. The next P is predisposing factors, these are facotrs which make the patient more likely to present with MH difficulties, and may include biological factors (brain injury, genetic vulnerabilities), environmental factors (socio-economic status, trauma), and psychological factors (core beliefs or personality factors). The next is precipitating factors which are factors which preceded the onset of the problem such as substance use, or interpersonal, legal, occupational, physical or financial stressors. The next P is perpetuating factors which are factors that are maintaining the current difficulties such as ongoing substance use, behavioural patterns, biological patterns (insomnia), or cognitive patterns. The final P is protective factors, which refers to anything present in the patient’s life which is mitigating the difficulty or the impact of the difficulty such as social support, skills, interests, or personality characteristics. The 5 P framework is useful because it gives an excellent overview of the patient’s life which promotes holistic and person-centred care.
role within the mdt
In addition to their role for patients, SLTs also have a role within the MDT itself. They can provide psychoeducation of other team members in relation to the relationship between SLCN and mental health as well as collaborating with other mental health professionals to ensure communication needs are considered in the context of other mental health assessments (and interventions). Additionally, they can inform the team members as to the linguistic demands of traditional psychiatric treatment methods, and inform them as to the importance of taking on SLT recommendations regarding the adaption of these to suit the young person’s needs, and thereby optimise the intervention.
policies
Sharing the vision: A mental health policy for everyone (Government of Ireland) was published 2020, and was intended to serve as a framework for the implementation of mental health care in Ireland. However, the policy neglected to clearly outline the role of SLTs in the provision of mental health care. The IASLT published a response in which they outlined 5 premises for the importance of SLT involvement in mental health care provision. These are as follows. 1. Communication is key to the success or failure of this policy. 2. Communication is the focus of speech and language therapy. 3. Communication is central to mental health and mental health care. 4. Communication is central to recovery in a mental health context. 5. The management of dysphagia is a key role of SLTs in Mental Health Services for all patients over 18 years. These premises clearly define the SLT’s role in mental health services.
Mental health is effective functioning in daily activities resulting in: productive activities (such as work, school or caregiving), healthy relationships, and the ability to adapt to change and cope with adversity
American psychological association
“mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life”
WHO 2014
Mental illness is a collective term for all diagnosable mental disorders - health conditions involving significant changes in thinking, emotion and/or behaviour or distress and/or problems functioning in social, work or family activities.
american psychological association
An externalising behaviour refers to impulsive, overactive and aggressive behaviour
Law & Plunkett 2009
Internalising behaviour refers to shy, anxious or withdrawn behaviour
Law & Plunkett 2009
an estimated 81% of young people with mental health difficulties presented with at least mild speech, language or communication needs which had previously gone unrecognised.
Hollo et al. 2014
