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

2. 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 (A4C Band 4)

3. 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

4. The Speech & Language Therapy Team SLT Team Manager Lead SLT Women’s services Lead SLT Personality Disorder Vacant Lead SLT Learning Disability Senior SLT Senior SLT x2Senior SLT Me!

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Possible solutions -Activity 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

14. 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