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Key points

  • A high proportion of adults presented to mental health services may have speech, language, communication and swallowing difficulties. However, often problems are not recognised as they may be masked by the mental health symptoms
  • Adults experiencing mental health problems are at increased risk of harm due to the risk of swallowing difficulties can pose
  • Communication needs present a barrier to explaining concerns around mental health and accessing psychological therapies
  • Speech and language therapists support adults with mental health problems in the accessibility and accuracy of referrals, assessments and interventions that are verbally mediated and reduce the risk of swallowing problems leading to choking and pneumonia

What is mental health?

Mental health refers to a state of social, physical and mental well-being which can be affected by biological, individual and social influences and perspectives (WHO ICF 2001). Disorders of mental ill health may be transitory, enduring or recurring and cause personal distress or impaired functioning in one or more areas of an individual’s life.

There is a high incidence and prevalence of speech, language and communication and swallowing difficulties associated with mental health in adults. Specific mental health problems have communication and eating, drinking and swallowing difficulties commonly associated with them, for example, schizophrenia, psychosis, dementia and depression. However, often problems are not recognised and there is a risk that they may be masked by the mental health symptoms.

Communication

There are important links between mental health and speech, language and communication needs. Communication needs put people at risk of developing mental health problems and those with mental health problems may also have communication needs. Being able to communicate is essential in explaining concerns around mental health and accessing talking therapies.

The size of the problem

  • People with a primary communication difficulty are at a greater risk of experiencing mental health problems than their peers, commonly anxiety and depression
  • 84% of attendees at area psychiatric services had language impairments
  • 74% of attendees at area psychiatric services had communication difficulties
  • Verbal and non-verbal communication skills are a key component of effective de-escalation techniques in mental health services

Swallowing

Mental health problems can also have eating, drinking and swallowing difficulties (dysphagia) associated with them. They may be an intrinsic part of the disorder or a side effect of medication.

The size of the problem

  • There is a greater prevalence of dysphagia in acute and community mental health settings compared to the general population
  • There is also evidence for an elevated rate of death due to choking in acute mental health settings partly due to the effects of medication
  • The risk of death due to choking in people with schizophrenia has been reported as 30 times more likely than in the general population

Role of speech and language therapy for mental health

Speech and language therapists (SLTs) have a unique role in identifying the communication characteristics and swallowing difficulties. They can also provide therapeutic programmes to develop speech, language or communication skills.

SLTs are integral members of the multidisciplinary team supporting clients with mental health problems. They:

  • Identify speech, language, communication and eating, drinking and swallowing difficulties
  • Support patient safety by reducing the risk of swallowing problems which can lead to malnutrition, dehydration, choking or aspiration pneumonia requiring hospital admission and in some cases causing death
  • Support access to verbally-mediated interventions and individual or group-based talking therapies which require significant understanding and expressive language skills
  • Support other professionals and staff to recognise and understand how to respond to communication needs and dysphagia and how to tailor information to support decision-making and discuss treatment options.

Resources

Factsheet Key messages on mental health

Video - communication and swallowing in mental health

For more videos visit the RCSLT YouTube channel

Related Topic Areas

Key organisations