Bridging the Gap: Mental Health & Speech-Language Pathology
Written by: Kendra Wormald / Treatment / September 06, 2023 / 10 minutes read
Terminology
Mental Health refers to the state of your psychological and emotional well-being. It is a necessary resource for living a healthy life and a main factor in overall health. It does not mean the same thing as mental illness (FraserHealth, 2023).
It is helpful to think of mental health as a wellness continuum that ranges from wellness to un-wellness.
Mental Wellness is an internal resource that helps us think, feel, connect, and function; it is an active process that helps us to build resilience, grow, and flourish. It is not about always being happy. It’s about being able to manage well in your daily life – in good and bad times (FraserHealth, 2023)
Psychotherapy is a controlled act under the Regulated Health Professions Act, 1991 (Paragraph 14 of s.27 (2))”. The practice of psychotherapy is “the assessment and treatment of cognitive, emotional or behavioural disturbances by psychotherapeutic means (Tellis & Barone, 2018).”
Counseling is one of the activities outside of the controlled Act of psychotherapy. Counseling is the "assistance provided in an interactive manner to individuals (i.e., clients, patients, and/or students) and their families/caregivers dealing with challenging emotions and life situations in an effort to facilitate realistic and clearly understood goals and improve quality of life" (Flasher & Fogle, 2012; Tellis & Barone, 2018).
Types of Counseling
Personal Adjustment Counseling: “... targets feelings, emotions, thoughts, and beliefs expressed by individuals and their families/caregivers (e.g., realization of the pervasive impact of a communication disorder on day-to-day life) (ASHA, 2023).”
Informational Counseling (Family/Caregiver Education): “...discussing with individuals and their families/caregivers the nature of a disorder or situation, intervention considerations and techniques, prognosis, and material and community resources” (ASHA, 2023).
Scope of SLP in Counseling
As an SLP it is our responsibility to deliver education, guidance and support to individuals, their families and their caregivers. Services can target adaptation, decision making and interactions related to emotional reactions, thoughts, feelings, and behaviors that result from living with the communication, feeding or swallowing disorder/deviance, or related disorders or difficulties (CASLPO, 2023)
The Gaps
Research supports the lack of knowledge and training provided to both mental health providers and SLPs pertaining to counseling and collaboration. A lack of a holistic or client-centered approach and lack of clear boundaries from governing bodies also creates gaps in service
“ ... most SLPs (n=124) felt they lacked confidence and received insufficient training to address psychological well-being" (Northcott et al., 2017).
"... poor awareness and understanding of children's language needs was reported to negatively affect the delivery and effectiveness of mental health interventions" (Hobson et al., 2022).
Systematic research is needed to understand how to successfully adapt psychological services to make them accessible to those with language needs, and to ensure that mental health problems are detected in children with language difficulties (Hobson et al., 2022).
Comorbidities Across Populations
Evidence suggests that those living with speech language and communication challenges also live with mental health and wellness challenges
... 45% of children who were referred for services because they had a mental illness also had communication or language difficulties. (Conti-Ramsden & Botting, 2008)
... clinical levels of depression range from 20% to 39% in children and adolescents with DLD compared with 14–18% in peers without DLD (Conti-Ramsden & Botting, 2008)
... 46% of the stuttering group met screening criteria for social anxiety disorder, compared to only 4% of controls... 85% of the stuttering group who met screening criteria for social anxiety disorder also met screening criteria for generalized social anxiety disorder, compared to only 50% of controls. (Hancock, Northcott, Hobson and Clarke, 2022)
It is helpful to think of mental health as a wellness continuum that ranges from wellness to un-wellness..
SLP Counseling Intervention
Required Skills: Attending and listening, self-awareness, empathy, responding, probing future-oriented probes, brainstorming, summarizing, challenging and validating.
Effective Counseling Requires:
1. Practice (and lots of it)
2. Willingness to take risks
3. Ability to make mistakes… and learn from them
4. Understanding of our own needs, bias, motivations, strengths, boundaries, and areas of concern
5. Brining counseling in from the start of intervention (Yaruss, 2020)
The use of breath can be an impactful tool to support communication and the nervous system. See our Masterclass Breathing for Communication .
Approach Examples: Cognitive Behavioural Therapy, Person-Centered Counseling, Existential Counseling, Narrative Therapy, Positive Psychology
Emotions of Communication: Grief, shame, inadequacy, depression, guilt, fear / anxiety, embarrassment, loneliness / isolation, helplessness
Counseling is not an optional approach or set of strategies that you may or may not be used. Rather it is an essential part of clinical service delivery (ASHA, 2016). Client centered therapy involves following the direction of the client; however, the clinician must still have a plan in mind. Counseling is only meaningful if it results in improvements in the client’s life. Success is not just good sessions, but an organized, coherent plan for moving towards solutions and action (Yaruss, 2020)
Limitations
If SLPs do not feel comfortable addressing a particular issue or taking a specific approach, we should not do so. As indicated in the Code of Ethics, "... audiologists and speech-language pathologists should be specifically educated and appropriately trained to provide the services that they offer" (ASHA, 2023).
How Can I Support My Own Mental Wellness as an SLP?
Consider the types of tools and resources you can utilize to get well, be well, and stay well. These may change over time.
Talk and de-stigmatize
Examine your thoughts
Reflect on the tools you have
Support physical health
Take time away from the screen/noise and sit in silence with intentional breath
Debrief post-session
Remember your why. You joined this field to help others. Do not allow the paperwork and bureaucracy to rule your heart and mind. Focus on the eyes sitting across from you. They matter the most. And so do you.
“Never give from the depths of your well. But from your overflow. Our world needs your gifts. Begin by giving yourself the nourishment you require to do your meaningful work" - Johnson and Palafox
Contacts and Supports
CMHA: https://cmha.ca/find-your-cmha
BounceBack: https://bouncebackontario.ca/
ConnexOntario: 1-866 -531-2600 or www.connexontario.ca
Crisis Services Canada: 1-833-456-4566
Distress and Crisis Ontario: http://www.dcontario.org/
Good2Talk Helpline: 1-866-925-5454 or text GOOD2TALKON to 686868
LGBTIQA+ Youthline Ontario: 647-694-4275 + https://www.youthline.ca/ (chat, text and email currently available)
Kids Help Phone: 1-800-668-6868 or text CONNECT to 686868
Children’s Mental Health Ontario Centres: cmho.org/findhelp/
Hope for Wellness Help Line: 1-855-242-3310
SLP Mental Health Support:
https://www.linkedin.com/pulse/essential-role-speech-pathologist-mental-health-teams-kizzy-searle/
https://www.simplepractice.com/blog/why-slps-should-be-involved-in-mental-health/
https://www.speechpathology.com/ask-the-experts/speech-language-pathology-and-mental-8544
“Don’t forget to look after your mental health on your pursuit to reach your goals.” - Mirriam E. Miles
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.
