Article written by Emma Cleary, Speech and Language Therapist at Rampton High Secure Hospital.
A typical week for me may look like this:
| Monday Mental Health | Tuesday Personality Disorder | Wednesday Mental Health | Thursday Mental Health | Friday Mental Health |
8.30- 9.00 | Handover meeting | Handover meeting | Handover meeting | Handover meeting | Handover meeting |
9-10.30 | Supervision | MDT Meeting | Preparation for Pragmatics Group | CPD: Dysphagia | Indirect intervention: SLT support |
10.30- 12.00 | Patient session: Assertive / passive / aggressive communication styles | Patient session: Communication and self-harm | Preparation for Pragmatics Group | Patient session: Capacity Assessment | Patient session: Emotional Regulation |
12- 12.30 | Lunch | Lunch | Lunch | Lunch | Lunch |
12.30-14.00 | Patient session: Rapport building | Developing resources | Pragmatics Group | Support Psychology Group | Patient session: Meal time observation, dysphagia |
14-15.30 | Patient session: Sentence construction / SVO | Patient session: Initial Assessment | Pragmatics Group | Support Psychology Group | Patient Session: Self-esteem |
15.30-16.30 | Writing up notes / reports | Writing up notes / reports | Writing up notes / reports | Writing up notes / reports | Writing up notes / reports |
To explain this a little bit more clearly, I’ll take Monday more in depth.
Rampton High Secure Hospital is one of three high secure hospitals in England and Wales. All patients admitted to Rampton are detained under the Mental Health Act 1983, and are classified as having a learning disability, mental illness, and/ or personality disorder. I work across 2 care streams: Mental Health and Personality Disorder, and on Mondays I work in Mental Health.
Handover meeting
It is important to begin each day with a handover meeting, where staff who worked the day/ night/ weekend before, inform the staff working the current day, of any recent changes or things to be aware of. This supports us to make informed decisions about our planning for the day, understand the dynamics of the ward and the physical and mental state of the patients.
Supervision
Any AHP will receive supervision at some level from a professional of a higher banding from themselves. Due to the complex nature of the patient group, this is offered monthly at Rampton. I value supervision as a resource to discuss my work, seek advice on any barriers I have encountered, and to address any emotional difficulties I have encountered whilst working with these severely ill individuals who have experienced a lot of trauma.
Patient session: Communication Style
Sometimes a patient may lack insight into their communication style. They may not realise that the way they communicate can be perceived as aggressive by a listener, and therefore affect their relationships, and their access to treatment. SLT can offer therapy to develop their insight, and then support them to practice this in their day-to-day communication.
Patient session: Rapport Building
Some patients may have very high levels of anxiety and attending 1-1 sessions may be too advanced to achieve. I may aim to develop a rapport with a patient by visiting them on the ward and having a conversation in a low-pressure, safe environment. A positive therapeutic relationship is key to supporting a patient in SLT, so laying this groundwork and utilising soft SLT techniques such as positive reinforcement and modelling of positive communication strategies, is very important.
Patient session: Sentence Construction and Subject Verb Object (SVO)
Many patients will not have received SLT in school, or did not attend school and therefore would not have received communication support such as syntactic construction. This work will aim to support patients’ receptive language and understanding of how to form grammatically correct sentences. SVO intervention will also support the patient’s ability to express themselves, and vicariously target skills such as verbal memory and confidence to communicate.
Writing up notes/ reports
Legally, medical professionals need to write notes regarding every patient we saw that day on the NHS database, within 24 hours. And another big part of working in forensics is report writing. For instance, a patient will have a Care Programme Approach meeting every 6 months, where all disciplines with which a patient has been working (e.g.: Occupational Therapy, Psychology, Arts Therapy) will submit a report on the patient’s work and progress.
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We are very thankful for Emma Cleary who kindly shared her experience and insight with our community on her work at Rampton.
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