ACQ_Vol_11_no_3_2009

Mental health

Exploring the need for the speech pathologist in forensic and mental health settings Laura Caire

This article provides a brief overview of findings in the literature concerning comorbidity of communication impairment and social, emotional, and psychiatric difficulties including those associated with juvenile offending. The need for and role of speech pathologists in mental health and forensic settings is discussed. L anguage is an essential tool for communication (Speech Pathology Association of Australia, 2001). It is through language that humans learn to express emotions and thoughts, develop self-image and influence the behaviour and attitude of others. It is not surprising, therefore, that the comorbidity of communication disorders and mental health problems has been estimated as ranging from 50% to 80% (Baltaxe & Simmons, 1988; Benner, Nelson, & Epstein, 2002; Cantwell & Baker, 1991; Cohen, Barwisk, Horodezky, Vallance, & Im, 1998; Cohen, Davine, Horodezky, Lipsett, & Isaacson, 1993; Eichmann, 2008; Giddan, Milling, & Campbell, 1996; Gualtieri, Koriath, Bourgondien, & Saleeby, 1983; Kotsopoulos & Boodoosingh, 1987; Zadeh, Im-Bolter, Cohen, 2007). Many of these language impairments are unsuspected. Among children who have a language impairment, the most common types of psychopathology are externalising ones, e.g., ADHD, CD, ODD (Zadeh et al., 2007). Many juvenile offenders also present with language impairment. For example, in a study conducted by Snow and Powell (2008), more than 50% of a community sample of male youth offenders had unidentified language impairment which could not be accounted for by low IQ. The participants presented with particular difficulties in narrative (storytelling) skills and figurative/abstract language. It is ironic that although so many juvenile offenders present with language impairment, the justice system expects them to perform many tasks that require higher level metalinguistics, executive functioning and language skills, without appropriate communicational support. The tasks include: • understanding rules, linking actions to and predicting consequences; • learning from their “mistakes” and responding to punishment; • comprehending commonly used signs such as “no trespassing” and words like “penalty, caution” and “flammable”;

• understanding questions posed by police and solicitors; • understanding the court process; • dealing with complex information and understanding lengthy explanations (such as those regarding diagnoses, medication and treatment options); • understanding ulterior motives, such as recognising when they are being scapegoated or set up by peers, being taken advantage of, or knowing when another person is joking or serious; • practising appropriate social behaviour including empathy and using language in a way that takes account of a social hierarchy (e.g., peer vs. teaching assistant vs. principal); • appropriately problem-solving and resolving conflict through offering of verbal solutions (vs. aggressive/ physical/impulsive ones) and negotiating outcomes; • taking responsibility for their actions (when they may not even understand what they did wrong); • proposing ways to make amends; • telling a clear narrative of events using adequate detail and sequencing; • making positive peer and community connections; • giving reasons for their behaviour and actions; • organising themselves, planning ahead and formulating goals; • making sound judgments and thinking through decisions; and • regulating affect, behaviour, and emotional arousal and controlling their responses and participating in talking- based therapies. (Cohen et al., 1998; Conti-Ramsden & Durkin, 2008; Gilmour, Hill, Place, & Skuse, 2004; Hart, Fujiki, Brinton, & Hart, 2004; Sanger, Moore-Brown, Magnuson, & Svoboda, 2001; Snow & Powell, 2008; Fujiki, Spackman, Brinton, & Hall, 2004; Speech Pathology Association of Australia, 2001; Zadeh et al., 2007). It could be argued that because of these adolescents’ inability to request assistance or participate in communicative discourse with mental health and legal professionals they could easily be taken advantage of or not treated fairly as a result. In the Charter of Human Rights and Responsibilities document “Protection of freedoms and rights for everyone in Victoria”(2009), Victoria’s Attorney- General, The Hon. Rob Hulls MP, writes “At the heart of Victoria’s Charter of Human Rights and Responsibilities is respect: the belief that everyone is entitled, as we say, to ‘a fair go’” (p. 2). On their website under “The Victorian Charter of Human Rights and Responsibilities explained” the

Keywords adolescent language juvenile offenders psychiatric disorder

mental health communication impairment

Laura Caire

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ACQ Volume 11, Number 3 2009

www.speechpathologyaustralia.org.au