Speak Out April 2021

models of care for groups across the whole of life; a state- wide trauma service; more support for people who are at risk of coming into contact with the justice system and eliminating seclusion and restraint practices. It was positive that speech pathologists were acknowledged as valuable members of multidisciplinary mental health care teams across the lifespan and was pleasing to hear quotes from other mental health professionals who talked about the benefit of having speech pathology in their multidisciplinary teams. In addition, we welcomed calls from the Chief Psychiatrist, Dr Neil Coventry, to create Lead Allied Health positions, which would include speech pathology, within the Department of Health to provide governance to speech pathologists in mental health all around the state and to ensure a multidisciplinary perspective on mental health is achieved. However, we do not believe the report goes far enough to mandate a clear pathway to achieve truly multidisciplinary teams in all mental health care teams across the lifespan and ensure speech pathologists are seen and acknowledged as essential members of each and every mental health team across the state. As speech pathologists, we recognise how communication and mental health difficulties are inextricably linked. With studies indicating that over 80% of children with emotional and behavioural disorders had previously unidentified communication difficulties and children with communication difficulties as being at a much greater risk of developing social, emotional and/or behavioural difficulties, it is clear speech pathology services are required wherever there are mental health concerns about a young person. But as we know, communication difficulties do not just affect children, with over 60% of adults in mental health services having communication difficulties. The ability to communicate effectively is imperative in forming and maintaining relationships, participating in mental health treatment and support, and participating in all aspects of life, such as school and work. In addition to this, 30-60% of people in mental health services have difficulties with eating and/or drinking that can be life-threatening. Without access to speech pathologists for assessment of swallowing and communication difficulties, for differential diagnosis and provision of tailored intervention, a significant proportion of people who are in contact with mental health care teams are not being provided with the support they require to achieve personal recovery.

Recommendation 56 is focused on supporting consumers to exercise their rights and Recommendation 28 is focused on developing system-wide roles for the full and effective participation of people with lived experience of mental illness, however they fail to acknowledge that a proportion of people who have experienced a mental illness may also have a co-occurring communication difficulty meaning they are less able or even unable to participate in such initiatives, and furthermore there are no recommendations or strategies to ensure this cohort are considered and included. People with communication difficulties are far too often labelled as non-compliant, manipulative, or violent within the mental health system even though we know behaviour is a form of communication. People will express their emotional state using behaviours if they do not have sophisticated communication skills and so speech pathologists must be available to assist in helping people communicate more effectively in mental health care settings. Additionally, speech pathologists play an essential role in upskilling both clinical and non-clinical mental health supports to be able to work with the consumer, at their level, and allow them to have true and meaningful two-way communication exchanges. Communication is an essential human right that needs to be made available to all people who experience mental health difficulties. If co-design of services and supports are to be truly representative of the whole of the mental health consumer group, those with communication difficulties, that may not otherwise be able to participate, must be catered for. The report, while detailed in its description of what is needed and why, remains ambiguous and open to wide interpretation about how these changes will be enacted and how we will be able to provide a system that is both responsive and inclusive of the needs of all people across the lifespan, whilst remaining safe and containing. As they say the devil is in the detail and so we will continue to listen carefully for specific clarification from the Department of Health over the coming weeks. Speech Pathology Australia is dedicated to ensuring speech pathologists are recognised as key members of all mental health teams across the lifespan and promoting communication as an essential human right. The full report can be found here: https://finalreport. rcvmhs.vic.gov.au/ Chantele Edlington Senior Advisor Justice and Mental Health

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April 2021 | Speak Out