Uniquely Challenging
Working as an SLT Assistant in Forensic
Mental Health
Fiona Williamson
Rampton Hospital
Introduction
My Background History

Employed in Dec 2000

Full time contracted 35 hrs pw

First (& only) SLT Assistant employed at
Rampton Hospital

Only SLT Assistant working in the High Secure
Hospitals in England (as far as we know)

Initially employed on Assistant pay scale

Following successful re-grading now TI 2 (A4C
Band 4)
Introduction cont’d
Working environment
Large Victorian building in a rural setting
Security constraints
Client group

Patients with a primary diagnoses of either Mental
Illness, Personality Disorder or Learning Disability

Secondary diagnoses such as Asperger’s Syndrome

Often limited educational attainment

Exacerbating factors such as effects of medication,
institutionalised behaviour, lack of volition etc
The Speech & Language
Therapy Team
SLT Team
Manager
Lead SLT
Women’s services
Lead SLT
Personality Disorder
Vacant
Lead SLT
Learning Disability
Senior SLT
Senior SLT
Senior SLT x2
Senior SLT
Me!
Roles & Responsibilities

To provide supportive clinical
patients under guidance of
patients. SLT package of care
supervising Therapist

Plan and manage own
independently
timetable, negotiating with
Develop activities to meet
Head SLT re workload
defined intervention needs

Write reports for identified
work, 1:1 or groups to identified
devised by SLT but delivered



Participate in regular
Source and prepare resources
supervision with supervising
to support therapeutic
Therapists and Head of SLT
interventions as required and
requested by SLT team
Opportunities of working at
Rampton Hospital

Opportunities to co work with other professions- in
past have co facilitated groups with Occupational
Therapists and Nurses

Opportunity to utilise a wide range of therapeutic
interventions, for example Personal Construct
Psychology

Provides you with a clear insight of the effect
communication difficulties have on an individual
and the relationship between communication and
level of risk
Opportunities of working at
Rampton Hospital

Involvement in all aspects of patients care

Ability to follow patient through their treatment
pathway during time spent at Rampton

Opportunity to work with a diverse range of
communication difficulties

Opportunity to work with patients across all
directorates, i.e. Learning Disability, Personality
Disorder, Mental Health & Women

Involvement in patients rehabilitation trips and
transfer to Medium Secure Units
What are the Challenges?
Activity
Before I go onto talk about the challenges I’ve
faced, what are the challenges you face in
your roles?
Activity 1:
• Break into groups of 5
• What are the ‘challenges’ you face?
• Feedback to the main group
10 minutes
Challenges of working within this
setting

Limited understanding/ lack of awareness of
SLT Assistant role

Limited understanding of benefits/purpose of
SLT for this client group within own profession
and others

Dysphagia can ‘overshadow’ other aspects of
our roles

Lack of appropriate training courses both in
house and external

At times feel isolated & without peer support
Challenges of working within this
setting – client focused

Issues re perception of SLT

Expectations of ‘curing’

Often intervention is about maintaining skills
rather than developing

Variability in presentation

Difficulties with engagement

Relapses in mental health

Co-morbidity issues e.g. drug misuse
Challenges of working within this
setting – client focused

Patients often utilise sessions to discuss
issues

Can at times be emotionally draining

Need to ensure remain focused on SLT
intervention & aims

Areas aren’t conducive to therapy

Security policies and risk issues can prohibit
ideas you may have for intervention &
resources
How I’ve overcome/dealt
with challenges
Kept smiling & a good sense of
humour!
 Regular clinical and managerial
supervision
 Thinking ‘outside the box’ for training
courses -even though not directly relevant,

identify aspects that can be transferred to your
client group
Possible solutions -Activity
Activity 2

Looking at your ‘theme’, what ideas or
strategies can your group identify to
overcome those challenges?

Feedback to the main group
15 minutes
Close and Any Questions?
I am more than happy for people to contact
me if they have any queries or would like
further information:
fiona.williamson@nottshc.nhs.uk