Article written collaboratively with Emma Cleary, Speech and Language Therapist at the Rampton High Secure Hospital.
Q: Tell us a little bit about yourself 👋🏼
My name is Emma Cleary, and I am a speech and language therapist (SLT) working at the Rampton High Secure Hospital.
Note from editor: Rampton High Secure Hospital is one of three high security hospitals in England and Wales. Patients are only admitted to Rampton Hospital if they are referred by a health professional and assessed by the Hospital as meeting the criteria for admission. All patients admitted to a clinical service in the Hospital are detained under the Mental Health Act 1983 (MHA) and classified as having a learning disability, mental illness and/or a psychopathic disorder. Patients will have been assessed as requiring treatment under conditions within a high secure environment, meeting the criteria of posing a grave and immediate danger to themselves or the public. Many will have come via the Criminal Justice System. Most admissions will be under Part III of the MHA, either from the court, from prison or a medium security unit. Those patients who have not committed a criminal offence are a civil admission under Part II of the MHA and will usually have come from a lower level security hospital setting and have been assessed as potentially a serious danger to others. Referrals come from: - courts - prisons - secure hospitals - general mental health services - independent sector hospitals The average length of stay in the Hospital is approximately five years, but a very small number of patients are likely to remain at Rampton Hospital for a significantly longer period of time. Information from: https://www.nottinghamshirehealthcare.nhs.uk/rampton-hospital
Q: What is something that you didn’t know or may be less mindful of until you started working within the criminal justice sector?
This was my first job as a qualified SLT. This meant that alongside learning how to be a SLT and work in a hospital, I had to learn a lot about the Mental Health Act and its relationship with patients during their time at Rampton, before Rampton and after Rampton. All patients are detained at the hospital by the Mental Health Act, which means their lives are dictated by the Ministry of Justice (MoJ). Each patients will be detained under different sections, which means there are different requirements and restrictions to their sentence. I need to know this when I’m thinking about the patient’s experiences prior to admission to Rampton, and their future goals. For example, once a patient has completed treatment, will they be returning to prison, or moving to a Medium Secure Unit? Patients will be in touch with the Ministry of Justice during their time at Rampton, e.g.: continuing court proceedings, tribunals, appeals. This means that their sentence could change, at any point and a consequence their life plans. As you can imagine, this is extremely stressful!
Therefore I need to recognise these stressors, and the feeling of loss of control many patients will feel as a result. I think about how a patient will respond to court proceedings, and use SLT as an outlet to talk about coping strategies. Some patients come to SLT looking for support, and some patients don’t want to talk about it at all. It’s important I understand what they’re going through, and provide the opportunity for the patient to process in way they can.
Q: How have you found this line of work and what do you enjoy about it?
I love working in forensics.
Many patients end up at Rampton, or similar forensic institutions, because they have been failed by the system from a young age. Many patients have not received education, care or targeted intervention which many take for granted until they arrive here.
There is a preconception that people in criminal justice will not care or want to improve, which I have found to be not the case. I notice every day that some patients improve just from receiving daily care, from SLTs, nurses, psychologists, occupational therapists and all members of the MDT. All the staff at Rampton are working towards the common goal of helping these patients. We offer specialised mental health treatment which is frequently proven to be successful, and we see progress where the patients themselves never believed it was possible!
Q: Could you tell us a story within your work where SLT has made a significant difference on an individual’s life?
I worked with a patient who had recently received a diagnosis of Autism, and was referred to SLT to support him with this. This patient had no knowledge of how Autism may affect his communication needs, so myself and a colleague began a scheme of work to inform the patient and support him to develop some insight into his own communication style. The patient developed a Communication Passport of his needs and difficulties, and was able to present this to staff to educate others about Autism.
As this was happening, the patient was experiencing difficulties in his Multi-Disciplinary Team (MDT) meetings, which was leading to difficulties building relationships and achieving personal goals. The patient was feeling stressed coming into this meeting, which caused him to communicate aggressively, and further impeded his ability to communicate appropriately and work with the MDT. SLT therefore began work specifically targeted on these meetings.
We supported the patient to develop insight into different communication styles, consider communication in terms of body language and verbal skills alongside words, and developed resources to take into the meetings to support him. These meetings became more successful within weeks, as the patient continued to utilise our SLT sessions as an opportunity to debrief and discuss his communication on the ward and in these meetings.
After 9 months of this intervention and supporting SLT work, the patient was referred to a Medium Secure Unit due to his work at the hospital and tangible progress on his mental health. I believe this demonstrates the impact communication difficulties can have on a patient’s access to treatment, and the benefits of willingness to work on these together.
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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.
🤓 What is something new that you have learnt from reading Emma's journey and experience?
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