Many thanks to Claire Wiseman & Ann Lafferty from The Advocacy Project (Scotland) for this guest blog, including a great example of how Talking Mats helped a young woman with learning disabilities and psychosis share her views about being in hospital, receiving medical treatment and her preferences in respect of future post discharge welfare decisions:
For some time, The Advocacy Project have been thinking about how we could use the Talking Mats Framework to support people going through legislative processes such as the Mental Health (Care and Treatment) (Scotland) Act 2000, Adults with Incapacity (Scotland) Act 2000 and the Adult Support and Protection (Scotland) Act 2007.
Recently the Mental Welfare Commission published a best practice guidance on Supported Decision Making – https://www.mwcscot.org.uk/good-practice/guidance-advice, which we referred to as part of our presentation for the recent Talking Mats is 21 celebrations (click here to see the presentation Talking Mats and Supported Decision Making PP 2 (1)). The feedback from this session was that ‘yes’ there is a need for symbols to support legislation. As accredited trainers, we’ve also been asked when we’re delivering training to lawyers, Mental Health Officers, Social Workers, support workers and other advocacy organisations if there are specific symbols related to Supported Decision Making, particularly with regard to legislative issues.
Here is one of the Supported Decision Making and Talking Mats examples shared in our presentation:
One of our staff supported a young woman with a learning disability who was thought to be experiencing a psychotic episode. She had been detained in an in-patient learning disability unit under the Mental Health (Care and Treatment) (Scotland) Act 2003 on a Short Term Detention Certificate. The clinical team then made an application for a Compulsory Treatment Order, which was granted. Later, when discharge planning was in progress, an application for Welfare Guardianship was made under the Adults with Incapacity (Scotland) Act 2000.
Although the young woman was able to communicate verbally, the effects of the psychosis combined with her learning disability meant that her conversation was discursive and she was very easily distracted. Using a combination of Talking Mats and our additional symbols over a number of sessions, the advocacy worker managed to ascertain her views about being in hospital, receiving medical treatment and her preferences in respect of future post discharge welfare decisions.
The Talking Mats reports were submitted as evidence at two mental health tribunal hearings and the Welfare Guardianship hearing at the sheriff court. We received positive feedback from the Curator Ad Litem, Mental Health Officer and Sherriff regarding the reports as they had never had Talking Mats reports submitted before during these proceedings.
The use of Talking Mats had been instrumental in supporting the young woman to put forward her views and ensuring an outcome she was happy with.
Going forward, Talking Mats and The Advocacy Project will be exploring the possibility of a symbols set for Supported Decision Making and legislation. We are currently looking at funding possibilities.
A fantastic example of the power of Talking Mats – if you have any Talking Mats stories you would like to share, please get in touch! Just send me an email at firstname.lastname@example.org
Many thanks to Dr Sally Boa, Head of Education, Research and Practice Development at Strathcarron Hospice in Stirlingshire, for this latest guest blog – linking to her great presentation at our TM is 21 event in August. Sally’s presentation – Talking Mats and Palliative care – focused on using Talking Mats in Palliative and End of Life Care, and included information about the Talking Mats ‘Thinking Ahead’ resource – here Sally shares her own experiences:
Talking about death and dying and making plans for the future is difficult to do. This is partly because no one likes to think about their own mortality and partly because as a society we don’t talk about it. I work in a hospice where people are encouraged to talk about the care and treatment they would want as their condition deteriorates. Even here, these conversations can be difficult, particularly if someone has communication or cognitive difficulties, if there is uncertainty about prognosis or if there are different opinions within the family. The ‘Thinking ahead’ Talking Mats resource is a great tool to use to enable these conversations to happen. In my presentation at the ‘Talking Mats is 21’ event, I provide some background about how the resource was developed. I have used it to support those with communication difficulties to have a voice and also with people who simply find this a difficult topic to think and talk about. Use of the Mats helps people to think through the issues one at a time and see for themselves how they feel about things in relation to one another. Most importantly, it helps open up the conversation about the future and helps people to prioritise and see for themselves what they need to do in relation to making plans for the future. Then they can get on with living and doing the things that are most important to them.
A most memorable example of using Talking Mats with someone towards the end of life is when I was asked to work with ‘Gill’ who had severe communication difficulties. I used the ‘Thinking ahead’ resource with her and found out that she had made many plans in relation to sorting out her affairs (e.g. power of attorney, funeral arrangements). She hesitated when I showed her the ‘making memories’ symbol and at the time I couldn’t work out why. To finish the session, I used the ‘indoor interests’ symbols with Gill and we had a great conversation about all the things she enjoyed doing. When I gave Gill the ‘arts and crafts’ symbol, she became really animated, and was able to tell me that she wanted to finish creating a memory book of photos that she had been making up for her family. Using the Mats, Gill managed to convey why she had hesitated with the ‘making memories’ symbol. Following on from this, we had a conversation with the hospice creative arts coordinator who was able to support Gill to complete, not only her memory book, but also other creative pieces. In her last few days of life, Gill was able to identify and work towards really important goals and left some amazing memories for her family.
To find out more about our Thinking Ahead resource, which is available to those who have accessed our Foundation Training – follow this link – https://www.talkingmats.com/product/thinking-ahead/
If you haven’t accessed our Foundation Training yet – find out more here https://www.talkingmats.com/training/foundation-training/
Rachel Woolcomb, our Talking Mats OT Associate, shares a recent personal experience where she used Talking Mats to support a difficult conversation:
The vision of Talking Mats is to improve the lives of people with communications difficulties. I have been reflecting recently on the definition of ‘communication difficulties.’
When I first heard about, and started to use Talking Mats 10 years ago, my perception was that it was fantastic for those that could not speak but I must admit I didn’t really consider using it with people who, such as myself, could use their voice to communicate.
Over the years as my understanding has developed, and I have looked further into the use of Talking Mats as a ‘thinking tool’ I have come to a different conclusion.
I would like to suggest that at some points in our lives, each one of us is likely to experience a communication difficulty. I don’t mean that we cannot physically speak, but that we cannot express what we really want to say in words. Perhaps a topic is too difficult to talk about with someone so we don’t bother, or we are overwhelmed by the subject that we don’t really know where to start.
One such subject is that of death and dying.
We know it will happen to us all one day but to talk openly with loved ones, is for some reason, too much to comprehend, too emotive, or considered bleak.
I am very fortunate enough to have grandparents in their 90’s however the conversation about their wishes for the future goes unspoken. It is a challenge for my parents to raise the issue therefore it remains the big unknown.
This is a common problem. In 2009, The National Council for Palliative Care wanted to address this issue and set up the Dying Matters Coalition in England and Wales, to help people talk more openly about dying, death and bereavement and to make plans for the end of life.
Talking Mats have produced a set of topic cards called ‘Thinking Ahead.’ https://www.talkingmats.com/product/thinking-ahead/
These were created in consultation with Strathcarron hospice to help people with advanced illness or long term conditions to think ahead and plan for the future. The three topics in the set are: Affairs, Care and Treatment and Personal Values.
My Mum was interested in my role with Talking Mats and wanted to understand what it was all about. We had already started to talk about the challenges of having difficult conversations, especially about death, and therefore over a drink, in a relaxed coffee shop, we embarked on a journey of discovery using a Talking Mat. My Mum as the Thinker and myself as the Listener .
She used the Talking Mat to help her think about things she had not considered and was able to make plans about what she wanted to do next. I heard her wishes and her thoughts, on why certain things were important to her. It was a very special time, facilitated by a Talking Mat.
My challenge to you as readers of this blog is to ask yourself ‘what do I have difficulty talking about’ – A Talking Mat just might be the answer!
Another resource you might find helpful is ‘Let’s Talk about Death and Dying’ – www.ageuk.org.uk
Rachel will be running a ‘Talking Mats as a Thinking Tool’ workshop at our Talking Mats is 21 Event is in Stirling on Thursday 15th August 2019. Dr Sally Boa from Strathcarron Hospice will also be running a ‘Talking Mats in End of Life Care’ workshop at this event. Thanks to funding from NHS Forth Valley endowment committee the event is free but you do need to book your space https://www.eventbrite.co.uk/e/talking-mats-is-21-tickets-62362171935
You can come to the morning only, afternoon only or come for the whole day.
If you can’t come to our event watch out for out blogs and social media celebrating the reach of Talking Mats for 21 days before the 15th of August. Please join in with your contributions using the hashtag #TMis21. For 21 days after our event we will be having a special Birthday offer! Watch this space, more to follow …….
We are all looking forward to celebrating Talking Mats is 21 on the 15th August
The morning is aimed at people who are experienced Talking Mats practitioners and will extend thinking and Talking Mats practice. There are an interesting range of parallel sessions to choose from. Each participant will get to choose three topics to attend.
- Talking Mats as a Thinking Tool
- Embedding Talking Mats in Schools
- Talking Mats in Forensic Settings
- Talking Mats in End of Life Care
- My experience of using Talking Mats as a parent
- Talking Mats and Positive behaviour Support
- Talking Mats and Supported Decision- Making
- Empowering people with Learning Disabilities to be Talking Mats Listeners and Trainers
- Talking Mats and Children’s Mental Health
The afternoon is more informal and there will be an opportunity to engage with some of our partners – see how they use Talking Mats and try things out . There will be posters on the use of Talking Mats in lots of different places and for a wide range of applications.
Plus there will be lunch, cake and a few bubbles !
Thanks to funding from NHS Forth Valley endowment committee the event is free but you do need to book your space https://www.eventbrite.co.uk/e/talking-mats-is-21-tickets-62362171935
You can come to the morning only, afternoon only or come for the whole day.
If you can’t come to our event watch out for out blogs and social media celebrating the reach of Talking Mats for 21 days before the 15th of August .Please join in with your contributions using the hashtag #TMis21. For 21 days after our event we will be having a special Birthday offer! Watch this space, more to follow …….
Thanks so much to all the practitioners who have sent us guest blogs about using Talking Mat in a Criminal Justice setting. Here are our top 5 – in no particular order!
1. Supporting Families in the Criminal Justice System: Sally Kedge, Speech and Language Therapist from Trouble Talking New Zealand shares two powerful case examples of using Talking Mats with children and families caught up in the criminal justice system. https://www.talkingmats.com/support-for-prisoners-families-experience-from-new-zealand/
2. Communication Needs within Youth Justice – Part 1: On 17th April 2017, we organised a seminar to look at underlying issues and share good practice when addressing the communication needs of people in youth justice. We had representatives from: the Scottish government, the NHS; Third sector organisations working in youth justice, the police, social workers, professional bodies, universities and social work – from as far afield as New Zealand. The emphasis from the start was that understanding communication is key to improving service delivery. https://www.talkingmats.com/communication-needs-in-youth-justice/
3. Communication Needs within Youth Justice – Part 2: The afternoon session of our seminar on 17.04.17 continued the underlying theme that communication support needs are often hidden and many looked after children have support needs that remain unidentified. The outcome of the day was the establishment of a collaborative network. https://www.talkingmats.com/youth-justice-and-communication-needs-2/
4. Setting up a SLT Service in Prison: This inspiring blog by Jacqui Learoyd explores her role in setting up a speech and language therapy ( SLT ) service in a prison and her use of Talking Mats in that setting https://www.talkingmats.com/setting-up-an-slt-service-in-prison/
5. Has Talking Mats been used in Court? Two registered intermediaries talk about a couple of cases where Talking Mats was used as part of the achieving best evidence (ABE) interviews. https://www.talkingmats.com/talking-mats-used-court/
If you have been inspired and are not yet trained, come along to one of our Foundation training courses – for details see https://www.talkingmats.com/training/foundation-training/
We also offer online training if you are unable to access the training locations – for details see https://www.talkingmats.com/training/online-training/
Do you want to introduce Talking Mats to people with a communication disability and autism, but know they will need support to learn it?
We are holding a 2 hour seminar on the 1st of February in Stirling to share ways of supporting people with autism to learn to use Talking Mats and express their thoughts.Twilight ASD Seminar
Do you want to help people think about the future and what they might want to have in place at end of life? Talking Mats and Strathcarron Hospice have developed a powerful new resource to support these sensitive conversations and an advanced course is being held in Stirling on the 21st February and in London 27th of March http://www.talkingmats.com/training/specialist-seminars/
These opportunities are only open to people who have attended Foundation training
When considering someone’s mental capacity its is important to bear in mind that the right to self-determination is enshrined in law.
In 1948 Eleanor Roosevelt, as the chair of the United Nations Human Rights Commission, was the driving force in creating the Universal Declaration of Human Rights Act (1948).
Since 1948 there have been laws passed in many countries stating that people with communication disabilities should have equal rights, including and specifically in the complex area of mental capacity. In the United States the Federal Law that covers this is the Americans with Disabilities Act of 1990 . In the UK the key Acts of Parliament are the Mental Capacity Act (2005) England and Wales and the Adults with Incapacity Scotland Act (2000).
The UK Acts specifically focus on mental capacity and say that every adult has the right to make decisions unless proved otherwise and that each individual has a different capacity to make decisions about different aspects of their life. In addition they state that we must assume that someone has Capacity unless it is established that the person has substantial difficulty in one or more of the following criteria in the following diagram.
There are a number of important expectations behind these Acts which are particularly significant for people with communication difficulties.
- Everyone should be supported to make their own decisions (including Augmentative and Alternative Communication methods)
- Adults should be encouraged to make use of their skills and to learn new ones where that would be helpful
- Information to support understanding needs to be given in a way that is appropriate to his/her circumstances (using simple language, visual aids or any other means).
- People are entitled to make their decision – this is not about what we think is good or bad
- Judgements on capacity:
- cannot be based on age, behaviour or disability
- need to be made decision by decision – (so not being able to make more complicated decisions does not apply to all decisions)
- cannot be based on past experience of decisions – they need to focused on the here and now
- must take into account the adults socio-cultural circumstances wherever relevant
- where a person is able to retain the information relevant to a decision for a short period only, this should not prevent him or her from being regarded as able to make the decision
- If someone is judged to lack capacity then decisions must be in their best interest and any measures taken on their behalf are to be the least restrictive to the person
- It is important to assess people when they are in the best state to make the decision
Please let us know how you deal with self-determination and capacity issues where you work.
In a future post I will explain how Talking Mats can help support decision making and the identification of Capacity.
We are very grateful to Anna Volkmer for sending us this blog, Lets Talk about Capacity…
She has just had an excellent book published – Dealing with Capacity and Other Legal Issues with Adults with Acquired Neurological Conditions http://www.jr-press.co.uk/dealing-capacity-legal-issues.html. In it she describes how AAC methods, including Talking Mats, can be used to support people in expressing their decisions.
Prior to 1959 people who were considered “non-compus mentis” were cared for under the “parens patriae” principle. Literally translated this meant that they were ‘parents of the country’ and decisions to protect them and their property were made by the Crown (the Lord Chancellor). These people were often described as “Chancery Lunatics”. In 1959 the “parens patriae” jurisdiction gave way to the Mental Health Act. This Act instructed that “the judge may, with respect to the property and affairs of a patient, do or secure the doing of all such things as appear necessary or expedient…for making provision for other persons or purposes for whom or which the patient might be expected to provide were he not mentally disordered” (section 102 (1)(c)). Unfortunately, this Act did not make adequate provision for non-financial decisions such as medical decisions. During this period it was case law that guided professionals in supporting their patients who lacked capacity in medical decision making. It was not until 2005 that the first Mental Capacity Act was given Royal Assent, accompanied by the Mental Capacity Act Code of Practice in 2007.
I returned to the UK from a 5-year stint working in Melbourne, Australia, just after the Mental Capacity Act had been published. Mental capacity was on the tip of everyone’s tongues and as the speech and language therapist working on a multi-disciplinary team I became an integral part of this process. Patients I was seeing, often people with primary progressive aphasia or other types of dementia, were asking about how to make future decisions. They and their families were keen to understand how the mental capacity act worked, how to prepare for the future and how to have their voices heard. On the other side of the coin I was working on an inpatient ward where staff were concerned about ensuring we were fully assessing the decision making capacity of people with cognitive and communication difficulties, often holding best interest discussion to plan for the future of these individuals. Many of these decisions related to dysphagia, but others related to accommodation and finances.
What concerned me was the lack of evidence available across the speech and language therapy arena in this area. There was little to none in terms of written research, let alone written advice or even examples of good practice tailored to speech and language therapy clinicians. As I asked around I found an enormous disparity in the services that speech and language therapy clinicians were providing across different trusts. I had previously written a book on dementia, and had included a chapter on assessments of decision-making. At this stage some of the only research related to communication and decision-making had come from Talking Mats. This had demonstrated that using the talking mats tools can support families and caregivers in conversations with their loved ones when discussing decisions to be made. They found that conversation enabled people in understanding, retaining and expressing themselves in decision-making discussions.
Following a particular stimulating discussion with the publishers at J&R press, they invited me to submit a book proposal on this topic. As I was developing this idea I found the topic of mental capacity was raised more and more often at study days and seminars I attended. At these study days I started linking in with more like minded speech and language therapists such as Mark Jayes, Hannah Luff and Claire Devereux. These were clinicians who all agreed on the diversity of our potential role in supporting our patients around mental capacity issues. These common interests enabled a collaboration. Our book is now published.
Through these connections I became aware of other work being done; Mark Jayes holds a NIHR doctoral fellowship award and is conducting research in the development of a communication and capacity assessment tool kit. Claire Devereux is the chair of the Southern Psychiatry of Old Age Clinical Excellence Network, together we have held a workshop with the clinical specialists where we developed a consensus document on role of the speech and language therapist in capacity assessment. This is to be published in Bulletin magazine later this year. Hannah Luff is a clinical lead speech and language therapist at South London and the Maudsley NHS Trust and is currently a member of the review panel looking at the NICE SCIE dementia guidelines.
The wonders and value of networking never ceases to delight, enthuse and inspire me! And you can purchase our book at the following website (there is currently a discount rate until 21st February):
You can follow me on my blog https://annavolkmersbigphdadventure.wordpress.com/ or on twitter @volkmer_anna
Following the success of previous seminars we are holding further specialist seminars in Stirling and London for anyone who has done the Talking Mats training. The topics will be:
- Talking Mats and the Eating and Drinking resource (morning)
- Talking Mats and Capacity (afternoon)
During the Eating and Drinking seminar, we provide background on how and why the resource was developed and showed some DVD examples of people using the resource. This really brings things to life and shows how important it is to give people (with and without speech) the opportunity to consider and talk about different aspects of eating and drinking. We also give people hands-on practice in using the symbols from each topic. Each participant will receive a copy of the full Eating and Drinking resource, including symbols, a mat, and explanatory booklet.
During the Capacity seminar we will discuss the fundamental principles of the Capacity Act and participants will have a chance to consider how Talking Mats can help people to:
- weigh up information
- communicate their views/wishes and feelings.
They will also be given the opportunity to work through some practical examples and think about options to help people understand issues and make decisions.
If you have completed a Talking Mats training course and would like to attend either of specialist seminars, please click on the relevant course and fill in the registration form.
Has Talking Mats been used in court ?
This is a question that we have often been asked and up until now we have been until able to give examples. On a recent training in Belfast there were two registered intermediaries, their role is to assist vulnerable witnesses and defendants with communication difficulties in the criminal justice system. The registered intermediaries scheme was set up in England and Wales and more recently was established in Northern Ireland. On the course they talked about two cases where Talking Mats was used as part of the achieving best evidence (ABE) interviews.
1. The first case was the case of R versus James Michael Watts http://www.bailii.org/ew/cases/EWCA/Crim/2010/1824.html . Here the clinical forensic psychologist used them to support an individual with severe disabilities to express her view of what had happened.
2. The second case that was discussed was the work of a registered intermediary, Catherine ‘O’Neil where she used them with a young man called Tim in his early twenties who had been severely stabbed and suffered a severe head injury which resulted in locked in syndrome. He had some very limited movement of his hand. Initially, Catherine worked with him to establish a yes/ no and then went on to assess Tim’s ability to use Talking Mats. The focus of the first Talking Mat was to find out about his interests and to enable Catherine and Tim to engage and interact with each other. Catherine said ‘he seemed totally relieved to be able to communicate his narrative. This allowed us to get to know him and his likes, dislikes and interests. Tim had never been a great friend of the police and in the like/dislikes/ don’t know mat, I included many pictures including Basketball, which went slowly but immediately to YES; Snakes under No and Police he joked and eye pointed to the door.!’ Catherine went on to use Talking Mats and these were used jointly with the police in 5 ABE interviews. This did enable evidence to be gathered in terms of the assault weapon, people etc. Through the support of a skilled registered intermediary Talking Mats contributed to enabling the victim to have a voice at the trial where otherwise none would be had. In this case a conviction was made.
We like to keep up to date about how Talking Mats is being used. You may well know of other cases where Talking Mats is being used to support people with communication disability to access justice. If so we would love to hear about them so please let us know.