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What’s the most important issue in mental health ? Good treatment? Timely hospital care? Being treated with respect? Contact at times of crisis? All of these are important, but you’ll probably find that effective communication is at the heart of all of these. If we were to ask service users what they valued most about the health and social care workers supporting them, what would they rate as most important? I think answers like ‘they really listened to me’ or ‘they don’t talk down to me’ would score quite highly.
Mental health problems can often be a barrier to good communication, and we need to think about how these might be overcome. For example, people with thought disorder may be very distracted, and people with depression may find it difficult to concentrate on what is being said. You will find a number of QCS policies that address communication issues, covering matters such as the importance of good communication, and getting in specialist help to overcome communication difficulties. These policies look at communication between various parts of the organisation, including communication with service users and their families.
The art of communication
In this blog I want to think about some basics in communication. It’s difficult to give a list of dos and don’ts – these are just some ideas of what makes for effective communication and what problems we might encounter. How we communicate is perhaps something we don’t think about too closely on a day-to-day basis: Someone says something to us, our brain processes what has been said, we formulate a reply and say it, and so the cycle of communication goes on (and probably a lot quicker than the way I’ve described it).
There is sometimes the need to communicate a difficult message – perhaps some bad news, or turning down a request. Small everyday interactions can also have huge significance. As a care home worker you may be admitting people to a care home on a regular basis, but for the service user this is a once in a lifetime occurrence. The QCS admission policies encourage us to think about how this is managed.
Think about some experiences of communication in your own life – perhaps a sales call on the telephone, perhaps a chat with someone in a shop. What makes for some of these being unsatisfactory experiences, and others ones that cheer us up? There must be something about the content of the communication, and the way it happened that makes the nature of communication so varied. If you want to read some interesting theory as to how interaction takes place, and why it sometimes goes badly wrong, have a look at some of the material on Transactional Analysis (or TA for short) developed by Eric Berne, particularly in his book Games People Play.
So what are the basic issues in communication?
- Communication depends on good listening
Often, as health and social care workers, we focus on guiding and advising but we need to also concentrate on hearing the service user’s views. Communication is a two-way process, so can we say we are really listening to what the service user is saying?
- Listening is more valuable than hearing
If we say something to someone, have they genuinely taken on board what we have said? There may be many reasons why they don’t take it in – they’re anxious, or perhaps they don’t agree with what is being said.
- Think about how you ask questions
Questions that invite just a ‘Yes’ or ‘No’ might not tell us much. Do we avoid asking probing questions for fear of exposing distressing thoughts? Or do we interrogate too much, putting the person under pressure?
- What are you trying to get across when you communicate with someone?
Sometimes people will struggle to take on board a number of different issues, particularly if they are anxious, so try and break down what you are saying into a number of messages
- Is there are a power relationship here that might affect the communication going on?
Might the service user just say what they think the worker wants to hear because the worker is in a position of authority? Can you use any of these factors to inform your own communication skills?
What I've described so far is communication involving speaking and listening. The QCS policies identify the benefits of this, as it gives an opportunity for a two-way interaction. It’s probably the most complex form of communication because it also involves a whole range of other factors.
- The tone or manner of voice in which the communication is carried out
- The environment in which it is carried out – an office with one person sat behind a desk, a surgery, or someone’s own room or home
- Non-verbal elements – body language, eye contact, expression, we can learn a lot from what’s not being said, as well as from what is said
- Personality clashes, or someone reminding the person of someone else in their life – ‘you sound just like my mother!’
Of course there are other forms of communication – if someone is struggling to take in something you are saying, then putting it in writing or in picture form can reinforce a message. We all learn in different ways.
I've written mainly about some of the general principles of communication but of course you might need to consider some specialist issues which you as a worker might need help with in order to improve interaction with someone. Assessment of someone’s communication skills are an integral part of the process of assessing someone’s care needs. These are some of the issues you may need to consider
- Cultural factors
- Thought disorder
- Mental capacity
- Autism, or a learning difficulty
A useful resource for your team or care home might be a directory of specialist sources of help for people with communication difficulties such as a local Deaf Association or an interpreter service. You might not have such information available or it may be out of date, so you might need to compile your own directory! The QCS policy CC31 about service users with communication difficulties can give guidance here.
David Beckingham – QCS Expert Mental Health Contributor