Before You Speak: T.H.I.N.K.
Tag: Verbal Communication
What are the Historical Contexts to Communicating Mental Health?
Research Paper Title
Introduction: historical contexts to communicating mental health.
Abstract
Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage.
Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue.
The researchers introduction provides some framework for the history of communicating mental health over the past 300 years. They show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public. Communicating about mental health, they argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology.
However, while the modes of communication have developed, the issues involved remain essentially the same. Most practitioners have sought to understand and to innovate, though not always with positive results. Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers. Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness.
While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear.
Reference
Wynter, R. & Smith, L. (2017) Introduction: historical contexts to communicating mental health. Medical Humanities. 43(2), pp.73-80. doi: 10.1136/medhum-2016-011082.
Verbal and Non-Verbal Skills
Verbal Skills
The skills you should use to show you are listening to the person are simple:
Listen without interrupting.
Pay attention.
Ask appropriate questions to make sure that you are both clear on what is being said.
Listen to the words and the tone of voice and look at the body language – all will give you clues as to how the person is feeling.
Check your understanding of what is being said by saying something like ‘it sounds like you are saying (or feeling)… have I understood that right?’
Summarise facts and feelings.
Minimal prompts such as, ‘Mmm’, ‘Ah’, or ‘I see’, may be all that is necessary to keep the conversation going.
It is okay to have long pauses in the conversation. The person may simply be thinking or lost for words. If you say something to fill what you see as an embarrassing silence, you may break the train of thought or rapport between you.
Sitting quietly, but attentively, through a period of silence will demonstrate that you value being with the other person. This is more effective than anything you may say will demonstrate.
Non-Verbal Skills
Make use of non-verbal skills (or body language) such as:
Be attentive.
Keep eye contact comfortable – do not stare or avoid eye contact.
Keep an open body position – try not to cross your arms across your body.
Sit down, even when the other person is standing – it will make you seem less threatening.
Try not to sit directly opposite, facing the other person – this may seem as though you are invading their space.
Overcoming Communication Difficulties
Communicating with People from Different Cultures
Any successful communication recognises the uniqueness of every culture, every relationship, and every individual – including you.
Some forms of verbal and non-verbal communication are appropriate and others are not appropriate. For instance, some individuals may regard prolonged eye contact as rude. We all have different ways of communicating our fears and needs when we become unwell. Invite the person to tell you about their life experiences, values, and belief systems. Also, ask them how they feel about asking for care and support.
Establish what is realistic for the individual, as well as what is culturally acceptable. Some cultures encourage the use of silence, whereas in others it creates embarrassment or awkwardness. In the French, Spanish, and Eastern European cultures, the presence of silence is a sign of agreement.
Working with an Interpreter or a Bilingual Worker
When an individual does not speak English at all, has limited English, or chooses to communicate their distress in their mother tongue, the best solution is to use a professional interpreter. The choice to use a trained interpreter or a family member must be made by the individual who is experiencing problems. Being able to do so will help the individual to fell that they are in control of the situation.
Language holds and creates the individual’s reality, experience, culture, and world view. A good interpreter will concentrate on accurately conveying equivalent meaning as well as reporting the direct answers to your questions and other responses offered. You should also be aware that the interpreter may bring their own bias to the situation.
Working with a British Sign Language Interpreter for the Deaf
There are very few services available for deaf people with mental health problems, although recently some deaf workers have been trained in mental health first aid.
If no deaf mental health first-aider is available, you may need to use an interpreter. In this case, you should take care to always face the deaf person when speaking and respond as though it is the deaf person speaking to you when the interpreter speaks. Remember that the interpreter is being the deaf person’s voice. Maintain good eye contact and show your feelings through your facial expressions. Deaf people do much of their communication through body language and facial expression, and are therefore skilled at reading feelings.
If no interpreter is available, you can still offer support and concern by showing your willingness to communicate. Deaf people can often lip read and can vocalise using English. Be patient and try hard to understand. Show your concern as you would with anyone in distress and ask the person who you can call for help.
Important Note
If you need to use a pen and paper to ask the person who they would like you to call for help or support, use very simple English.
British Sign Language is a different language to English – a person who was born deaf may not have English as their first language.
Mental Health Matters 
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