Mary Blog

Mary Hartshorne, Director of Outcomes and Information at I CAN, tells us about the complex relationship between speech, language and communication needs and mental health

Children and young people’s mental health is in the spotlight – a 70% increase in rates of depression and anxiety over the last 25 years, 20% of adolescents experience mental health difficulties. Given the scale of the problem, and the fact that a huge percentage of these are not getting the support they need it’s not surprising that the Government has made a commitment to improving support.

One of the first steps to achieving this has to be about understanding more about the factors involved in children and young people’s mental health – and understanding about the importance of speech, language and communication skills is crucial to this. The relationship is complex!

Fundamentally, communication skills enable us to build and maintain relationships, to understand and express feelings and emotions – and to help us problem solve. In a recent Public Health England Report, good communication skills were identified as supporting resilience when it comes to mental health. Interestingly, the same report identified communication difficulties as risk factors for mental ill health, indeed many studies show that the likelihood of mental health difficulties is increased where children have persistent language difficulties. Thinking about it, that’s not surprising – it’s harder for children with language difficulties to talk through their thoughts and feelings, harder for them to interact with other children socially and to solve problems or to understand the subtle social rules of interaction – they can easily feel lonely and isolated. This can be seen even in quite young children with language difficulties – they are more likely to be withdrawn, and also more likely to be ignored by their playmates.

It’s important to remember that this link between early language difficulties and later mental health issues is not inevitable – poor language skills do not cause mental health difficulties. In fact, recent studies have identified many children with language difficulties as having innate social tendencies – and this prosociability can contribute to positive peer relationships and facilitate resilience. Children need the right support to maximise on this predisposition.

I said the relationship wasn’t straightforward – that’s not the end of the story! Looking at the relationship the other way round, as many as 45% of young people referred for mental health services have communication difficulties. These difficulties frequently go unidentified – language difficulties are often ‘hidden’ by the presenting difficulty, especially where there may be concerning outward emotions or behaviours such as anxiety, depression or self-harm.

Whatever the reason or relationship, early identification of language difficulties is crucial. Unidentified, the risk is that children and young people will not get the support they need to lower the risk of mental health difficulties. For those children and young people with co-occurring mental health and communication difficulties, many interventions, support or recommended therapeutic techniques such as cognitive behaviour therapy rely on good ‘higher order language’ skills – the ability to discuss opinions flexibly, use language to reason and to interpret abstract concepts such as feelings. Not identifying a difficulty with language means that young people will be unable to benefit from the limited support which is available.