by Ashley Mohesky, MS, LPC Associate, supervised by Mark Rehm, LPC-S; guest blogger

co-authored with an interview by Alicia Alverson, MS, CCC-SLP, ATP; NWACS board member

reading time: 6 minutes

The views expressed in this post are those of the author and do not necessarily reflect the views and policies of NWACS. No endorsement by NWACS is implied regarding any device, manufacturer, resource, or strategy mentioned.

This guest blog is written by Ashley Mohesky. Ashley is a mental health professional and uses AAC. Ashley previously wrote a blog on mental health barriers and solutions for people who use AAC (PWUAAC) for Smartbox Assistive Technology that she is re-sharing for the NWACS blog. Additionally, I had the pleasure of asking Ashley some questions related to literacy, AAC, and mental health. You will find these at the end of Ashley's important share about mental health.

While there is an increased awareness of mental health, it is still a hidden subject within the AAC community. According to the Center for Disease Control, 32.9% of adults with disabilities experienced 14 or more mentally unhealthy days within a 30-day period in 2018. Since PWUAAC do not communicate with traditional verbal speech, many believe that mental health struggles don’t exist within this population. This belief is a myth.

Barriers AAC users may face

When PWUAAC have difficulties expressing themselves, they may engage in “negative” behaviors. This can lead to the assumption that they are being naughty. Which causes the rise of mental health struggles. For example, when I have a hard time communicating because I am not being heard, I become frustrated. I want to scream to get my point across. Although I am able to effectively communicate once I take a deep breath and collect my thoughts, not every user has this ability.

PWUAAC may also struggle with mental health because they don’t have access to vocabulary to communicate their feelings. AAC softwares do have premade pages for discussing feelings. But they are only surface level. For example, they may not have words such as:

• anxiety,

• depression, or

• panic attack

to accurately describe one's mental health. Because PWUAAC don't communicate traditionally, there is a lack of education for them around how to communicate their feelings on a deeper level. 

Providing support for AAC users

So, how can professionals and caregivers support PWUAAC? It is as simple as listening and validating. As well as creating a plan to improve mental health. Another way to assist PWUAAC with mental health is to always presume competence. For example, if a teenager who uses AAC tells a teacher they are feeling depressed and wants to seek help, it is imperative the teacher takes them seriously. They should try to help in the best way possible. Not automatically assume the teenager doesn’t know what they are talking about. Unfortunately, mental health doesn’t discriminate against anyone. With the right tools and support, it can be overcome.

Like other areas of life, the disabled population is an afterthought when it comes to mental health services. While in graduate school to become a mental health therapist, it became clear that there were few therapists who knew how to work with PWUAAC. A few examples of these discrepancies are: 

• only allowing phone calls for initial consultations,

• not having a way to schedule appointments online, and 

• not including interventions that incorporate AAC. For example, using games on the AAC device as part of therapy.

Graduate counseling programs do not address working with PWUAAC. Yet, there are ways to provide effective counseling to PWUAAC. Beyond making initial consultations and paperwork more accessible, it is important that therapists check in with their clients. Checking that interventions and treatments incorporate using the device during sessions. Therapists must also adapt to meet the needs of PWUAAC.

Although there is a large gap in mental health services for PWUAAC, there is hope. People who have a different means of communication deserve the right to seek help for their mental health. As a mental health professional and an AAC user, it is my mission to ensure that access to mental health care for PWUAAC increases. Mental health is as important as physical health. Everyone deserves the right to be mentally healthy as much as possible.

Interview with Ashley

Q: Many PWUAAC do not have literacy skills or have limited literacy skills. Not because they can't learn them. Because they haven't had literacy instruction that is accessible and meaningful to them. How do you think having literacy skills impacted your education experience? Both early on, in college, and in graduate school?

A: Before I received my first communication device, no one knew how intelligent I was. Once I received my device and started using literacy, it became clear that I was going to have a bright future. Because I received a device at a young age and developed necessary literacy skills to communicate, I excelled in public education, college, and graduate school. In fact, people have joked that I should go for my PhD (that is not happening). I believe that if I hadn’t learned proper literacy skills, I wouldn’t have gone as far as I have, and still going. During my academic career, I used to write blogs. It was a way to process the grad school experience, as well as give others hope if they ever read my blogs. I have also considered writing an autobiography. 

Q: How has having literacy skills impacted your experience as a mental health professional?

A: Because I communicate with written words, I need literacy skills to be an effective therapist. Access to literacy has given me the ability to help people in ways that may not have been possible if I didn’t have the capability to use literacy in meaningful ways. I don’t recall learning literacy from an AAC standpoint. I am grateful for the professionals who helped me develop those necessary skills to be able to help those in need, in an impactful way.

Q: How do you see literacy impacting the way you or PWUAAC are able to communicate about their mental health and emotional well-being?

A: The ability to use literacy when talking about one’s mental health can be extremely valuable. It allows PWUAAC to accurately communicate how they feel. Therefore, communication partner(s) can better understand how to effectively help the individual. That said, effective communication and literacy skills don’t always mean someone will reach out when they are struggling. According to the Diagnostic Statistical Manual of Mental Health Disorders, one indicator for depression is difficulty with concentration or focus on daily activities. Because AAC takes much concentration, literacy may not always have a greater impact when someone is battling with depression or similar struggles.

Q: We know that the ability to read and write opens up the opportunity for independent and autonomous communication. Do you think there are potential impacts that literacy has on one's mental health itself?

A: Everyone craves social connection, whether we describe ourselves as introverts or extroverts. When we don’t have those connections due to the inability to read and write from a communication standpoint, it can feel isolating. In order to maintain relationships, communication needs to come from both individuals. Also, when someone who has communication difficulties is unable to communicate that something is bothering them, it can cause their struggles with mental health to worsen. Therefore, reading and writing skills should not only be for academic purposes. PWUAAC deserve the right to learn these skills to become effective communicators. Ultimately having the ability to talk about their struggles, so they can receive help and support.

Q: Is there anything else you would like to share from a personal or professional perspective about your journey with AAC, literacy, or mental health?

A: Mental health is as important as physical health, if not more. The mental health field needs to incorporate the disability population, mainly PWUAAC, into their care standards. The disability population deserves mental health care. They should not have to be left behind when trying to find support for their mental health needs.