Learning from the experiences of disabled SLTs: part 1 of 2

This podcast is the first of two podcasts looking at the experiences of disabled speech and languages.

We open in this episode with an interview with Mélanie Gréaux, author of a report  published early April,  ‘SLTs on the tight rope: Learning from the experiences of disabled SLTs in the workplace’. The report explores the experiences of disabled SLTs and what we can do to promote disability inclusion in the profession.

We cover:

• What was the research question you wanted to ask? 
• Why is this of interest to you?
• What do we mean by disability and who are we talking about?
• What did you find? 

Interviewees:

 Mélanie Gréaux, Consultant on disability, World Health Organisation

Resources:

https://www.rcslt.org/wp-content/uploads/2025/04/SLTs-on-the-tightrope-Learning-from-disabled-SLTs.pdf

Please be aware that the views expressed are those of the guests and not the RCSLT.

Please do take a few moments to respond to our podcast survey: uk.surveymonkey.com/r/LG5HC3R

Transcript

Transcript Name: 

learning-from-the-experiences-of-disabled-slts-part-1-of-2

Transcript Date: 

20 June 2025

Speaker Key (delete/anonymise if not required): 

HOST:                         JACQUES STRAUSS 

MÉLANIE:                   MÉLANIE GRÉAUX

MUSIC PLAYS: 0:00:00-0:00:07

HOST:                         0:00:07 Welcome to another RCSLT podcast. My name is Jacques Strauss. 

As you may know, RCSLT recently released a report about the experiences of SLTs with disabilities in the workplace. This is a really important area for the organisation, for a number of reasons. SLTs want to ensure that their profession is as inclusive as they would like the professions of their service users to be, so there’s a responsibility to lead the way, to set the example. And maintaining a diverse workforce strengthens the profession and allows SLTs to better serve their communities. 

Today’s episode is the first of two parts in which we explore how well the profession is catering to SLTs with disabilities, and we’re speaking to the author of the report, Mélanie Gréaux. I started by asking Mélanie to tell me a bit more about herself.

MÉLANIE:                   0:00:56 My name is Mélanie Gréaux, and I’m a speech and language therapist by training. I trained at UCL in 2018 and then I pursued a PhD at the University of Cambridge, looking at issues on diversity and inclusion in the speech and language therapy workforce. Following that, I worked with the World Health Organisation’s disability programme, doing lots of activities to advance health equity for persons with disabilities. Lately – and I guess that’s why I’m invited here today! – I’ve worked on the recent RCSLT report entitled ‘SLTs on the tightrope: Learning from the experiences of disabled SLTs in the workplace’. 

HOST:                         0:01:44 How did this report come about? 

MÉLANIE:                   0:01:45 It was initiated by the RCSLT Disability Working Group, who identified a massive gap in research and data to better understand the experiences of disabled SLTs.

So, what you see is that there’s very little information out there – a few anecdotal stories, perhaps a handful of good quality but small-scale studies on the experiences of disabled SLTs. 

With this report, we aim to conduct a very exploratory study but at a larger scale. The central question that we asked was: What are the experiences of disabled speech and language therapists in the UK, and what can we learn from them to improve inclusion, equity, and diversity in the SLT workforce? 

HOST:                         0:02:41 When you say there is little data available, I take it that’s a problem for most professions and not just SLTs? 

MÉLANIE:                   0:02:48 That’s a very, very good question. There is not a lot of data, so, unfortunately, we don’t know too much. That doesn’t mean that there’s not a lot of disabled doctors, nurses, physiotherapists, and in all of the other professions, but there’s very little visibility and there’s very little discussion. 

We’re starting to see a little bit more of this coming out, especially with different governments pushing for this diversity, equity, and inclusion agenda, but there’s still very, very little out there that we can extract a lot of information on. 

Recently, in the UK, there’s been quite a very good momentum for neurodivergent healthcare workers. This group is particularly dynamic, but yeah, there’s still a lot of gaps that we need to fill to make sure that all of these professions attract and can retain a very diverse range of people, including persons with disabilities. 

HOST:                         0:03:52 Can you tell me what got you interested in the field? 

MÉLANIE:                   0:03:54 It’s, again, a very good question, and I guess I almost fell into that almost by accident. I trained in speech and language therapy, so as you said, there’s already those links with disability, focusing more on speech, language, and communication differences. But already the thinking around disability inclusion kicked in. 

But I really got passionate and interested about it when I joined the World Health Organisation, because it really is about doing activities on how to advance health equity for persons with disabilities, which is a huge agenda, and that really allowed me to understand the complexity of disability within a specific sector, which is health. 

So, it got me thinking in terms of financing in health, governance in health, different models of care that we use in health, but also the workforce in the health sector. And when we think about disability inclusion in the workforce, we think both in terms of the training, so making sure that doctors, nurses, physiotherapists, speech and language therapists, everyone working in the health sector has the skills and competence and confidence to be able to provide services for persons with disabilities. 

But then there’s another side to the story, which is around making sure that we can hire and retain workers with disabilities. And so, when the RCSLT Disability Working Group got a lot more vocal and interested in finding more data, it really resonated with that aspect of my work, and I really was excited to be able to contribute to this study. 

HOST:                         0:05:48 A very difficult question, but what do we mean when we say ‘disability’? 

MÉLANIE:                   0:05:54 It’s very complicated. Defining disability is very complicated. There’s many ways and many models that have been developed to try to better understand what is disability. 

Some models, for example, there’s the charity model, which focuses on efforts and activities to provide persons with disabilities with money, gifts, food, but that is based on the assumption that persons with disabilities cannot contribute to society, which luckily, we’ve very much moved away from! 

Then there’s another group of people that may understand disability under a more medical model. So, this model focuses heavily on the health condition and the medical factors that can be mitigated to optimise everyday functioning of people. Very much looking at those medical factors and not thinking too much outside of this box. 

And then, and I guess that’s the one that resonates a lot more closely with the understanding of disability that we see in speech and language therapy, definitely that we tend to align ourselves within the WHO, is the social model. It’s seeing disability as arising from the barriers in society and the environment. Barriers could be physical, attitudinal, or systemic. 

That understanding of disability as someone with a health condition, impairment, or a difference that faces those barriers in society and in the environment is very much how we conceptualise disability. 

Just to add to that, the actual working definition that we use in the report, we’ve aligned ourselves with the definition stated in the UN Convention on the Rights of Persons with Disabilities, which states that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others. As you can see, quite close to the social model of disability. 

HOST:                         0:08:15 SLTs are, of course, familiar with these models. But, of course, the question is to what extent people think about them in their own profession. 

So, broadly, what did you find? 

MÉLANIE:                   0:08:28 We had such an incredible, large dataset with very, very rich insights. And just for context, there’s 357 people who responded to the survey, that is from which the survey is based on. Among them, 71% were actually respondents who disclosed identifying as a person with disability. A lot, a lot of data. 

If you pull all the data into a Word document, it’s going to be over 80,000 words, which is the equivalent of a 300-page book, so it was a very, very large dataset. I was surprised by how complex and nuanced the experiences are. And everyone’s story was very, different. Even respondents who have the same condition, impairment, or difference could express very different needs, aspirations, or challenges that they face in the workplace. 

So yeah, it was around getting into the nitty-gritty of this complexity that was extremely interesting and valuable; to not just think about barriers and opportunities, but really getting into some of the nuances of those experiences. 

We saw a lot of testimonies from SLTs who expressed facing a lot of discrimination or ableism in the workplace – and that could be from a policy that is not very accommodating of their needs, or a manager who doesn’t really have the time or capacity or willingness to support the disabled employees, or a colleague who’s saying a comment that was hurtful for the SLT. 

HOST:                         0:10:28 So, the headline, before we delve deeper into the report, is that there is discrimination or ableism within the SLT profession, in case anyone thought, given the nature of the job, that there wouldn’t be or that it would be very rare. Were you surprised by this? 

MÉLANIE:                   0:10:46 I was perhaps thinking that, because it’s the speech and language therapy profession, we know that SLTs are such strong advocates for their clients, and yeah, they can have a really big impact in terms of improving the participation of their clients with a speech, language, or communication difficulties. Usually, you see a lot of people valuing SLTs’ input and saying how much that’s made a really big and positive difference in their lives. 

But somehow it looks like it gets stuck in the clinical room and perhaps we do not apply some of those skills outside of the clinical room and, say, specifically within the community of SLT. We know that we have the knowledge and the skills, but it’s about thinking about visibility, inclusion, and applying it in different ways that we may have been trained in. 

But the good news is that we probably have a lot of the foundation skills already. It’s just about thinking out of the box and applying it in those other spaces in in the workplace.

HOST:                         0:12:00 In the report, you distinguish between equity and inclusion at the individual level, the collective level, and then the systemic level. Could you talk us through your findings in a little more detail? 

MÉLANIE:                   0:12:12 In terms of the individual level, so we’re looking very much at the experience that is very close to the SLTs themselves, some of the findings that we have showed that disabled SLTs really talk a lot about the unique strength. And I really want to focus on that, because they do have a lot! Things like creativity, empathy with the clients, flexibility to work around their needs and their work life, and incredible resilience as well. 

But they also were expressing a lot of challenges, things like exhaustion, a lot of masking – trying to hide some of your challenges, to not be seen as different or to not be seen as less than, less capable than your other colleagues. And together, that creates those values, those strength, and those challenges creates quite a fragile positionality for those SLTs, not in the sense that they are inherently fragile, but are fragile in that balance in which they must navigate their everyday work experiences. 

A second big one, and I’ve already touched upon it earlier, is that we haven’t seen two stories alike. There’s huge, huge differences in terms of what the SLTs were saying, what mattered to them, their personal circumstances, their priorities, their needs, their aspirations, the opportunities that they were given in the workplace, but also the challenges that they were facing. It makes us think around what kind of solutions do we need to provide, and to not go for the one size fits all approach, but very much looking at a person-centred approach, which is actually what we recommend for our clients. 

And then finally, on the individual lens, it was very interesting to look at how the SLTs were reflecting on their professional positionality and trajectory as well. To be more specific, a lot of them were saying either feeling like they were at the centre and in the spotlight of their community or in the margins. There was no really in between, and usually it was SLTs who had more physical difference, who had assistive devices, something that visually people could identify them as perhaps someone having a disability. And those persons were sometimes unwillingly in the spotlight and not being able to escape this identity that perhaps they didn’t want to be. They’re more complex than having a disability, but somehow having a more visible disability makes them a lot more in the spotlight. 

But then you have another group of SLTs who were saying that they very much felt evolving in the margins, hiding, not wanting to be seen or for their difference to be so central to how people were seeing them, it’s probably also in reaction to all the systemic barriers that they are to this sense to want to protect yourself. 

So yeah, either being right in the centre, very visible, and not escaping this label of being a disabled SLT, or quite the opposite, so that was interesting. 

And also a lot of people reflecting on the trajectory of feeling like their career pace was much, much slower than their peers without a disability because of not having the same opportunities, perhaps having to work part-time to accommodate some of their health needs. 

HOST:                         0:16:27 Can you tell us what you mean by the collective level and what you found? 

MÉLANIE:                   0:16:31 The collective level is very much around who are the people around the disabled SLT that have an impact on them? And we have a lot of findings on managers, colleagues, support groups for disabled SLTs, and other actors. And what we found is that everyone can make a massive difference. 

For example, for the managers, we’ve seen that SLTs have talked a lot about the positive qualities that they associate with the manager that is respectful, inclusive – things like, for example, having an open door office where you can go and talk about things that you may need in the workplace without formally having to ask for that could be very helpful to feel like you can, at any time without bothering someone, be able to ask for support. Managers that are also very proactive into asking, do you need any help, or how is everything going, is also very, very positive, and sometimes can unburden SLTs because we’ve seen that a lot of disabled SLTs really have to drive to maintain their support system, whereas it really should be a shared responsibility, and managers have a very crucial role to make that happen. 

But what we’ve seen is SLTs talking about managers that were also not very supportive. And here it’s things like not having the time for a chat, not enforcing some of the policies that could support disabled SLTs, not pushing for some of the reasonable adjustments that SLTs ask for – these kind of things. 

But here, I must say that it was very interesting to see SLTs reflecting on the fact that they don’t see that as most of the time that it’s the fault of the managers themselves, but it’s usually the system, like the barriers in the environment that means that the managers have very, very little time, they’re very stressed out, and it means that it’s also very difficult for them to support in the best possible way their employees with disabilities. 

HOST:                         0:19:01 So, it’s at the collective level that colleagues and managers can make a really big difference. But, of course, that is impacted by systemic issues, including the multiple issues facing the NHS around funding and staff and waiting lists, etc. 

Can you talk us through the systemic issues beyond the known challenges facing the criminal justice system, educational institutions, and, of course, the NHS as well. 

MÉLANIE:                   0:19:29 The system is a little bit broken or a little bit rusty, but it also means that we know where we’re to target in terms of the solutions. One thing that really stood out was around the guidelines, the laws, and the policies either not being implemented, not being enforced. We may have some of those policies in place, but there’s very little monitoring and very little evaluation on whether or not it happens. Things like the reasonable adjustments, for example, that employees in the UK can have access to, and there’s a law for that. But sometimes there’s not a lot of those processes in place, or they’re not followed in such a rigorous way that everyone can benefit from them. 

Also, what we saw in terms of the policies is around the policies around sick leave. SLTs with disabilities are more likely to need heavier sick leave allowance to attend a medical appointment, to recover from a medical issue or something. And what we see is that disabled SLTs got very stressed, because they would reach the maximum of their allowance, and then it would trigger a warning and then their whole position was in jeopardy because there was not this flexibility around this policy, and not a lot of understanding on having a different approach for people with different needs, which, really, we should be thinking about. So, some of those laws and policies either not being implemented or not really being responsive to the needs of persons with disabilities. 

Then another thing is the work culture. As you rightly said, the NHS is under a lot of pressure right now, and that’s felt by everyone – people with and without disabilities. But it does impact persons with disabilities probably a lot more because people then have less time to want to look about the reasonable adjustments, and even what we’ve seen is that that creates a negative environment around people who have certain needs, for example, some resentment from colleagues who do not want to or feel like it’s too much and they don’t have the time and to look at how to implement some of those reasonable adjustments. 

Again, not a fault of the people, but because it creates this very stressful environment it becomes very challenging to implement some of the strategies that disabled SLTs might need, and this flexibility, this understanding, perhaps a slower pace, more flexibility around the work expectations. So, that’s one. 

Then there’s also the actual environment. Things like physical barriers. A very easy example would be if you have a wheelchair user do you have lifts, or is there only stairs? And also, things like a very, very busy open working space, which is becoming very, very [prominent/permanent 0:22:53] now, but that could be extremely challenging for some neurodivergent colleagues to navigate, or for people with a sensory difference. All of those things mean that there can be some challenges in that environment. 

HOST:                         0:23:10 So, it would be fair to say that the systemic changes are going to take time, and organisations like RCSLT will play a role in helping bring those about. But there are things that people can start doing from today at the individual and collective level. Do you have any final thoughts for our listeners? 

MÉLANIE:                   0:23:32 In the report, I should mention that we have a lot of recommendations! And we summarise them as well, so that it is not too overwhelming, but there’s some details for those that want to go into the details, and there’s also high-level recommendations to start on this journey to become more inclusive in the profession. 

What we recommend for managers and their colleagues as well, but particularly managers because they really do have a strong impact onto the experiences of SLTs, is to actively engage with all of their colleagues with disabilities to better understand their needs and to provide appropriate support. So, not making assumptions, but really sit down, have this discussion, quite an open discussion, and really look at what helps, what doesn’t help. Establish regular check-ins to create this open, efficient, and trust-built dialogue between you and your colleagues is very, very important. 

And another big recommendation is to promote a culture of inclusivity by setting clear expectations and fostering an environment where all employees feel safe to disclose their needs without fear of discrimination. It’s about reflecting on what you can do and opening the dialogue. Not being intrusive; I think there’s a balance to get there, but showing interest, learning about disability and asking your colleagues, what can I do to help? Is there anything that that I’m doing that is not very helpful, or can I change this, what do you feel about that? Establishing this dialogue, not being scared to open up because there could be a lot of stigma and a fear of saying something wrong. But usually what we see is that we just need to start the dialogue. 

I feel very strongly that the speech and language therapy community is like 90% there in terms of we have the skills, we have the knowledge around disability inclusion. Yes, we may need to reshape that, but it’s there. We just need to be thinking about the applications to the workforce now. If everyone just does a little something every day to make things better with their colleagues with disabilities, I think it’s going to change a lot of things very quickly. 

HOST:                         0:26:11 A big thank you to Mélanie for her time. In the next episode, we will be talking to SLTs with disabilities to get their views on the report, hear about their personal experiences, and what they think we can do to improve equity and inclusion in the profession. 

Until next time, keep well. 

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