When a Fire Extinguisher is Thrown at Your Head…

I don’t think I quite knew what the term “challenging behaviour” was before I stepped into the doors of the Brain Injury Rehabilitation Trust’s unit in Glasgow, where drug raids, control and restraint and gang segregation were part of my everyday working life.

As a kiwi “fush and chup” speaking Speech Pathologist, being thrust amid a group of people with thick Glaswegian accents in a country so far from my own and culture equally as foreign was a far cry from the population I was used to working with.


Speech Pathologists have commonly been regarded as diction specialists or the person who prescribes thickened fluids. I can tell you – we are so much more than that. We are the communication experts and the clinicians who advocate for and provide people with a voice in a range of contexts.

The context for me in Glasgow, was working alongside people who had suffered from an acquired brain injury and whose behaviours were too challenging to be anywhere else in the community. Their behaviours manifested as aggression and agitation, as disinhibited actions, as impulsivity – all were behaviours that showed a brain that was injured and whose cells were not able to all be spontaneously repaired. All were also methods of communication since every behaviour is communicating something.

There were days where I wondered what I had gotten myself into…

  1. There was the day where one of the patients had the armed defenders squad called and the unit was surrounded by police pointing guns at the building.
    In a moment of communicative genius, this gentleman devised a plan to write a fellow patient a note to ask him to call the police, stating that he was being held hostage in the hope they would get him out of the unit. The speech pathologist in me gave full credit to the man – not only did he manage to call the police which meant executing several speech techniques we had been working on, but he also used great executive strategies to source the address of the unit and devise this plan.
  2. There were the patients who would score drugs from the local tanning salon (our suspicions of it being a money laundering business proved true), then stash them away until a drug dealer would come and visit. The slight, and in this context, very inconvenient issue with an acquired brain injury is that your memory is often impaired so when these said dealers came to the unit, unfortunately the patient would have no recall of where these drugs were hidden. Enter the drug squad and police sniffer dogs who were much more astute at locating the hiding place.
  3. There was the patient who was so frustrated when he couldn’t communicate his needs that he picked up a fire extinguisher and tried to throw it at my head. Thankfully I ducked.

The one thing I quickly learnt as a speech pathologist, was looking beyond those behaviours to what everyone was trying to say. Just because someone doesn’t speak, doesn’t mean they don’t have something to say and just because someone is speaking doesn’t mean they know what they are saying.

Frustration, intolerance, grief and confusion can manifest as a number of what could be termed “maladaptive behaviours”, however, when it is broken down, it is simply someone trying to say something without necessarily using words.

I want you to imagine:

  • Not having the ability make your mouth move as you want it to
  • Having it take so long to produce a sentence that those in the conversation have already moved on before you can give an opinion or respond
  • Constantly misreading situations, or
  • Not remembering what you want to say.

Sometimes it is just easier to use your fists or to show your anger than it is to speak.

Impaired communication leads to isolation and loneliness, grief, a sense of being misplaced and frustration. It was a privilege to work alongside some of the most challenging people and to assist them in meeting their goals and develop the skills to be able to communicate and socialise:

  • To make a phone call or write a text to a family member and be understood
  • To confidently be able to order a milkshake from KFC
  • To be able to interpret facial expressions in others and not always misreading situations
  • To read a bedtime story to their child… things so many of us take for granted yet can be the difference between a life well lived and a mere existence

I left Scotland changed for the better as a clinician.

Not just because I had learnt tenacity and resilience, nor because I had mastered how to speak in a Scottish accent and how to keep warm in the -10 degree winter wind.

But because I had learnt what it was to look past a behaviour in order to see what someone was trying to say and how we, as a team, could support them to find and have their voice heard.

I got to help change lives and that, for any clinician, is why we do what we do.

Sarah Raffell
QLD Business Development Officer / Speech Pathologist