By Susan Guthrie, PGR at School of Healthcare, University of Leeds & Cardinal Clinical Academic Research Fellow

Advanced Practitioner Speech and Language Therapist at Leeds and York Partnership Trust

Phd supervisors:

Prof John Baker & Dr Jane Cahill (University of Leeds) / Prof Bronwyn Hemsley (University of Technology, Sydney)


Mealtime experiences vary for everyone. How we feel day to day about eating and drinking changes depending on how we feel, on what we are doing and on where we are situated. My research is continuing to investigate the mealtime experiences of people who have a mental illness. This includes exploring aspects such as choking to understand how stresses affect mealtimes and how difficulties may be influenced by different aspects of the mealtime context including social factors.

Me at mealtimes resource

Over the last few months, I have discussed mealtime experience with different patient groups in Leeds. In the Help from Experts by Experience for Researchers (HEER) group we looked at the use of an accessible conversation resource “Me at Mealtimes” developed by a group of service users at Calderstones NHS Trust in 2013. The pictures and topics were originally selected by service users in Northwest England who directed a graphic artist to create the images supporting easy read text. The service users then trialled the resource to help them think about how they were coping with eating, drinking and swallowing. We were delighted that BiLD included this in the resources published on their website, there were 470 downloads in the first 2 months.

In 2020 BiLD were no longer able to include this booklet in their health resources. I brought it to the SUN and HEER meetings for review and it helped the group members to think about topics around eating, drinking and swallowing – we discussed what can go wrong and ideas for supporting safe and enjoyable mealtimes. The resource can now be accessed

These free downloads can be used to encourage insight and focus attention on different aspects of swallowing. If anyone has any concerns regarding swallowing difficulty then specialist support and advice is available from Speech and Language therapy or Medical staff.

We would welcome your comments and feedback on this resource – contact Susan Guthrie

Swallowing difficulties (dysphagia) are prevalent in people with mental illness (Bazemore et al., 1991, Regan et al., 2006). Dysphagia can be triggered and exacerbated by a variety of potential factors (Cicala et al., 2019, Guthrie and Stansfield, 2017, Guthrie et al., 2015, Hwang et al., 2010). Our integrative literature review has found a predominance of biomedical research into this topic with little attention to psychosocial influences on mealtime wellbeing and quality of life aspects. The aspirations of clinicians to achieving shared decision making and co-production in mental health recovery pathways (as highlighted in recent national guidance) are not apparent in the studies we found and reviewed (NHS England, 2016, NHS England, 2014, NHS England, 2017). There is a paucity of research considering the patient perspective for adults with mental illness and dysphagia in contrast to the recent dysphagia studies for people with dementia, intellectual disabilities, and people with acquired physical health conditions (Ball et al., 2012, Belafsky et al., 2008, Leslie and Crawford, 2017, McHorney et al., 2000).

We were delighted that our integrative review was accepted for a poster presentation at the forthcoming European Society for Swallowing Disorders virtual conference in October 2020. There is an accompanying short video clip to introduce the poster and outline the key findings.

The next steps are to extend our investigations and follow the concerns voiced in the service user groups by talking to people on inpatient wards. Once ethics approvals have been granted, Susan will be recruiting patients and staff to talk about their experiences of mealtimes on inpatient wards. Details will be posted here and across Leeds and York.

If you have any queries or would like to talk to Susan, her contact details are:

BALL, S. L., PANTER, S. G., REDLEY, M., PROCTOR, C. A., BYRNE, K., CLARE, I. C. H. & HOLLAND, A. J. 2012. The extent and nature of need for mealtime support among adults with intellectual disabilities. Journal of Intellectual Disability Research, 56, 382-401.

BAZEMORE, P., TONKONOGY, J. & ANANTH, R. 1991. Dysphagia in Psychiatric Patients: Clinical and Videofluoroscopic Study. Dysphagia, 6, 2-5.

BELAFSKY, P. C., MOUADEB, D. A., REES, C. J., PRYOR, J. C., POSTMA, G. N., ALLEN, J. & LEONARD, R. J. 2008. Validity and reliability of the Eating Assessment Tool (EAT-10). Annals of Otology, Rhinology, Laryngology, 117, 919-924.

CICALA, G., BARBIERI, M. A., SPINA, E. & DE LEON, J. 2019. A comprehensive review of swallowing difficulties and dysphagia associated with antipsychotics in adults. Expert review of clinical pharmacology, 12, 219-234.

GUTHRIE, S., LECKO, C. & RODDAM, H. 2015. Care staff perceptions of choking incidents: what details are reported? Journal of Applied Research in Intellectual Disabilities, 28, 121-32.

GUTHRIE, S. & STANSFIELD, J. 2017. Teatime Threats. Choking Incidents at the Evening Meal. Journal of Applied Research in Intellectual Disabilities, 30, 47-60.

HWANG, S.-J., TSAI, S.-J., CHEN, I.-J., HSU, F.-C., LI, C. & KAO, K.-P. 2010. Choking incidents among psychiatric inpatients: A retrospective study in Chutung Veterans General Hospital. Journal of the Chinese Medical Association, 73, 419-424.

LESLIE, P. & CRAWFORD, H. 2017. The concise guide to decision making and ethics in dysphagia, J&R Press Limited.

MCHORNEY, C. A., BRICKER, D. E., KRAMER, A. E., ROSENBEK, J. C., ROBBINS, J., CHIGNELL, K. A., LOGEMANN, J. A. & CLARKE, C. 2000. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia, 15, 115-121.

NHS ENGLAND. 2014. NHS five year forward view. [Online]. London. HMSO. Available: [Accessed 23.10.19].

NHS ENGLAND. 2016. Implementing the five year forward view for mental health [Online]. Available: [Accessed 23.10.19].

NHS ENGLAND. 2017. Five year forward view for mental health: one year on [Online]. NHS England, London. Available: [Accessed 17/07/2020].

REGAN, J., SOWMAN, R. & WALSH, I. 2006. Prevalence of Dysphagia in Acute and Community Mental Health Settings. Dysphagia, 21, 95-101.

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