UK Council on Deafness

A Sign of the Times

Modernising Mental Health Services for people who are Deaf

On this page

• Introduction
• Mental Health & Deafness Conference
• Response

Introduction

The Department of Health launched their consultation document, A Sign of the Times, at our recent Mental Health and Deafness conference on 11th July. A summary of the document is enclosed. If you would like a copy of the full document you can obtain one, quoting 27966/A Sign of the Times, from:

Department of Health Publications,
PO Box 777, London, SE1 6XH
Tel: 08701 555455
Fax: 01623 724524
Email: doh@prolog.uk.com
Or it can be downloaded from the DoH website: www.doh.gov.uk/mentalhealth

The UK Council on Deafness will be co-ordinating a joint response, which will be compiled by SIGN. If you would like to contribute to our response rather than making your own, do please send your comments to us by 10th September. We will then present an interim report at the Council Meeting on 26th September.

SUMMARY of SIGN OF THE TIMES

By the Department of Health

A Sign of the Times is a Department of Health consultation document. It is about the best way to improve mental health services for Deaf people. When we talk about Deaf people, we mean those who use sign language as their main way of communicating.

There are more than 50,000 Deaf people in the country. Mental health problems occur more frequently in Deaf children compared to hearing children. Deaf adults appear to suffer more from mental health problems than hearing adults, although it is unclear just how large this difference is.

The hearing community are largely unaware of the unique identity of the Deaf population. They tend to think of Deafness purely as a physical problem and don't know about the cultural and social issues.

Deaf people find it hard to get help from health and social services. Deaf people with mental health problems are no exception. There are three very specialist mental health services for Deaf people in the whole country and a high secure service at Rampton Hospital. They have come about because of the commitment of individuals rather than a proper plan. They can't look after everyone and certainly can't see everyone close to their homes. They also have to deal with a wider range of problems than a hearing service would.

There is a National Service Framework for Mental Health, which sets out the standards that everyone with mental health problems should expect.

These standards are about;

• mental health promotion;
• primary care and access to services;
• services for people with severe mental illness;
• caring about carers,
• the prevention of suicide.

A Sign of the Times looks at how we could meet these standards for the Deaf community. It also talks about the ideas that people have come up with so far

There are some things that most people seem to agree about;

• that Deaf people find it hard to access mental health services.
• that Deaf awareness is very important.
• that good mental health services for Deaf people will cost more.
• that a Deaf person is more likely to get better in a signing environment.
• that we don't know enough about the needs of Deaf people.
• that we won't be able to do a great deal very quickly.

We say that local health and social services should work together to make sure that Deaf people are included in their plans. This would mean;

• more interpreting available
• training in deaf awareness for staff in places like doctors' surgeries
• training for some staff in how to spot mental health problems in Deaf people

We say that we will continue to need the very specialist services but that we need something between them and local services.

There seem to be two choices here.

1. We could try and make sure that every mental health service was able to meet the needs of nearly every Deaf person.

or

2. We could try and help the specialist services to spread themselves more widely and support all Deaf people with serious mental health problems.

However we do it, we should make Deaf children and young people a priority.

It is important that the three centres work very closely together.

We need more research into the needs of Deaf people.

We want to know what people think and all ideas are welcome.

In the Autumn, we will put all the ideas together and come up with a plan.

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Mental Health & Deafness Conference

The programme for this conference, sponsored by the Department of Health and SIGN, being held on 11th July 2002 includes the DoH consultation document: "A Sign of the Times - modernising Mental Health Services for People who are Deaf" presented by Bob MacDonald, Policy Advisor at the DoH; Brendan Monteiro, Consultant Psychiatrist at John Denmark Unit, National Centre for Mental Health & Deafness, Manchester. "Mental Health Services for Deaf Adults"; Peter Hindley, consultant child and adolescent psychiatrist at National Deaf Services. "The mental health of deaf children and adolescents: assessment and management"; Naomi Sharples, Project leader for Deaf Peoples Access to Nurse Education and tutor for the Deaf and hearing students at the University of Salford. "The role of Education in meeting the standards for mental health outlined in A Sign of the Times"; and Pauline Latchem, Outreach & Development Worker, Deaf People & Mental Health at Brent Deaf People's Limited. BDPL run a Mental health Drop-In in partnership with Brent MIND, working together to improve access for local deaf people - a model for service development in other areas.

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Response

A response by the United Kingdom Council on Deafness

Introduction

Deaf children and adults (whose primary means of communication is British Sign Language) are more vulnerable to mental health problems. Deaf children are approximately 1.5 times more vulnerable than hearing children to the whole range of mental health problems(1) and approximately 30% of a community sample of Deaf adults experienced one or more common mental health problems such as depression or anxiety disorder(2).

Against this background Deaf people have historically experienced much greater difficulty in accessing all forms of health service, in particular primary care, where access to BSL interpreters at short notice is nearly always impossible. Family members, even very young children, often act in this role.

Mental Health Services, where direct communication with the patient is essential for accurate assessment and treatment, have developed, but only due to the energy and enthusiasm of a small group of practitioners. The three specialist services (London, Birmingham and Manchester) cover the whole country, but not in a unified, co-ordinated way. Only one centre (London) has a dedicated service for deaf children and families.

The haphazard, disjointed and unplanned way that mental health provision for Deaf people has developed leads to inequality in service delivery. This has been highlighted in numerous reports and research findings over the years. 'Sign of the Times: Modernising Mental Health Services for people who are Deaf' is the Department of Health response to a homicide enquiry which commented on the lack of any central strategy. The tragic killing of a woman in 1998 by Daniel Joseph, a Deaf man with a severe mental illness, prompted this action. But Deaf people still experience poor mental health care on a day to day basis and much will need to be done to alter this situation. This report will be warmly welcomed by the Deaf Community if it does bring about real change.

The United Kingdom Council on Deafness is the umbrella organisation for charities and professional bodies concerned with deafness. We offer the following specific comments on the consultation document.

General Comments on the Executive Summary

This is a well thought out, well researched document. However, its implementation will be hampered by the lack of a realistic strategy to ensure service development actually happens, with a clearly documented action plan. We will be pleased to assist in this process.

There is real concern that the lack of knowledge concerning the demographics of the Deaf Community will inhibit decision-making or stop the development of a comprehensive service. This must not happen.

Certainly it must be recognised that the development of services will be curtailed by the lack of experienced, skilled staff able to communicate in sign language. Only with the recognition of British Sign Language by the Government will this situation really change.

Neither of the two options for modernising Mental Health Services for people who are Deaf are totally viable.

Option 1, that of enhancing the role of primary and local services, will inevitably be curtailed as:

• no one primary care trust will have sufficient deaf people, particularly those with severe mental health problems, to justify the provision of specialist service
• clinicians will lack the exposure and experience necessary to develop appropriate skills
• the recruitment of BSL trained, medically qualified staff will hinder service delivery
• the paucity of trained BSL interpreters will restrict appointments
• the timescale for delivering this option will likely see the momentum for change grind to a halt

Option 2, that of the three specialist services assuming full case co-ordination responsibility for all Deaf people with severe mental illness in England, is also riddled with difficulties.

• It would be impractical, if not dangerous, for a doctor in London, Birmingham or Manchester to accept full responsibility for a patient hundreds of miles away. The Daniel Joseph inquiry was critical of the care co-ordination of someone living just a handful of miles away from a specialist centre!
• Recruitment of staff, as in Option 1, will hinder service development, particularly CPN's with sign language skills
• Will a Deaf person with a mental illness have the motivation to travel, or keep contact with a distant service provider?
• Is it effective use of specialist staff time to spend it travelling the length and breadth of the country?
• The appropriate level of funding may also not be available, leading once again to a partially commissioned service as is now being seen with the Children's Service Plan

Of the two Options, the second is more likely to prove successful in that there is already a core of experienced, knowledgeable and committed staff to help drive the initiative forward.

However, we do question the ability of the new PCT's and Social Care Services to develop plans to meet the needs of the Deaf Community. Recommendations from previous reports, for example the Social Service Inspectorate (1997), have still to be actioned many years later.

The appointment of a suitably experienced and empowered individual to push through the recommendations of this report may be one answer to the implementation problem.

The Deaf Community has also been embracing other ideas not mentioned in depth in this report, for example, the use of video telephones and counselling support at a local level.

Information technologies are bringing about rapid change and a proposal to use these new technologies within service delivery would be welcomed.

The notion of a Deaf Healthy Living Centre, a 'one-stop-shop' for Deaf people to access health, social care, employment and advice was developed some years ago. Sadly, funding from the New Opportunities Fund for a trial centre in London was not forthcoming but this notion still has much merit and could fit well into a national service framework.

The Challenge of Service Development

Experience shows that commissioners do not fully understand the implications and difficulties in working with Deaf people, particularly those with mental illness. By implication they are therefore making judgements with some degree of ignorance. Future research then becomes a key issue. We accept there is a wealth of practice based evidence but more solid research information is required for decision makers and we welcome the strong recommendation that the NHS R&D programme supports such research.

There is also some concern that the specialist services have had to become 'Jack of all trades', coping with the full range of mental health conditions. This is clearly not always the best approach for some conditions, for example, substance abuse, or those with additional disabilities, i.e. acquired learning difficulties or autism.

However, this section of the document is particularly well written and we will fully support the comment that 'developing Mental Health Services for the Deaf Community in keeping with current mental health policy is undoubtedly challenging and will require sustained efforts'.

Meeting the Standards for the Deaf Community

Sign of the Times clearly illustrates the difficulties of even partially meeting the National Service Framework Standards. This fact must not be ignored. For too long the Deaf Community has received a substandard service and equality must now happen. Unless there is a change one may expect more Disability Discrimination Act cases.

Indeed, health services provided to the Deaf Community should be exemplary and a template for services provided to the hearing community. This should be the Government's aim in accepting the recommendations of this report.

We believe Deaf people with mental health problems are particularly disadvantaged:

• at arrest by the police
• in court proceedings
• in prison, where they may not be able to access courses leading to an early discharge

and

• in the time taken to receive a diagnosis
• in the time taken to receive an assessment
• by unnecessary long term hospitalisation
• at Mental Health Review Tribunals

The plight of Deaf prisoners leads to much mental distress and sometimes severe consequences. The treatment of Deaf people in prison could be a case of denial of their human rights. More evidence-based research is required in this area.

The report does suggest many ways forward to meet the standards. We warmly welcome these, particularly the suggestions that there should be financial incentives to encourage professionals to develop an interest in Deaf people. The initiative to engage local community health nurses should be pursued but within a well funded strategy.

Proposals for Service Development

Generally we support the intentions in this section of the report. We would, however, like to comment that the Deaf Community should be involved in developing Mental Health Services. There is much qualitative evidence to show how services can be improved and much of the training can be delivered by the Deaf Community. Furthermore, the implementation process should be inclusive, involving D/deaf people, service providers and organisations representing D/deaf and hard of hearing and deafblind people.

Improved mental health care for Deaf people should not be viewed as an option but as an absolute necessity if we are going to have fair, just and equitable services for everyone in society.

Whichever route is chosen, no-one should underestimate the requirement for:

• a medium to long term commitment by the Government
• funding at an appropriate level
• a desire to see a fully commissioned Mental Health Service
• timescales that are achievable
• Strategic Health Authorities leading where appropriate
• prioritising of this initiative within the recently restructured PCT's
• an understanding of the difficulties of working in the Deaf field
• an effective commissioning and delivery arrangement in place

The example of the poorly managed delivery of Highly Specialised Deaf Services for Children and Young People is indicative of the problems of working in this field. This service should now be pressed forward with all expediency.

In simple terms there now has to be clear decision-making and follow through of those decisions if future commissioning arrangements are to be successful and effective. Deaf people should be able to expect and receive fair, just, accessible and equitable Mental Health Services as do hearing people.

The UK Council on Deafness warmly welcomes this document. We concur with the Minister of State for Health's acknowledgement that Deaf people have previously been overlooked and that the proposals in this document can make a significant difference to the lives of Deaf people with mental health problems.

References
Hindley, P. (1999)
Checinski, K. (1991)

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