Providing effective mental health services for deaf and hard of hearing patients

A Deaf Advisor explains how the National Deaf Service calls on a range of professionals to meet the specific needs of the deaf and hard of hearing communities:

The first research of its kind in 1994 found that 40% per cent of the deaf or hard of hearing population were affected by mental health issues, compared with 25% of the hearing population.

This disparity appears unchanged since, with guidance from the Joint Commissioning Panel for Mental Health citing the prevalence of mental health problems within the deaf community as ranging from 30 to 60%. It also states that sign language users, in particular, have an increased vulnerability to mental health problems compared with the general population.

Deafness itself is not a cause of psychosocial problems, but such problems are likely to be impacted by parental, societal and cultural factors such as communication and attitudes towards deafness. More than 90% of deaf orhard of hearing children are born into hearing families and yet only one in 10 of those parents will learn to sign, which can have an adverse impact on the child’s psychosocial and emotional development.

The National Deaf Service (NDS) aims to provide effective mental health care that matches the deaf community’s complex language profile and cultural linguistic identity, through a wrap-around service that meets its needs holistically. We provide care not only locally and regionally but also nationally, including for patients from Wales, Scotland, Northern Ireland and Ireland. We also have a role as educators for other trusts, liaising with their teams on consultations and joint assessments where our experts can add value.

As a Deaf Advisor within the NDS, my role is to ensure that our service remains deaf aware, deaf friendly and accessible. Our team includes both deaf and hearing professionals who are all aware of and understand deaf culture, identity, language, values and beliefs. We are unique in many ways. We give deaf service users and young people choices of tailored care, respect their communication preferences – sign language, spoken or interpreters – and ensure respect and dignity.

Our adult inpatient service, Bluebell, has the highest proportion of qualified Deaf nurses compared to similar services and as a result, some shifts are led by Deaf professionals only.

We provide assessment, treatment and interventions for a full range of mental illnesses, behavioural and psychological problems in adults and children, young people and their families, including Deaf people with visual impairment. However, we also recognise our wider role in supporting our service users and advocate strongly for their needs to be met, and for their rights to be implemented by involving service users, families and carers in their care.

All our teams are multidisciplinary and we have good collaborative links across our services. The skills mix in our teams reflects the partnership approach we have taken to supporting service users, as they include psychiatrists, mental health and learning disability nurses, occupational therapists, speech and language therapists, social workers, psychoanalytic psychotherapists, clinical and counselling psychologists, community mental health nurses, outreach workers, activity co-ordinators and community support workers.

Our services would not be complete if we did not have sign language interpreters available. They are part of our daily routine and are funded by the Deaf professionals’ access to work scheme (AtW).

Our partnerships also include working with local authority social services, schools, local community mental health teams and so on, where we collaborate to ensure the best holistic care and support. We also work in partnership with specific deaf charities that can provide help with accessing the right kind of housing, independent advocacy and support.

Our CAMHS services work closely with families, schools, and local child and adolescent mental health services (CAMHS) to provide psychological therapies and assessment, family therapy and the UK’s only inpatient unit for deaf children and young people aged between six and 18 with severe complex emotional and psychological problems.

Referrals into our services for children and young people can be made by a range of services that may already be involved in their support, including CAMHS, paediatricians, audiologists, social services, schools, GPs and the national deaf outreach service.

Looking to the future, I would hope that health professionals across the country will take into consideration the needs of their deaf and hard of hearing patients in a way that reflects how we work in the national service. I’d like to see a better understanding of the assessments for deaf people, who are often misdiagnosed, and funding for deaf services that enables individuals to have a choice of treatment. I’d also like to see more focus on language, respecting people’s communication preferences, and using qualified interpreters, not trainees or communication support workers.

With a greater and shared awareness of the specific needs of the deaf community, particularly in mental health services, we can make a real difference.

Lenka Novakova

Lenka Novakova is a Deaf advisor working for a national Deaf mental health service based in South West London and St. George’s Mental Health NHS Trust.

Lenka previously worked in deaf education and then went on to work as a child mental health worker at the National Deaf CAMHS Corner House inpatient unit.

In her current role, she focuses on promoting the importance of deaf culturally and linguistically affirmative provision across the NHS and other mental health care providers.

A strong believer in empowerment and positive thinking, Lenka encourages Deaf service users to be actively involved in ongoing service development through quality improvement and innovation projects.

The field of mental health drives her to continuously develop her current role so that she can achieve the maximum impact and influence on provision for both service users and other medical and non-medical professionals.