The Psychological Wellbeing of the Deaf Community: A Social Exclusion Perspective more

Psychological Wellbeing and Social Inclusion of the Deaf Community Daniel Weisberg Psychological Wellbeing Practitioner Self Help Services Clarification ‡ ³Deaf community´ refers to the cultural and linguistic minority group whose first and / or preferred language is British Sign Language (BSL) (Tucker, 1998). ‡ People who are deafened or hard of hearing, ³d´ Generally able to access mainstream services (Iezzoni, O¶Day, Killeen & Harker, 2004). ‡ The Deaf community have poor access to mainstream mental health services, often being referred inappropriately to specialist tertiary services without an assessment being completed at primary care (D¶Aoust, 1999) On that note« Historically ‡ Deaf children were taught intelligible speech, rather than education (Conrad, 1977) ‡ Many leave school with poor understanding of the world around them ‡ Result: Poor unemployment rates, reduced opportunities ‡ Deaf community unemployment rates (13%) ‡ Hearing community unemployment rates (4%) (GP Survey, 2010) ‡ Updated data: Hearing unemployment: 8%. Deaf unemployment is 3.25 times, can expect 26% «Mental Health ‡ Prevalence: Deaf: 10%, Hearing 6% (DoH, 2005) ‡ Improving Access to Psychological Therapies (IAPT) is almost useless ‡ IAPT was set up to: ³«reduce social exclusion in people suffering from depression or anxiety disorders«´ (DoH, 2008) ‡ On the contrary, IAPT has led to further social exclusion: ‡ IAPT is a hearing programme Social Exclusion and Deafness ‡ Deaf community are part of a cultural heritage (DoH, 2005) and share values, beliefs and norms (DoH, 2002) ‡ 101,107 Deaf adults in England use BSL (GP survey, 2010) ‡ BSL is a language in its own right ‡ BSL is NOT English translated into signs. BSL has its own grammar and is communicated through signs, facial expressions and body movements ‡ ³Reading´ therapy in English is not sustainable Challenges of IAPT ‡ In order to deliver inclusive mental health services, need to challenge: ± ± ± ± ± Cultural awareness of the Deaf community Lack of BSL fluent and culturally aware practitioners Assessment tools in English Self help materials are in English Small size of Deaf population ± separate funding ‡ Greatest challenge: Providing culturally and linguistically appropriate service Current Policy ‡ ‡ Department of Health (2002). A sign of the times: Modernising mental health services for people who are Deaf. London: HMSO Adapts the NSF¶s seven standards that people with mental health problems should expect into appropriate standards for Deaf people ‡ ‡ Department of Health (2005). Mental health and Deafness: Towards equity and access. Best practice guidance. London: HMSO ³Deaf people need special attention as they have biological and environmental barriers, plus barriers to education, employment and access leisure and social activities most of us take for granted´ Both reports identify that Deaf people and their carers are disadvantaged when accessing mental health services The need for communication support, respect and cultural awareness is essential Fluent signing environments are most therapeutic There are a lack of evidence-based interventions: Our knowledge is lacking ‡ ‡ ‡ ‡ ‡ British Society for Mental Health and Deafness conference, 22 March 2012, London Service Developments ‡ Three possible options ± Revise the current model: Use BSL interpreters ± Train the current workforce in BSL ± Employ a workforce reflective of the Deaf community ‡ Project aim: ± Determine which of the three options is most likely to reduce social exclusion of the deaf community ± Implement the most accessible, efficient and acceptable model 1: Use BSL Interpreters ‡ IAPT remains inaccessible ‡ Does not encourage Deaf community to engage ‡ Use of an interpreter is likely to: ± Make therapy feel forced ± Make boundaries between practitioner and client ambiguous ± Harm relationship around trust and confidence in practitioner (Freed, 1988) ± Miss risk / important background information ‡ Logistics: ± Interpreters charge, require booking (Signature, 2011) ‡ Practitioners have no cultural awareness 2: PWPs / HITs Learn BSL ‡ No interpreters ‡ BSL taught at 4 levels: I, II, III, IV-VI ± ± ± ± I: Deaf awareness, basic conversation II: Advanced conversation III: Minimum requirement for therapeutic work IV-VI: Interpreter standard ‡ To reach III, would take 4 years. ‡ High drop-outs: 1 pass III, 65 start ‡ High cost, time wasted? 3: Deaf PWPs / HITs ‡ No interpreters, no training ± Feel included and understood ± Reduction in inappropriate referrals to Step 4+ ± Linguistically and culturally aware (Deaf awareness for hearing practitioners) ± Accurate assessments and evidence-based interventions ± Reduce chance of errors (e.g., risk assessments) ± Deaf community would report improved mental health 3: Deaf PWPs / HITs ‡ Consequences« ± In North West, 12,730 Deaf people (H. Flynn, personal communication) ± Prevalence of mental health problems, 10% ± = 1,273 people in North West ± 50% of people with mental health problems visit GP (likely to be less for Deaf community, Sign Health 2008) (Burstow, 2011) ± 637 people more likely to engage ‡ Supported through multi-referral pathways (self, other disciplines, professionals) Into Action« ‡ Self Help Services ± Cannot afford to take on Deaf practitioners ± Small numbers of those supported makes the system poor value for money ‡ Does not mean problem should be ignored ± Deaf awareness training ± Deaf culture training ‡ Example of success (DoH, 2005) ± ± ± ± Newcastle upon Tyne NHS Foundation Trust Since 1999, annual Deaf awareness training Now open to local primary care services Compulsory element of nursing courses Into Action« ‡ Liase with external organisations to encourage any Deaf people to get in touch / seek support ± Age Concern, Job Centres, Libraries, Sure Start Centres, Churches etc. ‡ Discussed in supervision: what service provisions we would need to make, stigma, lack of knowledge ‡ Sought advice on how to improve access ± Difficulty due to small numbers ‡ Links with BSMHD, Links with SignHealth, BSL Healthy Minds ‡ Add BSL to languages, Deafness to disability Into Action« ‡ Encourage Self Help Services to bid for contracts / submit tenders ± North West IAPT, fronted by Hazel Flynn, won a bid ± Press Release ± 1 year pilot across North West, IAPT BSL service ± Deliver accredited PWP course in BSL (Liverpool John Moores University) ± Translation of outcome measures (PHQ, GAD, WaSA) ‡ Manchester University project, Social Research with Deaf People (SORD) ‡ http://www.nursing.manchester.ac.uk/bsliapttranslation/ ‡ Expected April 2012 ± Translation of Northumberland Self Help materials ‡ 8 guides, posted on websites: DoH, IAPT, SignHealth Evaluation of Progress ‡ Review demographics ‡ Examine any changes in referral rates ‡ Take evidence to managers as reason to push tender Conclusions ‡ Many of the Deaf community are socially excluded ‡ The current IAPT programme does not cater for them and current services are inadequate ‡ Deaf awareness is necessary and ought to be initiated as soon as possible ‡ Hiring Deaf practitioners is more effective and accepted than interpreters or BSL fluent hearing PWPs / HITs ‡ By increasing participation and engagement, we can improve the physical and mental health, quality of life and the role of the Deaf community within society Thank you ‡ Any questions? References ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Burstow, P. (2011). 50 Years On: Did we ³underestimate their powers of resistance´? How can talking therapists support the Coalition¶s radical ambition to make our health and social care system work better for the people who need it? London, UK: Health care conference, ³Psychological Therapies in the NHS´. Conrad, R. (1977). The reading ability of Deaf school-leavers. British Journal of Educational Psychology, 47(2), 138-148. D¶Aoust, V. (1999) Complications: the deaf community, disability and being a lesbian mom ± A conversation with myself. In V.A. Brownworth & S. Raffo (Eds.). Restricted Access: Lesbians on Disability. Seattle, WA: Seal Press. Department of Health (2002). A sign of the times: Modernising mental health services for people who are Deaf. London: HMSO. Department of Health (2005). Mental health and Deafness: Towards equity and access. Best practice guidance. London: HMSO. Department of Health (2008). Improving access to psychological therapies implementation plan. London: HMSO. Freed, A. (1988). Interviewing through an interpreter. Journal of Family Practice, 22, 131-138. GP Survey (2010). Department of Health, GP Patient Survey Results 2010. Iezzoni, L.I., O¶Day, B.L., Killeen, M. & Harker, H. (2004). Communicating about health care: Observations from persons who are Deaf or hard of hearing. Annals of Internal Medicine, 140(5), 356362. National Health Service Information Centre (2011). Attitudes to mental illness ± 2011 survey report. NHS information centre: London. Signature (2011). Retrieved November 12, 2011 from www.signature.com. Tucker, B. (1998). Deaf culture, cochlear implants and elective disability. Hastings Center Report, 28 (4), 6-14.