Chris Bojas: Improving access to mental health by translating into BSL

Mental health is a big issue nationally right now: it’s constantly in the news, and in particular there are some serious issues among children and young people, where the reported levels of mental health problems are rising.

Rates of mental health problems are even higher in the Deaf community: by some estimates, two or three times higher than among hearing children.

Watch this article in BSL below, or scroll down to continue in English!

The reasons for this are a complicated mixture of factors. They include physical problems and complex syndromes; the family environment; educational experiences.

When people don’t have access to language, other difficulties can arise like understanding how others think or feel, anxiety or poor social skills.

Good mental health care is needed; and it also needs to be accessible to Deaf children and young people in the same way that it is to hearing children and young people.

How are mental health problems diagnosed? Usually a screening tool is used: this is a set of questions that makes it possible to understand what some of the issues affecting an individual are.

The questions ask about a child’s behaviour, their emotional life, their ability to pay attention, or how they get on with others. Questionnaires like this are used to measure various aspects of mental health.

The results from a questionnaire make it easier to see what kind of treatment might be needed. But of course a vital issue for the child or young person, or their carers, is that the questions have to be in a language that they can understand; otherwise, they will not be able to answer the questions, and the results might not be accurate.

One of the commonly used tools is called the Strengths and Difficulties Questionnaire (the SDQ). It was first designed in English, and it has now been translated into over 80 spoken languages.

The SDQ can be used by parents, teachers, or clinical professionals; or the young person can also complete the questionnaire by themselves. The SDQ gives reliable results, so it is an important tool.

In order to improve access to mental health care, a team based in York translated the SDQ into BSL. It was the first time a clinical tool for mental health has been translated into BSL.

The translation means that children and young people and their families now have access to an important tool in their first or preferred language, so they have better access to mental health care.

The translation process involved a team of Deaf and hearing professionals working together, and was more complex than for more everyday things.

First, the English version of the SDQ was translated into BSL using a team of bilingual translators.

Next, a second team of independent translators translated the BSL version back into English. After that, an expert panel of linguists, translators and health professionals (a mixture of hearing and Deaf people) checked the original English version with the version translated back from BSL to see if they matched.

If they did, the BSL version was accepted. If they didn’t, the BSL version was revised, and the process repeated until the translation matched, or was effective close enough.

Finally, the BSL version was tested with Deaf young people and Deaf adults. They were asked to comment on whether the language was appropriate, and whether they could understand it.

The translation process brought up lots of interesting cultural and language issues. In English, the questions have just a few words, like “Steals from home, school, or elsewhere”.

The written English version has no facial expression or intonation: it’s just words on a page.

In the BSL version for 11-17 year olds, YOU has to be added when the question is signed. The signer also has to produce a facial expression: in the case of asking about stealing, it was important not to make the answer ‘no’ more likely, for example by frowning.

In other cases, it wasn’t clear what the English question meant exactly: for example, one question asks about ‘sickness’, and the team had to decide whether this means ‘vomiting’ or ‘feeling unwell’: the only way to be sure was to ask clinicians how they use the question.

At the end of this complicated process the team tested the questionnaire, to check whether the translation was reliable and produced the same results as the English version.  It did, so they were confident that it worked for Deaf people.

The BSL version of the SDQ is now publicly available, and it has inspired an ASL and a Norwegian Sign Language version too.

Having a BSL version of the SDQ gives Deaf children and their families better, more suitable access to mental health care. The translation process was also very rigorous, and is being used again to develop other translations: there is one in progress for a test for autism.

The York team has made a video about the translation process, and you can find it here.

We’d be very interested to read your feedback and thoughts in the comments below!

Chris Bojas is the Research Assistant (Project Officer) for a team at the Department of Language & Linguistics Science at the University of York. The team is working to inform the Deaf community about some important work they have done in translating assessment materials in to BSL.