Sally Austen: Why we created a book about clinical and legal work with deaf clients

To buy the book, click here.

Have you seen the term ‘organisational memory’? It refers to knowledge being passed within departments and between people.

I decided to write this book because, when it comes to information that improves access for deaf and hard of hearing people, organisational memory sucks!

How many times have we all explained that family members are not the same as registered interpreters; that poor access to early language can result in language deprivation; that lipreading ability fades as people get tired?

How many times have we explained that context and concepts and background information are crucial to understanding; and that face masks do just that – they mask faces!?

As a broadly hearing person, I am aware that my exasperation is nothing to that of my deaf and hard of hearing clients, colleagues, and friends.

But I have worked in the field of Deaf Mental Health Care for over 30 years – and I am sick of repeating myself. And I am sick of seeing my clients suffer.

I have seen clients with mental health problems under- and over- diagnosed; deaf witnesses with poor literacy expected to read the court palantypists’ blurb; and deaf parents lose custody of their children because the person assessing them was using the wrong tests, in the wrong way, with the wrong language.

So, with the help of some amazing colleagues, we put this book together – so that hearing professionals can have some of the necessary info close to hand.

An Introductory Guide for Professional Working with Deaf and Hard of Hearing Clients in Clinical, Legal, Educational and Social Care Settings.

It has 401 pages and 84 chapters covering topics such as language and access; physical and mental health; legal and social care issues – all from cradle to grave. The chapters and authors are listed below.

Of the 44 contributing authors nearly half are deaf, Deaf or hard of hearing. There are names you will know because they have decades of experiences – and others who you’ll know from social media because they are the vibrant new clinicians and researchers.

It’s on Amazon here:

An Introductory Guide for Professionals Working with Deaf and Hard of Hearing Clients in Clinical, Legal, Educational and Social Care Settings: Amazon.co.uk: Austen, Dr Sally, Holmes, Dr Ben: 9798520594826: Books

Herbert Klein (Independent Deaf Advisor for mental health), is author of chapters C8 BSL and D7 Video Interpreting.

Herbert says that getting this book out to ‘local hearing professionals will help make a more Deaf friendly environment and improve the clients’ experience of assessment, treatment, therapists and right care pathways’.

Herbert thinks the power of this book is that is it ‘simple, short, brief, and clear so hearing professionals have enough time to read and act’.

Another name you will know from deaf mental health care and advocacy is Lenka Novakova.

Author of D4 Deaf Relay Interpreters and D13 Non-native BSL users, Lenka is herself multi-lingual and gives clear but powerful instructions to hearing professionals who may know nothing about the needs of deaf people with complex language needs: it’s more than just providing a BSL interpreter!

My co-editor, Dr Ben Holmes, is a clinical psychologist working at the Birmingham deaf mental health service.

His frustration is that a lot of hearing professionals ‘do not know what they do not know’- and that the lack of specialist deaf service and deaf professionals makes it hard for them to learn.

He says the deaf client often has to instruct the hearing professional, which is frustrating and fatiguing – as well as risky in terms of misdiagnosis or mis-treatment.

Ben says ‘This book provides advice about how professionals can make adaptations to their practice. It also guides them to recognise when they may need to seek additional information and support from deaf professionals, specialist services and third sector organisations.’

Ben’s neuropsychology expertise has been invaluable in chapters B1 Language Deprivation, B7 Abstract Thought, E2 Cognitive Assessment, to name but a few.

We self-published this book to keep the price down so that every staff room, hospital, court and library could afford a copy. It is available for £12.99 on Amazon.

Please pass this info around to hearing professionals that you think need it. And if you have thoughts about any additions needed for the second edition (due out approximately 2025/6) there is an email address on the intro page and we would welcome your contributions.

Have a look at the chapters and the authors (below Sally’s biography).

Dr Sally Austen is a consultant clinical psychologist. She has worked for the NHS in both the National Deaf Mental Health Services, primarily with sign language users, and at the Royal Throat Nose and Ear Hospital, with people who identify as having a hearing loss, tinnitus or balance problems. In her private work, Sally provides supervision and teaching services, Expert Court Witness assessments and occasional media work.

Contents

A Introduction

1. How to use the Book
2. Your deaf and hard of hearing clients are missing! 
3. Terminology

Before you Assess or Treat

B The Importance of Language

1. Language Deprivation
2. Nodding
3. Literacy in deaf and deafened people. Using writing to communicate. 
4. Fund of information and access
5. Theory of mind 
6. Timelines
7. Abstract thought
8. Locus of control

C Communication and Identity

1. Communication and Language – Some Definitions  

9. Language Acquisition
10. Newborn hearing screen
11. Children with deaf parents 
12. Oral v Manual Debate
13. Deaf education: past, present and future
14. Bi- and multi-lingualism: how it can aid cochlear implantation
15. British Sign Language
16. BSL Alphabet
    10. ‘Being Hearing’, cultural naïveté and some audist assumptions

D Maximising Access

1. 1. Interpreters and communication professionals 
   2. Working with sign language interpreters (SLI)
   3. Using interpreters with non-fluent or language deprived sign language users.
   4. Deaf relay interpreters
   5. Booking a sign language interpreter
   6. NUBSLI: checklist for booking a BSL/English interpreter
   7. Video Interpreting
   8. Oral communication: lipreading 

• What is a lipspeaker?

1. Oral communication: improving the effectiveness of communication using residual hearing.
2. Communication with Deafblind people 
3. Deafblind alphabet
4. Non-native BSL signers
5. Checklist of your client’s communication needs

Assessments and interventions

E Cognitive and neurodevelopment

1. Diagnostic over shadowing
2. Cognitive assessments 
3. Deaf and hard of hearing people with intellectual disabilities
4. Autism Spectrum Disorders in deaf children and young people
5. Autism Spectrum Disorders in deaf adults
6. ADHD 
7. Deaf Older Adults
8. Assessing cognitive functioning remotely 

F Mental Health

1. Depression and anxiety in sign language users
2. Deaf people and trauma
3. Adjustment to hearing loss 
4. Deaf people and psychosis 
5. Do deaf people hear voices?
6. Pressure of speech or sign
7. Psychological therapies
8. Group therapy
9. Telemental Health
10. Medication and deaf, deafblind and hard of hearing people
11. Nursing/care coordinating with deaf service users: examples of good practice 
12. Challenging behaviour in deaf and hard of hearing children and adults
13. De-escalation of aggression
14. Restraint

G Health Service Provision

1. The Deaf community and systemic failings in health care
2. Prevalence of mental health problems 
3. National deaf child and adolescent mental health services
4. Specialist mental health services for deaf adults
5. Length of inpatient stay and delayed discharge
6. Deaf research hubs – past and present
7. Using standardised assessment measures with deaf people
8. Media walls

H Physical Health

1. Aetiology does matter: causes and consequences of deafness 
2. Tinnitus
3. Balance and dizziness in people who are deaf or hard of hearing
4. Genetic counselling
5. ENT multidisciplinary working and onward referral
6. Non-organic hearing loss (NOHL)
7. Deaf Wannabees
8. Sleep problems

I Legal

1. Deaf people in the Criminal Justice System: guidelines
2. Forensic mental health services for deaf people 
3. Capacity to parent assessments with deaf clients
4. Mental Capacity Act assessments
5. Mental Health Act assessment, sectioning, tribunals and lay managers’ hearings
6. Representing a deaf person in court
7. Safeguarding vulnerable adults
8. Deaf registered intermediaries for vulnerable deaf clients
9. Discrimination laws

J Conclusion

What we know we don’t know (e.g. future research areas needed)

K Appendices

1. Working with a deaf or hard of hearing (DHH) young person in CAMHS

Authors

1. Dr Kevin L. Baker  Consultant Clinical Psychologist working with deaf adults, families and children, and people with complex needs
2. Chris Bojas Deaf Intermediary, and Psychological Wellbeing Practitioner. working with Deaf adults
3. Cath Booth Head of Service Wales and South West Community, RNID: 31 years working with people who are profoundly Deaf with additional, complex needs and mental health issues
4. Grant Budge Specialist Deaf service inpatient ward manager
5. Dr Steve Carney Consultant Psychiatrist in Deaf mental health care
6. Adele Cockerill Assistant Psychologist
7. Dr Andy Cornes Consultant Psychologist, Family and Systemic Psychotherapist
8. Jackie Dennis  Registered Sign Language Interpreter
9. Dr Anne Easson Consultant Audiovestibular Physician
10. Dr Lindsey Edwards Paediatric Clinical Psychologist
11. Craig Flynn Deaf Intermediary
12. Lindsey Gagan Speech and Language Therapist, working with deaf adults in a mental health setting (JDU, Manchester)
13. Dr Hannah George Consultant Clinical Psychologist and Clinical Lead of the northern arm of Deaf CAMHS, working with deaf children, young people and families, and hearing children with deaf parents
14. Neil S. Glickman Ph.D. Licensed psychologist, University of Massachusetts Medical School and Private practice of psychology/psychotherapy
15. Abigail Gorman Policy and Public Affairs Manager for Deaf health charity
16. Dr Mary Griggs Clinical Psychologist, working with deaf adults
17. Louise Harte Registered Intermediary/Qualified Translator, working with Deaf adults and children
18. Dave Jeffery MSc. BSc. (Hons.), RMN, SPMH Deaf Community mental health nurse (now retired). Advanced Nurse Practitioner in violence reduction and aggression management. Co-edited (with Sally Austen) Deafness and Challenging Behaviour: 360 Degree Perspective
19. Maria Kilbride BA (Hons.) PGDip Registered Sign Language Interpreter (NRCPD), working primarily in secure mental health with inpatients and their associated Multi-Disciplinary Teams
20. Herbert Klein Independent Deaf Advisor in mental health
21. Dr Rachel Lever Clinical Psychologist, working with deaf adults in mental health services
22. Hellen McDonald Support worker with Deaf adults
23. Jennifer Meek Deaf Recovery Community Nurse with Deaf adults
24. Dr Constanza Moreno Clinical Psychologist, working in National Deaf CAMHS (London team)
25. Professor Jemina Napier Chair of Intercultural Communication, specialising in sign language interpreting and brokering
26. Lenka Novakova Deaf advisor, National Deaf Mental Health Service based in South west London and St. George’s mental health trust. Prior experience in deaf education and as a child mental health worker, National Deaf CAMHS Corner House
27. Jayne Oakes Deafblind specialist Interpreter working with Deafblind people
28. Dr Sue O’Rourke Consultant Clinical Psychologist
29. Dr Sarah Powell Highly Specialist Clinical Psychologist, working with deaf adults in primary care
30. Paul Redfern Senior manager, working part-time with British Society for Mental Health and Deafness
31. Dr Sara Rhys Jones Highly Specialist Clinical Psychologist, Learning Disabilities Directorate, Swansea Bay University Health Board
32. Dr Katherine D. Rogers NIHR Post-Doctoral Research Fellow, University of Manchester
33. Dr Katherine Rowley Lecturer in Deaf Studies and Interpreting, University of Wolverhampton, and Director of Language Wise
34. Nikki Stephens Hearing Therapist, working in the NHS and privately with tinnitus, hyperacusis, misophonia and cochlear implant patients, and also providing generic hearing therapy
35. Clare Wade QC Barrister, Garden Court Chambers
36. Dr Elizabeth Wakeland Clinical Lead, Forensic and Clinical Psychologist
37. Dr Rob Walker Consultant Child and Adolescent Psychiatrist & Clinical Lead, National Deaf CAMHS (Central England)
38. Jackie Wan Community mental health nurse
39. Christian Wasunna Barrister, Garden Court Chambers
40. Lesley Weatherson Lipspeaker and British Sign Language/English Interpreter
41. Hannah Whalley Community mental health nurse  
42. Asher Woodman-Worrell Sensory Adults Social Worker