Dr Sally Austen: Deaf mental health services – is specialist best? (BSL)

The UK has some of the best deaf specialist mental health services in the world. Sadly, that is still not enough.

Should we have to choose between specialist deaf mental health services or mental health services that can adapt to the needs of deaf patients? What are the issues? Here is a summary of them…

Spot the contradictions here!

For a deaf person to be assessed and treated by a Specialist (NHS) deaf mental health service, they must first be assessed by someone from their local mainstream mental health team. This means that a hearing service with no experience of working with deaf people, decides if the client needs to be referred to the deaf service! That makes no sense.

Who has the info?

It’s likely that neither the client nor the hearing professionals know of the existence of the specialist Deaf Services. How would they? Cuts in NHS resources have meant that specialist services have little money for advertising themselves or for educating mainstream clinicians.

Does the hearing service know how to book, prep and work with experienced interpreters? Do the professionals know that some mental health problems will present differently in deaf people and that most deaf people have significantly less social support to help them cope with the mental health problems, compare to hearing people? How confident are we that the local clinicians can complete an assessment that will be valid?

Is ‘Specialist’ good?

Specialist deaf mental health services have been around in the UK for about 40 years and are the envy of many other countries. But they can only be in a small number of places, so distance is always an issue. How far do most adults live from London, Birmingham or Manchester? People requiring deaf elderly care may have to go as far as the Isle of Wight!

Should we expect deaf clients to travel to specialist services, or should we expect mainstream services to learn how to work with deaf people? A local mainstream service could provide quicker services and the client staying near home can keep up with their job, family and friends. Support in the local community could be increased and barriers between deaf and hearing people broken down.

Being with your ‘tribe’ – a blessing or a curse?

On the other hand, a huge benefit of specialist services is that clinicians and other clients understand your language, culture and life experiences. You don’t have to explain about deaf schooling, deaf clubs or how hard it is to access GP appointments. Sometimes deaf clients and staff have so much in common that their worlds overlap.

Is this always a good thing? It’s great to have company. But what about your confidentiality? And what if the trauma that you need help with is connected in some way with one of the people you meet at the specialist service? This goes for deaf staff and staff patients. You may meet your old school friend, but you may meet your old school bully!

What about prevention of mental health problems?

Good mental health starts with families, language development, schooling, and community. It also relies on small problems being treated early so that they don’t become big problems. This is called Primary Care.

The NHS specialist deaf services are designed for people with severe and complex mental health problems. It does not provide a national deaf Primary Care service. So, sometimes the deaf person must wait for their mental health to get worse before they can get referred to an NHS specialist service. *

Everybody’s problem or somebody else’s problem?

My vote would be for the continued growth of specialist services with a national requirement for all local community mental health services to learn how to work with interpreters and deaf clients. Let’s not demand one or other – let’s demand both!

*The charity, SignHealth and some private providers do see deaf clients with primary mental health problems, but these are not part of a national NHS service provision.

By Dr Sally Austen, consultant clinical psychologist