Dr Sally Austen: Has video conferencing helped Deaf mental health care? (BSL)

I grew up watching science-fiction movies where everybody used video calls: on big screens in front of the space ship control desk or a little handheld devices. Most of us never expected to have access to this technology in our lifetime.

When I started working in Deaf mental healthcare in 1991, most teams had a video phone – but no one used them. They were either kept in drawers and couldn’t be found, or they were visible in offices, but no one knew how to use them.

It was obvious that deaf mental health services could make good use of video calls. Research showed that Deaf and hearing services were using video technology with the same frequency. In fact, the only health services that reliably used video calls were in ‘frontier’ communities (geographically isolated areas with fewer than six people per square mile such as in the Australian outback) or small islands such as in the Caribbean.

At Birmingham National Deaf Mental Health Service, we covered one third of England and 1/2 of Wales, so I really wanted us to make use of video technology. We practiced with a huge video conferencing screen in the trust headquarters, 8 miles away from our ward, connecting with Alderney in the Channel Islands, an island that has just 2000 people. We sat nervously in a line, waving at the other team over the ocean. We progressed a bit and persuaded our hospital to fit a screen in our own building.

But however hard we tried, the NHS internet safety management teams blocked us – as was happening all over the country. Even when an innovations team from Microsoft offered to sponsor us, the safety teams still thought the dangers outweighed the benefits.

Their concerns were:

• What if the patient gets distressed when they alone at the other end of a call?
• What if the connection cuts out halfway through a session?
• What if some other person is hiding out of sight of the clinician on the call?
• What if the Internet is hacked and confidentiality is breached?

And then Covid hit and everything changed.

Suddenly the information safety teams had no barriers. We could use any platform we wanted to contact the patients that we were unable to see face-to-face.

We developed safety features as quickly as we developed the technology. We were proud to not only maintain our deaf mental health service but to increase and develop it further because of video access.

So, has the emergence of video calls helped deaf mental health? My answer is Yes and No.

I remember that on the first day of lockdown I had to cancel a face-to-face visit with a patient four hours’ drive away. I later found out that this patient had severe challenging behaviour and would not have let us into his house. We would have wasted 8 hours of driving. Instead, due to video calls, we could build a relationship with him gradually, five minutes at a time over his iPad, until he trusted us enough for a face-to-face visit. It wasn’t either video or in-person. It was both! The video calls were a stepping stone to an improved face to face contact.

A BSL interpreter explains that interpretation suffers on video because sign language is 3 dimensional -but that it still has real value. In relation to services such as 999BSL and Mental Health 111 lines, they said.

‘Whilst the quality of interpretation is always impacted, these services afford Deaf people the opportunity to report symptoms or seek advice about the crisis they may be experiencing. They can be assessed and onwardly referred. So, I love that these lines exist because they reduce the accessibility gap a bit.’

It was certainly my experience that people who could not previously travel to see us in Birmingham because of disability, poverty or responsibilities such as work and childcare, were able to be seen and treated.

Video calls seemed great time savers. Professionals who needed to attend clinical meetings with us in Birmingham, could allocate 30 minutes of their time to a video meeting rather than spending the whole day travelling from Cambridge or Cardiff. But who makes the decision about whether to save time in the short term by having a video meeting or investing longer term in the greater quality and more personal face to face meeting that would take longer?

Professional in a deaf mental health service:

‘Covid plunged us all into using video for mental health settings, out of necessity. Whilst the statutory processes were fulfilled – CPA meetings, ward rounds, MHRT (tribunals), meetings with solicitors – the quality of service was hugely impacted.’

They went on the say that, even though the video call was less good for the deaf client, after Covid, the professionals found it convenient. This meant it took a lot of persuading (from the clients and the interpreters) to re-start the face-to-face meetings.

Jenny Meek, a deaf psychiatric nurse, reported that video calls had provided her with greater equality.

‘Being able to see faces, lips and sign language means I’m no longer excluded from everyday meetings or conversations that used to rely on lip reading.’

But she also added that professional video calls, require a huge amount of concentration and can be exhausting.

And, as the original internet safety managers commented, Jenny Meek cautions us:

When technology fails frozen screens, poor lighting, bad internet communication breaks down fast. In those moments, video calls remind me that access is still fragile and easily lost.

So, has video technology helped deaf mental health services? Yes. But it hasn’t solved every problem!.

By Dr Sally Austen, consultant clinical psychologist