SignHealth is committed to bringing better healthcare and equality of service provision to deaf people in the UK

To achieve our goals we will need to work in partnership with deaf people and deaf organisations, with health charities and other charities

Providing a World Class Psychological Therapy Service for Deaf BSL Users

Hazel Flynn – Clinical Management LeadCelia Hulme – KTP Associate UCLan/SignHealth

Presentation Aims

• Mental Health and Deafness

• Consider cultural & linguistic needs of Deaf community

• Recovery/Outcomes

• Summary

Mental Health & Deafness • 107,000 Deaf BSL users (IPSOS MORI GP Survey 2010)

• Most Deaf mental health services are at secondary/tertiary level providing Step 4/5 care

• Only ONE primary care available for sign language users

• Deaf people experience same mental health problems as general population

• Unequal access to mainstream services due to• Lack of access • Communication barriers• Cultural awareness

Issues for Mainstream Service

• Dispersed community

• Cultural issues

• Communication

• Language

• Access

• Lack of Deaf/BSL awareness

• Lack of engagement – stigma/fear

• English as a second language or limited understanding

Sick of It

• 5 year study from University of Bristol & SignHealth

• Under diagnosis and under treatment of conditions

are more common in Deaf people

• Risk of preventable heart attacks and strokes,

diabetes leading to complications such as kidney

failure and blindness

• Deaf people twice as likely to suffer depression

(24% D v 12% H)

Case Study - Laura

Background – physically abused by father, gang raped

(15yrs), DV ex husband, DV ex boyfriend, difficult

relationship with mother

Therapies: 3 episodes of treatment attempted before

referred to BSLHM

– in refuge 2 sessions with hearing counsellor

– therapy following crisis – self harming so severe had

hospital admission

– 10 sessions in a mainstream IAPT service

– Assessment with BSLHM – treatment offered

Considerations

• Conventional, treatment involving written English is unsuitable for deaf people (William & Austen, 2000)

• Deaf clinical service population – reading levels are generally lower than hearing counterparts (Glickman & Gulati, 2003)

• Pretending to understand written materials (Harper & Connell, 2007)

• Cognitive impairment common (Vernon & Andrews, 1990)

• Average reading age of deaf school leaver - 8.7 years old (Conrad, 1978)

Case Study - Laura

Background – physically abused by father, gang raped

(15yrs), DV ex husband, DV ex boyfriend, difficult

relationship with mother

Therapies: 3 episodes of treatment attempted before

referred to BSLHM

– in refuge 2 sessions with hearing counsellor

– therapy following crisis – self harming so severe had

hospital admission

– 10 sessions in a mainstream IAPT service

– Assessment with BSLHM – treatment offered

BSL Healthy Minds

• First psychological therapy primary care service for BSL users in England

• Step 2 & Step 3 interventions• Culturally Deaf aware therapists • CCMS & CS provided by appropriately qualified & BSL fluent

practitioners • Open referral system • Outcome measures (GAD7, PHQ9, WSAS) – translated into BSL • Northumberland Guided Self Help materials – translated into

BSL • No BSL Interpreters • Most therapy sessions in GP surgeries • Delivered by a Deaf organisation

What we offer

CBT/CfD

• Depression

– Childhood difficulties

– Power dynamics– Abuse

• Anxiety

–Limited life skills–Limited information

ABC formulation

• Patient’s language/their words/their understanding

• Enabling exploration of– Thoughts– Feelings– Behaviour

• Frequently recapping sustaining positive change

Accessible website and self-efficacy

Evaluation Report

National IAPT BSL IAPT

Recovery 44% 76%

Waiting Time to treatment

Within 28 days 64% 61%

After 28 days 36% 39%

Declined treatment 22% 15%

Drop-outs 25% 16%

Not suitable/referred on/signposted 7% 7%

Stepped up - 18%

Referred on after treatment 8% 9%

Evaluation Report

• Excellent recovery rates

• Low drop outs

• 61% access the service within 28 days

• High patient satisfaction (87%)

• Highlighted the importance of Deaf BSL therapists

(North West BSL Healthy Minds Evaluation Report, 2014)

Cost Comparison

BSL IAPT Mainstream IAPTvia Interpreter

Access to Tertiary Services

PWP – 1 episode of care

Assessment + 8 sessions

£180 x 9

Total: £1620

PWP – 1 episode of care

Assessment +8 + Interpreter

£255 x 9

Total: £2295

(N.B. does not include interpreter mileage/supervision cost)

In the event that a client is not seen at the appropriate level at primary care, access to specialist tertiary services is at a cost of £550/day

Summary

• Only psychological therapy service in BSL in the country

• 107,000 BSL users in England – small number but can result in costly treatment because of numerous referrals into mainstream

• Deaf people twice as likely to experience depression

• Cultural and linguistic needs must be considered if therapy is to be successful

• Clinical and cost effective – 1 professional in the room

Questions?

Contact

hflynn@signhealth.org.uk chulme@signhealth.org.uk

Tel: 01494 687606Mob: 07966 976 747Email:

info@bslhealthyminds.org.ukwww.bslhealthyminds.org.uk

– @bslhealthyminds

• Referrals:– Sign language user– Aged over 16 years

• Self referral • GP referral• Professional referral

References

• Conrad, R. (1979) The Deaf School Child. London: Harper & Row

• Glickman & Gulati (2003) Mental Health Care of Deaf People: A culturally affirmative approach. Mahwah, NJ; Lawrence Erlbaum Associate.

• Harper, A. & Connell, M. (2007) The role of deaf staff and interpreters in preventing challenging behaviour. In S. Austen & D. Jeffery (eds) Deafness and Challenging Behaviour: A 360o Perspective, Chichester, John Wiley & Sons, Ltd pp 208-222

• Hulme, C, KTP Associate (2014) North West BSL Healthy Minds Evaluation Report

• SignHealth. (2014 ). Sick of It . Available: http://www.signhealth.org.uk/health-information/sick-of-it-report/sick-of-it-in-english/

• Vernon & Andrews (1990) The Psychology of Deafness: NY; Longman Publishers

• Williams, C. & Austen, S. (2000) Deafness and intellectual impairment: Double jeopardy? In P. Hindley & N. Kitson (eds) Mental Health and Deafness. London: Whurr Publishers