Dumb & Dumber: Hearing Services for Deaf People Sue O’Rourke. Consultant Clinical Psychologist Mayflower Hospitals, Bury

‘You have to be deaf to understand……….’

Deafness  1:1000,  deaf, HoH, deafened, hearing impaired, Deaf  BSL users  Deaf people as a cultural and linguistic minority : BSL, Deaf clubs, cultural norms, shared experiences, Deaf humour, Deaf Olympics, etc etc  BSL as a recognised minority language

Deafness and Development  90% Deaf children have hearing parents  Problems around diagnosis and professional advice  Oralism vs Total Communication  Choices in education: mainstreaming/ deaf units/ deaf schools

Underachievement ………  Failure of the education system for Deaf children  Lack of access to higher education  Lack of access to professional training  Training in a second language/problems with written English

…………And successes  Deaf people in higher education  Professional training  Greater access eg via BSL interpreters and notetakers  Social workers and OT’s  Salford University RMN training for Deaf and hearing  Clinical psychology training

Deafness and Mental Health  Few epidemiological studies  Higher rates of behavioural problems than in hearing children (Hindley 1997)  Early descriptions eg (Denmark 1985) suggest not higher rates of serious MI but methodological problems  Now suggestions of higher prevalence of psychotic disorders in deaf, possibly subgroups eg rubella deafened  More ‘ problems with life’ as a result of lack of experience, poor coping skills - relating back to developmental experiences

Deafness and Forensic Mental Health  Lack of research  Young et al (2001) looked at all Deaf referrals since 1968  High % referred for assessment had no mental disorder  High % referred for ‘fitness to plead’ assessment  High % sexual offences

Issues for Specialist forensic services for Deaf people  Lack of evidence base  ?base rates of offending  Issues in risk assessment  Inability to use most psychometrics  Adaptations of treatment packages  Where to discharge to?  Prisons!

Models of care  Integration  ‘Bolt on’ support  Specialist services

‘Integration’ Placing a Deaf person in a service designed for hearing people with little or no additional support and no specialist expertise. Placing a Deaf person in a service designed for hearing people with little or no additional support and no specialist expertise. ‘we manage’ ‘we manage’ ‘He understands when he wants to’ ‘we write it down’

‘Bolt on’ The addition of support services such as an interpreter to a service designed for hearing people The addition of support services such as an interpreter to a service designed for hearing people  Problems securing funds for interpreter and to teach staff deaf awareness and BSL  How to assess when the interpreter is not there?  Peer group?  Access to treatment and therapy?

Specialist services A service designed to be culturally and linguistically appropriate for Deaf people. A service designed to be culturally and linguistically appropriate for Deaf people.  All staff Deaf awareness & BSL trained  BSL as main language of the environment including assessment and treatment  Knowledge about cultural norms  Development of treatments from a ‘Deaf perspective’  Employment of Deaf staff

Specialist services  John Denmark Unit, Prestwich Hospital, Manchester  ‘Old Church’ National Deaf Services, London  Denmark House, Queen Elizabeths Psychiatric Hospital, Birmingham  Rampton Hospital  Mayflower Hospitals, Bury

Prisons  How many Deaf prisoners?  ? estimated at any one time  Additional mental health problems? – how are they assessed?  No specialist services  No strategic development  No access to programmes  Particular difficulties for ‘lifers’

Prison Inreach Project  Rampton and Mayflower Hospitals  Assessment of all Deaf prisoners  Rates of mental disorder  Need for referral to mental health services  Needs within the prison  NSF, DDA and ‘Sign of the Times’

‘You have to be Deaf to understand……….’