1. Things to Consider When Working with a Deaf Service User Prevalence of mental health in deaf population ¼ of the whole population have mental health problems. Deaf people are almost twice as likely to experience mental health problems (40% -TEA report) There are increased emotional/behavioural disorders. More PDs. Comparable rates of schizophrenia but have more visual hallucinations. Prelingually Deaf have more tactile and visual hallucinations, a feeling of being spoken to, lips moving, hands signing. Others have some auditory. Tactile can be explained as a person’s perception of a voice.

2. Things to Consider When Working with a Deaf Service User cont’d Access to MH Assessments tend to be longer Appointments require more time Assessments are multi layered-assessing communication, language, social inclusion, social/emotional delay as well as mental health Education and treatment programmes adapted; break down to basic information, poor understanding of the body and health issue due to education practices and access to information. Paucity and dysfluency of BSL not to be mistaken for thought disorder. Difficulty with time lines is often seen as well as placement and subject identification. Visual resources; pictures, widgit, photos

3. Things to Consider When Working with a Deaf Service User cont’d Difficulties with group work Difficulties accessing employment and inclusion in local services Crisis difficulties, HTT and interpreting, accessing help for the person living alone Small deaf community and concerns re confidentiality with interpreters as many are from deaf families and attend varying appointments so they get to know a lot about 1 person Difficulties with family education, BFT due to lack of common language Using interpreters doesn’t automatically give access to full language. They cannot comment on style, rate, form or content of language Possible admission locally prior to specialist hospitals

4. How We Can Support You To Support Your Deaf Service Users Advice on adaptation of assessment and treatment tools which are designed for hearing people. Limited literacy and reading skills ~ 8yrs Deaf English-not thought disordered Skills in recognition of emotions and feeling and how to express these with SUs who have little or no language learned to understand or recognise own feelings. Possession of a language system is necessary to facilitate abstract thinking, so lots of ToM lacking. Support/supervision/advice to local Care Co-ordinators who will be accessing and signposting to local services and crisis management. Joint working and RC collaborations Medical specialist expertise and advice, for example, medications having differing effects depending on differences in brain physiology eg: due to meningitis Consideration of Differential Diagnoses – eg: tinnitus Working in collaboration with local mental health services – CMHT, drug/alcohol, PD teams, LD teams

5. Use of Interpreters Generally localities have contracts with Interpreter agencies. Different interpreters; BSL, SSE, hands on for deaf-blind, deaf blind manual, relay. Prep the interpreter about what the discussion relates to. The SU may have a preference; worries about confidentiality, gender of interpreter. Sit next to the interpreter so the deaf person has eye contact with you both. Speak at normal rate. The interpreter signs consecutively but may be slightly behind so allow time for the deaf person to respond or clarify issues. Check they have understood, change the wording of the question if so. The interpreter may ask for clarification if they have not understood or they think the Deaf person has not understood. Everything is interpreted so any aside comments will be translated or even bodily functions!! MENTAL HEALTH EXPERIENCE! Interpreters may try to make sense of thought disorder if not experienced.