British Society for Mental Health and Deafness

To place a notice on this notice board please send details to info@bsmhd.org.uk.

Note: The notices that appear on this Noticeboard are for information only - inclusion does not imply endorsement of the contents by BSMHD.

Extract from article in Volume No: 9 Issue No: 7 Progress in Neurology and Psychiatry www.progressnp.com

Epidemiological studies have indicated that Deaf people have the same incidence rates of psychiatric illness as hearing people. However, misdiagnosis is common, with behaviour disorders misinterpreted as psychiatric illness, or actual mental illness being mistakenly attributed to the patient’s deafness. This frequently leads to people being inappropriately managed for years, resulting in an increased overall prevalence of psychiatric illness. The Health Advisory Service (HAS) 1998 review ‘Forging New Channels’ highlighted an increase in personality problems, behavioural/adjustment difficulties, organic syndromes and learning difficulties among the Deaf population, compared with their hearing counterparts.

Between 1 in 1000 and 1 in 15 000 children are severely/profoundly deaf from early life. There is an increased incidence of emotional, behavioural and adjustment disorders in these children compared with their hearing counterparts (40-50 versus 25 per cent). However, the incidence of affective disorders and schizophrenia are the same. Deaf children are also much more vulnerable to abuse and neglect. There are currently very limited specialised deaf services for children in the UK. The very first (and only) inpatient psychiatric unit has recently opened in London, and a national children’s service has been proposed.

There are currently three Specialist Deaf Mental Health Services in England. Dr John Denmark opened the very first inpatient psychiatric service for Deaf people at Whittingham Hospital, Preston in the 1960s. He established the principles of providing assessment and treatment in the Deaf person’s own language, with an understanding of his/her social and cultural background. The London service followed in the 1980s and the Birmingham service developed from 1991. The multidisciplinary teams (composed of both Deaf and hearing staff) of Preston, Birmingham and London have attempted, with the combination of an inpatient unit at each site, community nursing and the development of satellite clinics, to provide national coverage. In addition, service developments are currently being planned in Scotland and Wales, and have already started in Northern Ireland. Because of the extensive geographical catchment area and tertiary nature of the service, the Deaf Services need to work with the local psychiatric teams in holding Care Programme Approach/ Care Co-ordinator responsibility, particularly when it comes to emergency/out-of-hours care. In these instances, Deaf awareness training and access to qualified BSL interpreters when arranging assessment of the patient are vital. All too often there have been reports of incidences where a patient’s relative has been used as an informal translator, which will inevitably prevent an accurate or objective interpretation of the patient’s presentation, and also impedes their right to confidentiality.

However, there are limitations to the current service provision. The present Specialist Deaf Mental Health Services are generic, as at present there is a lack of subspecialities such as mother and baby, learning disability, substance misuse and psychotherapy, and minimal access for Deaf people to the range of mental health services available to the general population such as early intervention, assertive outreach, crisis resolution and intensive care. Training hearing staff in BSL and deaf awareness is resource intensive and there is a lack of availability of appropriately trained Deaf staff. The three specialist services in England are relatively small units, therefore even average levels of staff sickness can have a significant impact and succession planning (especially at consultant level) is vital. Although satellite clinics (provided as part of contracts/non-contracted activity arrangements) are in operation in many parts of the country, it remains an inevitability that the closer the patient lives to the specialist unit, the greater the opportunity for access to the full range of the multidisciplinary team’s expertise. This is worse for patients who are Deaf-blind, who have the added issue of mobility difficulties.

Forensic needs for the Deaf remain largely unmet by the NHS. The Alpha Hosital (formerly the Mayflower Hospital), which opened in 2002, is an independent provider of medium-secure care, located in Bury, Greater Manchester. High security is presently provided by a specialist unit within Rampton Hospital, Lincoln currently accommodating eight patients. Although the standards of the National Service Framework for mental health and the NHS Plan are intended to apply to the general population, there is a shortfall in the applicability of these standards to the Deaf community. This was particularly evident at the 2000 Independent Inquiry into the Care and Treatment of Daniel Joseph (a profoundly Deaf man with a history of severe mental illness who, in 1998, was found guilty of the manslaughter of his landlady on the grounds of diminished responsibility). In response, the Department of Health consultation document, ‘A Sign of the Times’ was commissioned, focusing specifically on the needs of the Deaf community. The recommendations of the final report, ‘Towards Equity and Access’, include a national strategic framework for the development of future services for the Deaf population, which is consistent throughout the country. This may best be provided at a more community level, with locally based community psychiatric nurses specialised in Deaf awareness and BSL, working at a grass roots level in participation with GPs and secondary mental health services, with referral to specialised tertiary input for more complex cases. This is already successfully in practice in Nottingham, Northampton and Bristol. It is hoped that this will provide a more uniform service provision for the whole Deaf community, regardless of the patient’s proximity to the tertiary units.

With the advent of the ‘Towards Equity and Access’ documentation, the introduction of the Disability Discrimination Act, the development of Deaf Mental Health Services in Ireland, and the plans for Scotland and Wales, this is currently an exciting and optimistic time for the improvement of psychiatric care for the Deaf community. It must be remembered, however, that this is merely the start. There still remains a great deal of ignorance and a lack of understanding of the complex needs of this section of the community, which needs to be rectified before Deaf patients can feel that they have a quality of life and are receiving a service that is equal to that of their hearing counterparts.

I Am Deaf is a short book written to help children understand about deafness. It is part of a series of books written to help children understand about children with different conditions.

The book is simply and clearly written with plenty of photographs to illustrate the text. The text is accessible to primary aged children and presents deafness in positive terms. There are useful tips to help hearing children communicate with deaf children and to understand how deaf children experience the world. There are some weaknesses. It only describes children who use sign language and does not explicitly refer to children who use spoken language. The book was produced in New Zealand. Although New Zealand Sign Language is very similar to British Sign Language, some of the signs in the pictures do not relate clearly to the text and this may because of differences between NZSL and BSL. Finally there is a misconception about the relationship between signs and words. Signs represent concepts, which are represented by words in spoken language. In the glossary the description of sign language says “Some signs are for letters and some signs are for words.” It would have been more accurate to say that some signs are for ideas.

Despite these weaknesses I would recommend I am Deaf as a book to use when working with hearing children who are coming into contact with deaf children or to help them understand more about deafness.

Like many diagnosed with schizophrenia, 51-year-old Paul Hainsworth lives with voices in his head. At their worst, they used to cause him so much misery he would become suicidal. But for the last five years, his most prevalent voice, which he calls Oscar, has been friendly and comforting. ‘I first heard Oscar when I was 22,’ Paul recalls. ‘Oscar was frightening back then, and I thought it was some kind of satellite which had beamed signals inside my head … But now the voice is kind, like a doctor. Sometimes if I am watching television the voice will explain to me what is happening. I cannot see Oscar. There is no picture.’

Paul is deaf, yet he ‘hears’ voices. He is one of seven deaf people diagnosed with schizophrenia who, over recent months, met in a group run by the deaf charity Sign, in Balham, south London, to discuss their voices in sign languages. Facilitated by trainee clinical psychologist Jo Atkinson, herself deaf, and hearing occupational therapist Tamara Hallett, it has been a ground-breaking initiative. Never before have the accounts of deaf ‘voice-experiencers’ been so comprehensively explored. It is also a long-overdue acknowledgement of the experiences of deaf people who, with communication breakdown a pervasive problem, have had a sorry history within psychiatric services.

Research in 1998 from Belgium found that sectioned deaf patients spent on average a staggering 21 years in hospital. This was compared to 148 days for a hearing person. While there has been no similar UK study, the Department of Health, in its 2002 Sign of the Times document, recognised that psychiatric services are routinely failing deaf people, including the estimated 6,000 psychotic deaf patients. Partly as a bid to demonstrate how services can be different, the Living with Voices group aims to assist deaf voice-experiencers in finding ways to cope with and manage their voices. It evolved from treatment/self-help developments within clinical psychology and the mental health service user movement.

Like Paul, group members made it clear to Atkinson that they experience voices. ‘It is like a voice. I do not know where it is from,’ signs Paul. ‘It is like a radio antenna, and it is in my head, going outwards.’ ‘One group member seems to have auditory voices, but he was not born deaf,’ signs Atkinson. ‘We also have a member who was born deaf and says he has shouting in his mind. But he says he can't hear it. It seems that he just senses it.’

To hearing people, the question begging to be asked is how can it be that deaf people experience a voice? There are no studies on the sensual properties of the voices of deaf people diagnosed with schizophrenia. Which is why Atkinson's research, although not published until next year, is likely to be met with huge interest. Moreover, as a clinician who was born deaf, she is the ideal go-between for the hearing and deaf worlds.

‘A voice to a hearing and a deaf person may be different concepts,’ she explains. ‘To a hearing person, a voice is an auditory phenomenon. Whereas to a deaf person, the signs used to describe their voices means someone speaking in their mind, but it is not necessarily auditory. Some deaf people say they can hear something, but if you try and pin them down they can't describe it. They just say "arguing or shouting". They cannot describe the pitch, tone or volume. I think if voices are really a person's own thoughts, then feeling someone shouting in your mind is plausible. For example, if I argue with a deaf friend, I might say to another friend he shouted at me. But I would not mean he necessarily used his voice at all.’

The Living with Voices group has given members a chance to sign openly about their voices. For some, after many years of conventional psychiatric treatment, this has been their first time. ‘Before I came to the group I did not talk to anyone about it [the voices],’ signs Paul. ‘But I feel comfortable in the group and I think it is very useful for me to learn from other people and also to try and help them.’

In October 2002 The LINK Centre, in collaboration with the University of Greenwich, undertook a major study into the impact of acquired profound hearing loss for Deafened People.

Financed by a grant of over £190,000 from the Community Fund's Research Grants Programme, the three-year project aims to document the major effects of late-onset profound deafness in adults and their families using interviews, questionnaires and a web survey.

The study, which is being carried out by Paul Ashton (Research Assistant, University of Greenwich), Richard Hallam (Senior Advisor, University of Greenwich) and Maria Priestley (Research Manager, LINK), has now entered its third and final year. Preliminary findings will be available in May 2005.

Dr Lorraine Gailey, LINK's Chief Executive, said: "The project will provide high quality social research in the field of health and social well being by documenting the effects of such deafness in adults. The findings will be used to guide rehabilitation solutions and community actions. It will also focus on the impact on the families of those deafened people who themselves become socially isolated as a result of their relative's hearing loss.

"Very little academic research on the psychosocial impact on the individual and their family has been carried out, either nationally or internationally.

"There is little awareness of the effects of this kind of deafness, even amongst health professionals," said Dr Gailey. "The provision of specific rehabilitation and support services in the NHS, Social Services and in the voluntary sector is poor relative to other types of hearing loss. Research is needed on people who aren't currently getting access to voluntary or statutory services".

A number of themes are already emerging such as the profound impact on couples' relationships, the difficulty for even close partners to make adjustments to communication and the importance of religious faith.

At the end of the project (autumn 2005) we will be presenting our findings at a national conference hosted by LINK and at various symposia to health professionals. For further information, please contact Maria Priestley at the LINK Centre

The Deafness and Applied Psychology Special Interest Group (Deaf SIG) is a professional body of d/Deaf and hearing UK psychologists specialising in working with d/Deaf people. Comprised mostly of clinical psychologists working in the NHS and research psychologists working in applied fields of mental health and deafness, educational psychologists and counselling psychologists are also welcome to join. Most members are Chartered members of the British Psychological Society.

This group meets three times a year at a rotating venue to discuss issues pertinent to the field of mental health and deafness. Contact and sharing of information is encouraged at other times via an Internet discussion group. In this group all types of deafness and all ages of client are represented. Meetings include time for peer support, news of members, recruitment and training issues, updates of evidence-based information, conference details and feedback and discussion of new developments either clinically, academically or socio- politically. At each meeting there are three presentations either from members of the group or from invited outsiders: a clinical case presentation and discussion, a presentation of a piece of new research and a report about an aspect of a relevant service provision.

Members of this group are highly qualified and experienced in their field and regularly present at conferences or publish work in this field. 'Deafness in Mind. Working Psychologically with Deaf People Across the Lifespan' has recently been published by Whurr Publishers Ltd and is edited by Austen and Crocker, the chair and secretary of the SIG respectively. Many other members of the SIG have made significant contributions to the book.

The benefit of the group to its members is a high calibre of challenging but supportive peer interaction. Given that the field of mental health and deafness is small it is often the case that professionals work in some degree of isolation. Professional and personal support from such a group benefits the individual and the recipients of their work. It also satisfies many of the requirements of the BPS for psychologists to receive continuing professional development and peer supervision

To those outside the field of mental health and deafness this group is available as a point of consultation. We are happy to be approached on clinical, ethical, academic or training matters.

Our clients' only commonality is their deafness. As with many areas of clinical specialty, our clients have difficulties that span a wide variety of other areas and require services specific to their other needs e.g. older adult services, child services, neuropsychology, eating disorders, learning disability services and physical heath provision. Thus, we would very much welcome liaison with our colleagues in other fields in order to be able to jointly provide physical and mental health services that meet the needs of deaf people with mental health problems in a way that equals the services received by hearing people with similar difficulties.

For those interested in joining the Deaf SIG the following Aims and Membership details may be useful. For further information please contact Sally Austen (Chair) at sally.austen@bsmht.nhs.uk

The Emotional Development Of Children And Adolescents At Corner House Inpatient Unit

Corner House is an inpatient unit for deaf children and adolescents. It opened in January 2001 and is the only provision of its kind in the UK. Children and adolescents are referred for assessment and treatment. A core team of multidisciplinary professionals is responsible for their care in liaison with their families, guardians and outside professionals.

Social and emotional development arises from three main processes, which are closely interlinked: Children are born with an innate social relatedness. Through interaction with an available social and linguistic environment this is developed further. Both aspects, together, influence the developing brain.

Deafness alone does not affect social relatedness. However the following social and emotional risk factors have been identified for deaf children:

Some common deficits in the area of social and emotional development have been identified in children attending Corner House:

The aim is to enhance social and emotional functioning through an enriched, linguistically accessible social and emotional environment. This is achieved through real social and emotional experiences, and is reinforced by group, individual reviews and direct teaching.

A programme to assess and facilitate emotional development has been devised and is implemented in 3 ways:

The programme itself adapts and grows with every child in order to meet their specific individual needs.

Corner House School explores emotions through all subject areas of the Curriculum: specific emotion lessons, PSHE, Deaf Studies, English, Maths, Science and Art. This is approached in variety of ways, including photographs drawings, paintings, poems, role-play, video, discussion, games, emotion based story books, problem-solving tasks, etc.

Individual therapeutic work is set up in 1:1 sessions, group sessions with MDT members under the guidance of the Mental Health Occupational Therapist, family work and, in some cases, family therapy. Assessment outcomes inform the individual care plan, therapeutic and educational targets and action plans. The core team is responsible for ensuring that all staff are aware of these plans. All targets and action plans are monitored in daily handovers and reviewed in weekly core team and clinical meetings.

The multi-disciplinary team - work together to apply newly acquired skills in real life situations in the environment (necessity of frequent handovers) 24 hours a day. Opportunities are provided to review thoughts and feelings throughout each and every day.

The assessment and treatment of the emotional development of children and adolescents at Corner House focuses on four components, which build on each other:

Recognition and expression of emotions (facial expression, body language, vocabulary etc.) build the basis for emotional development in any child. It is important to assess not only recognition/expression of a range of emotions, but also to consider aspects such as the range within an emotion, e.g. irritation to rage, and the understanding of a common duration of emotions. Many of the deaf children at Corner House appear to have missed out vital aspects in this area of their development.

Without this basis, it is virtually impossible for children/adolescents to recognize and label their own and/or other people's emotions correctly, to reflect on them, discuss them, to recognize and discuss possible reasons/triggers for emotions, to realize that one emotion can trigger another and to see consequences. They consequently often find it difficult to see the link and, more importantly, the difference between their feelings and their behaviour, i.e. to understand that their feelings are normal/acceptable, but their present behaviour might not be - making it thus impossible for them to understand and learn about more appropriate strategies/behaviour. Some children/adolescents also have difficulties in generalizing their emotional skills/understanding, and/or in applying problem-solving skills/strategies.

All these areas need addressing before a child/adolescent can be expected to use theory of mind in the area of emotions, i.e. to demonstrate empathy and sympathy towards other people.

When applying the programme described above, a specific difficulty was identified in most children and adolescents at Corner House, namely a reluctance to acknowledge and address emotions they believe to be negative; for example they believe that being frightened is the equivalent to being weak, and being angry the equivalent to being naughty. This can be overcome in formal lessons showing the children and adolescents how to separate emotions from behaviour; learning that all emotions are acceptable it is how we express them that is important.

The assumption is often made that children with additional difficulties such as learning difficulties, autism, delayed language, etc. will not be able to access formal lessons focused upon emotional development. However this can be successfully achieved by shifting the emphasis from a cognitive-behavioural approach to a predominantly behaviourally orientated approach.

Corner House provides the children and adolescents with a safe environment to learn that emotions trigger behaviour and practise new skills and strategies in managing this.

Deaf people are still battling for equal access to mental health services - Liz Main reports

When I became depressed, the idea of trying to explain this to my GP without an interpreter meant I put it off for ages. When I finally decided to seek help, my GP referred me to a counsellor who didn’t understand my disability and who couldn’t sign. ‘I’ve had to take a step back and try to deal with my depression on my own. I wonder whether there was any point seeking help in the first place.’

This deaf woman’s account of trying to get help for a mental health problem is all too familiar to Sign, The national society for mental health and deafness. Set up in 1986, Sign has battled for years for better services for deaf people with mental health problems and provision of sign language interpreting, so they can at least communicate their distress to those supposed to help them.

It is estimated that about 40% of the nine million deaf and hard of hearing people in the UK experience a mental health problem at some point in their lives - higher than in the general population, where the rate is one in four. Yet diagnosis and referral rates are poor, says Jonathan Isaac, general secretary of the British Society for Mental Health and Deafness (BSMHD). All too often people don’t get help when they first go to their GP and their condition then deteriorates: ‘One of the significant issues for deaf people with mental health problems is that GPs just aren’t equipped to deal with the situation. If hearing people go along to the GP, they might be sent to counselling or given antidepressants. For deaf people it doesn’t happen. The GP can’t deal with someone in sign language, he or she doesn’t know a counsellor with sign language, so the person gets referred to specialist services and gets institutionalised,’ he says.

In March 2005 the Department of Health issued guidance for primary care trusts (PCTs) on mental health service provision for deaf people. Mental Health and Deafness: Towards Equity and Access makes 26 recommendations for improving mental health service provision for deaf people and came with a promise of £2.5 million annual funding from the DH to be distributed nationally among all 303 PCTs in England and Wales [sic]. A national panel comprising the BSMHD and representatives other deaf voluntary organisations, the DH, NIMHE/CSIP, the NHS and users was set up to oversee the implementation. Subsequently the panel agreed with the DH that £1.2 million of the 2005/06 funding would be held back from the PCT allocation for national initiatives. But the deaf charities say PCTs have been spending their share of the money to pay off financial deficits and fund other, non-deaf services. The Department of Health then clawed back half the £1.2 million for 2005/06, leaving only £650,00 to fund half the planned projects.

‘We have no idea yet what is happening in 2006/07 but it has been indicated that probably the funding will again go out to PCTs, this time not even badged, just as part of their total funding and rather unidentifiable,’ says Jonathan Isaac.

‘The sad thing is that the money wasn’t ring-fenced,’ says Steve Powell, chief executive of Sign. ‘We argued strongly that such a small amount of money would get lost within the system. PCTs have got major deficits. To try to get them to give this any importance has been extremely hard work. Deaf people haven’t been able to put pressure on. If you can’t communicate, you can’t put pressure on. You can’t pick up the phone and speak to the PCT chief executive. Ring fencing the money would have given deaf people the tool to enforce it.’

There is little indication that the £3 million distributed so far to PCTs in 2004/05 and 2005/06 has been used to implement the Towards Equity and Access recommendations. In September last year the panel reviewed progress. It found that only in the north east region had PCTs done any work towards implementing a local needs assessment the first recommendation. Implementation of deaf awareness training for primary care and hospital staff - the second recommendation - was similarly patchy, and only a few PCTs had bought the SignHealth interpretation software - recommendation four. The recommendation that specialist CPNs should be appointed in areas with high populations of deaf people has produced one part-time worker in the Newcastle area, and ‘plans for one’ in Rotherham. Action on the other recommendations is similarly absent or patchy, Isaac says. Like Powell, he thinks the government should have set specific targets and deadlines. ‘There’s a disconnection between the report and implementation. There’s no compulsion, just a request to PCTs that it should happen.’ The government’s line is that the DH does not issue instructions to PCTs as to how to spend their funding. The charities argue that, because there won’t be very many deaf people with mental health problems in any one PCT catchment area, they are unlikely to be motivated to act on the guidance. They want to see PCTs group together regionally to develop services covering a wider area. Sign has seconded two officers to the Department of Health, one deaf, the other hearing, to work with PCTs and deaf communities to turn the Towards Equity and Access recommendations into action, but so far they have had little success. Powell is now also working fulltime on its implementation, having delegated his other chief executive responsibilities. Sign wants to establish a contact in every PCT, but Powell says that at times the work can be ‘soul destroying’: even when one person in a PCT is enthusiastic - often because they have a friend or family member who is deaf or hearing impaired – they find it hard to bring their colleagues on board. The implementation officers say local pressure is the only answer to this and, in partnership with local deaf organisations, aim to recruit a representative from the deaf community in every PCT.

Powell says deaf organisations have one major card up their sleeve: the implementation in December of a duty on public services to provide equality of opportunity to people with disabilities, meaning individuals with disabilities must have access to the same services as any other person. Sign is drafting a scheme for PCTs that will help them meet this duty. Last year it also published with the Mental Health Foundation a charter of rights for deaf people and a service providers guide for NHS and voluntary sector services, setting out the basic rights of deaf people when accessing mental health services and how services can meet their obligations to users.

There are other incentives for GPs, Powell argues. ‘By improving access for deaf people, you will get not only better health care, but cost savings. Missed appointments by deaf people cost £20 million a year.’ Many such improvements - better signage and using technology to inform and remind people of appointments and ensure they are understood - are not expensive and, Powell points out, will improve services for all patients, not just deaf people.

It can take up to two days to book a sign language interpreter, which is not much use to a deaf patient in need of an urgent health care appointment. A 2004 survey by the RNID found that less than 20% of GPs and hospital health professionals used an interpreting service. Instead, family members, often children, are used as informal interpreters and more that 20% of deaf people left meetings with their GP unsure of what was wrong with them. More than 10% said they avoided going to the doctor because of communication problems.

To overcome the need for quick access to interpreting services Sign has developed SignHealth, a computer programme with actors signing in British Sign Language (BSL) common questions that GPs might need to ask a deaf patient (see photo). The questions relate to a wide range of health conditions, including mental health, and there is a separate section for reception staff. The programme also provides translations in 12 spoken languages, widening its use beyond the deaf community. Sign wants PCTs to buy SignHealth for all GP practices in their area, but so far take up has been disappointing. Most interest has come from PCTs in London. It costs an individual GP practice just £100 a year. Steve Powell (while stressing that SignHealth is not a replacement for an interpreter) says the minimum cost for an interpreter is £50 a session, plus travel expenses, and Language Line, a comparable translation service for people who don’t speak English, costs £2.50 a minute. GPs can also gain points for improving access and get extra funding through the GP contract, he says.

Lewisham PCT in London has bought SignHealth for all its GP surgeries. Tony Shreeves, SignHealth co-ordinator at the PCT and responsible for promoting it to GPs, practice staff and health visitors, says everyone who has seen a demonstration has been enthusiastic. ‘You don’t need training, you just have to show its capabilities. From our perspective, it’s not just great for use with deaf people. Now they’ve included interpreting for other languages it cuts the cost of having an interpreter, which is very high.’

This study is a systematic literature review into suicide in the deaf community and is a collaborative project between the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (Inquiry) and SIGN (National Society for Mental Health and Deafness). It is based at the Centre for Suicide Prevention, Williamson Building, University of Manchester, Oxford Road, M13 9PL, and is funded by the Big Lottery.

Why is this study being carried out? Although there is a large literature citing the rates and risk factors for suicide, both in the general and mental health population, the literature on suicide in the Deaf Community is less comprehensive. A systematic review of the existing literature is required in the first instance, to identify methodologies for investigating suicide in this population, with the aim of informing future studies.

What are the aims of the study? The study will focus on three specific areas: To define and describe the characteristics of sub-groups within the deaf community in which suicide has been investigated (e.g. those with acquired deafness and those who are deaf from birth). To identify methodological approaches that have been used to investigate suicide in the deaf population (e.g. epidemiological, survey, autopsy). To identify limitations of previous studies.

What do the SIGN/Inquiry team need from you? We need your help in identifying literature that may not show up in academic database searches (e.g. unpublished report, studies, or other similar documents). We would be very grateful if you could notify us with any literature that you may be aware of that could help to inform this study.

Letter from Brian Gibbons, Minister for Health & Social Services, Welsh Assembly Government to the British Society for Mental Health and Deafness, 2 April 2007

“We met in May 2006 to discuss the report of the work of the Mental Health Services for Deaf People Reference Group. I understand that you have subsequently met several times with my officials, most recently on January 23 rd. I have now considered the recommendations contained in your report and would like to take this opportunity to first of all thank you for your endeavours and second, to endorse the responses officials have made.

The meeting in January between the Reference Group and the Assembly Government involved a wide range of officials working within health and social care, including GP services, Mental Health, Children’s Services, Equalities, Human Resources and Training and the BSL Futures Project. I hope this demonstrated the Assembly’s continued commitment to improving mental health services for deaf people in Wales, as well as how a range of policy teams are working together across the Assembly Government to ensure we develop a joined up approach.

As you will be aware, much work has already been undertaken and further work is planned to improve services and reduce the health inequalities currently experienced by Deaf people. Some of these initiatives include:

The Assembly funded BSL Futures Project in order to increase the pool of BSL interpreters in Wales. I understand that two trainees are developing skills in mental health which is to be applauded
The Assembly funded EquIP programme (which includes RNID representation) in order to improve Deaf awareness in primary care and improve access for disabled people in GP surgeries
The highlighting of the ‘Mental Health Services for Deaf People’ report to the Wales Mental Health in Primary Care Network, thereby recognising the role that GPs need to play in delivering improved health services for deaf people
The issue of the ‘Mental Health Services for Deaf People’ report to all LHBs and the RNID report ‘A Simple Cure: Hearing the Doctor’ to every GP surgery in Wales, thereby demonstrating Assembly support for both documents
‘Delivering in Sign Language: Advice for Public Services’ and Assembly consultation exercise on the delivery of a wide range of public services in BSL, thereby demonstrating commitment to improving access to a wide range of public services for Deaf people
With regard to staff training, a proposal to include Deaf awareness and mental health in the NHS training programme Knowledge and Skills Framework Core Dimension 6 – Equality and Diversity.

All of this action is combined with the requirement that statutory health and social care staff and contractors comply with the Disability Discrimination Act. Healthcare Inspectorate Wales and the Care and Social Services Inspectorate for Wales will ensure that the relevant bodies are compliant with the legislation, including the need to Equality Impact Assess all new policies.

Once again may I thank you and the Reference Group for your commitment, enthusiasm and hard work over the past three years, and I look forward to continued partnership working to deliver better services to all the people of Wales. I wish you well in your future work.”

[back to top]

Research - Experiences of mental health issues among BME communities in the UK

The research will serve three purposes:

1. Give a voice to groups who are often not heard. Existing research about 'BME' communities’ experiences of mental health often lacks the perspectives and voices of those who have mental health problems or those who care for them. This can mean that their suggestions for improvements/solutions are not taken into account in policy and practice. Our research will use narrative qualitative interviews which will record what people say in their own words.

2. Provide support. Our findings will be placed on the DIPEx website (www.dipex.org). This is a valuable resource where people can access 24 hour emotional and practical support. It addresses questions such as: Do other people feel like this? What help is out there for me? What did other people do in my situation? The website has 1.5 million hits monthly.

3. Feed into training for health professionals. The DIPEx website provides a sustainable resource for service users, front line staff, service providers and trainers. Our research is used extensively for training health and other professionals. For example, DIPEx clips from the sickle cell and thalassaemia are used to help train specialist counsellors and generalists who counsel women but have little experience in working with 'BME' communities.

Full ethics approval has been obtained from the multi centre research ethics committee. We will cover the travel, childcare and other caring expenses of those who wish to participate. We are in the early stages of the project, so you still have the opportunity to suggest areas for investigation. If you have someone in mind that you think would like to participate, a newsletter where you could put in a notice, or if you would like to meet up to discuss the project or DIPEx further, please contact either of us. Please find attached a leaflet aimed at potential participants. We have also produced a Participant Information Pack which includes all the material people need to decide whether they want to take part.

Jorun Rugkasa, Senior Research Fellow, School of Integrated Health, University of Westminster, 115 Cavendish Road, London, W1W 6UW. Tel: 020 7911 5000 ext. 3919 or mobile 07738 496 646. Fax: 7911 5028 J.Rugkasa@westminster.ac.uk

Krysia Canvin, Senior Researcher, DIPEx Research Group, Dept. of Primary Health Care, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF. Tel. 01865 226672 Fax 01865 227137 Krysia.canvin@dphpc.ox.ac.uk, www.dipex.org

DIPEx (database of personal experiences of health and illness) is a charity that produces a unique website (www.dipex.org ) with video and audio clips from interviews in which people describe their experiences of health and illness. At present, around 30 different modules explore personal experiences of issues such as depression, HIV, sickle cell and thalassaemia, epilepsy, and caring for someone with dementia. Unlike most web resources aimed at providing information and support, each DIPEx module is based on a stand-alone rigorous qualitative research project.

[back to top]

Book Review – ‘Part of the Group. Games that Increase Social Understanding’

Part of the Group is a superb book that I cannot recommend highly enough. It is inspired in its simplicity whilst being based on sound theoretical principles.

By using group games that are in themselves the reward for participation, poverty in the four areas of ‘Social Cognition’ (communication, person conceptualization, social problem solving and perspective taking) is addressed. Although devised and written for those who work with deaf people who have additional needs I think this book would be of great benefit to those working with non deaf clients too. It can be applied to clients across the whole life span and a wide ability range.

The very existence of this book will be a relief to clinicians, teachers, vocational specialists and many others who have felt frustrated by their inability to help clients’ move on from such difficulties.

This book is extremely easy to read and use. Each of the four areas of social cognition is briefly explained and then between four and eleven games of increasing sophistication is provided in each area. Each game is described in terms of its goal, materials required, variations that can be used, issues that may need troubleshooting and issues for group discussion. Common problems are also pre-empted and solutions suggested.

As a clinician I was reminded me that I can have fun and encourage my clients to have fun whilst still doing some very useful work. For me a good measure of a book is when I find myself thinking ‘Oh I knew that already’ when in fact I was never previously doing what they suggest and wouldn’t have done so without this book to guide me. Part of the Group is novel but feels like common sense and as such, I think, has hit the nail on the head.

This is one of very few books that I can think of that addresses the needs of the highly trained clinician or clinical manager ie to be reassured that the intervention has a robust theoretical basis and at the same time to the needs of the ‘coal face’ worker (clinician, teacher, counsellor, nursery worker etc) ie to be able, without prior experience, to pick up the book, follow the instructions and successfully complete a useful intervention.

I will definitely be recommending this book to my colleagues in Great Britain.

[back to top]