Improving Access to Psychological Therapies

BSMHD and NHS North West are delighted to announce a two year project starting from 1st April 2010 that aims to enable all Primary Care Trusts throughout England to provide a psychological therapy service that is culturally and linguistically accessible in sign language, through the employment and training of a new workforce of Psychological Wellbeing Practitioners (PWP) and High Intensity (HI) Therapists. The development work is focused on ensuring that deaf people will be a major part of this new workforce. The project, which will be jointly managed by NHS North West and BSMHD, will:

• work with the Startegic Health Authority IAPT leads to create consortia of SHAs across England using a hub model and work with each regional hub to produce detailed service specifications and potential delivery model/s including identifying an IAPT site to be the lead PCT for the hub
• develop, with existing IAPT training providers, PWP training courses to be delivered in BSL designed to be accessible to all Deaf PWP trainees from across England
• support the training provider to deliver the PWP training to ensure it is appropriate for Deaf trainees
• develop and deliver a High Intensity ‘top-up’ course, delivered in BSL, for the existing workforce of qualified, and soon to be qualified, Psychological Therapists able to work in Sign Language
• develop and deliver a Supervision course, delivered in BSL
• develop, with existing IAPT training providers, High Intensity courses to be delivered in BSL designed to be accessible to all Deaf High Intensity trainees from across England
• support the training provider to deliver the High Intensity training to ensure it is appropriate for Deaf trainees
• develop a support infrastructure for this specialist workforce, including Supervision, peer support and continuing professional development
  arrange for the translation of appropriate Assessment Tools into BSL including GAD7, PHQ9 and Core
• produce IAPT Information in BSL on DVD and the internet

For further details visit the project website at www.deafiapt.org.uk

BSMHD has been advising the Department of Health Improving Access to Psychological Therapies Programme to ensure that services are accessible to deaf people. BSMHD has been represented on the IAPT BME SIG and welcomes the inclusion of specific advice to PCTs on the needs of culturally deaf people in the recently published Commissioning IAPT for the Whole Community Best Practice Guidance (Department of Health November 2008).

Further details at www.iapt.nhs.uk

For deaf people the risk is that, as a low incidence group, their needs will not have sufficient prominence in a local needs assessment to ensure that some of this very welcome investment is used to develop services appropriate for the deaf community. BSMHD are very pleased that the IAPT team at the Department of Health have included specific guidance to PCTs requiring them to invest in Psychological Therapy Services for deaf people.

Extract from IAPT BME Positive Practice Guidance:

1.4 People who are born deaf and communicate mainly in sign language see themselves as part of a distinct community with a common language and cultural heritage. Many users of sign language will view English, including written English, as, at best, a second language. Estimates suggest a prevalence of mental health problems of 40% in deaf children compared to 25% in their hearing counterparts.4 In deaf adults, a number of studies from different countries have indicated a significantly higher level of mental ill health.(Source: National Institute for Mental Health in England (2005) Mental Health and Deafness: Towards Equity and Access, London, Department of Health)

Extracts from the recently published Commissioning IAPT for the Whole Community Best Practice Guidance:

4.8 Non-English speaking people (including those who use British Sign Language as a first language) may not be able to communicate their needs effectively if an IAPT service lacks appropriate language skills, which could mean that proper and correct assessments may not be made.

5.9 Commissioners should, if possible, develop links with service providers with specialist cultural and linguistic knowledge.

5.10 Language-appropriate services that enable the correct assessment of individuals in a supportive environment are essential to engage non-English speaking groups.

6.1 It is an important principle that the IAPT workforce should reflect and be representative of the local community. The capacity and capability of therapists must be appropriate for the people they will be seeing.

6.2 Commissioners should understand their local population and demographic profile in order to commission an IAPT service with the appropriate number, skill mix and make-up of therapists.

6.14 All therapists should also be familiar with the wider healthcare community and be able to make referrals to other specialist services as and when required. Good links to other services in the locality will also increase referrals into the IAPT service. Therapists must have good knowledge of other care pathways so that their patients each receive a holistic care package.

6.16 Commissioners should be satisfied that service providers are taking steps to ensure that the therapy workforce is culturally aware and sensitive to the specific needs of individuals from different cultures and backgrounds, and to the needs of those with different religions and beliefs. They should ensure that all therapists have the skills and capabilities to work with such cultural diversity. Therapists should also be aware that, in some cases, engagement may only be possible through a referral to another therapist who is of the same background, culture or faith as the patient.

6.17 Some individuals wanting to access an IAPT service will not have English as a first language (e.g. those who use sign language, or those who do not understand or speak English). Commissioners will want to ensure that these language barriers can be overcome so that therapists can provide an effective and appropriate service. This is particularly important for the provision of written materials for self-help and computerised CBT that will be made available through low-intensity interventions. As a last resort, a translator may be required and commissioners may want to ensure that training is provided on working with translators so that a therapeutic relationship can be maintained and quality of care is not lost.

6.18 It is not normally acceptable for family members to fulfil a translator’s role in psychological therapies.

6.19 Recruiting low- and high-intensity therapists from minority groups should be encouraged. Specialist training for therapists (e.g. British Sign Language courses) should also be considered and funded. This may need to be led by a single PCT with a strategic health authority training commissioner.

Download a pdf of the full document here: Commissioning IAPT for the Whole Community Best Practice Guidance

IAPT for Deaf People Conference Proceedings - 26 March 2009

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