Dumb

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Dumb Dumber Hearing Services for Deaf People

• Sue ORourke.
• Consultant Clinical Psychologist
• Mayflower Hospitals, Bury

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You have to be deaf to understand.
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Deafness

• 11000,
• deaf, HoH, deafened, hearing impaired, Deaf
• 50-70 000 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

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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

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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

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And successes

• Deaf people in higher education
• Professional training
• Greater access eg via BSL interpreters and
  notetakers
• Social workers and OTs
• Salford University RMN training for Deaf and
  hearing
• Clinical psychology training

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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

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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

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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!

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Models of care

• Integration
• Bolt on support
• Specialist services

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Integration

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

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Bolt on

• 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?

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Specialist services

• 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

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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

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Prisons

• How many Deaf prisoners?
• ? 70-100 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

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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

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You have to be Deaf to understand.