1. SignHealth is committed to bringing better healthcare and equality of service provision to deaf people in the UK To achieve our goals we will need to work in partnership with deaf people and deaf organisations, with health charities and other charities Providing a World Class Psychological Therapy Service for Deaf BSL Users Hazel Flynn – Clinical Management Lead Celia Hulme – KTP Associate UCLan/SignHealth

2. Presentation Aims Mental Health and Deafness Consider cultural & linguistic needs of Deaf community Recovery/Outcomes Summary

3. Mental Health & Deafness 107,000 Deaf BSL users (IPSOS MORI GP Survey 2010) Most Deaf mental health services are at secondary/tertiary level providing Step 4/5 care Only ONE primary care available for sign language users Deaf people experience same mental health problems as general population Unequal access to mainstream services due to Lack of access Communication barriers Cultural awareness

4. Issues for Mainstream Service Dispersed community Cultural issues Communication Language Access Lack of Deaf/BSL awareness Lack of engagement – stigma/fear English as a second language or limited understanding

5. Sick of It 5 year study from University of Bristol & SignHealth Under diagnosis and under treatment of conditions are more common in Deaf people Risk of preventable heart attacks and strokes, diabetes leading to complications such as kidney failure and blindness Deaf people twice as likely to suffer depression (24% D v 12% H)

6. Case Study - Laura Background – physically abused by father, gang raped (15yrs), DV ex husband, DV ex boyfriend, difficult relationship with mother Therapies: 3 episodes of treatment attempted before referred to BSLHM – in refuge 2 sessions with hearing counsellor – therapy following crisis – self harming so severe had hospital admission – 10 sessions in a mainstream IAPT service – Assessment with BSLHM – treatment offered

7. Considerations Conventional, treatment involving written English is unsuitable for deaf people (William & Austen, 2000) Deaf clinical service population – reading levels are generally lower than hearing counterparts (Glickman & Gulati, 2003) Pretending to understand written materials (Harper & Connell, 2007) Cognitive impairment common (Vernon & Andrews, 1990) Average reading age of deaf school leaver - 8.7 years old (Conrad, 1978)

8. Case Study - Laura Background – physically abused by father, gang raped (15yrs), DV ex husband, DV ex boyfriend, difficult relationship with mother Therapies: 3 episodes of treatment attempted before referred to BSLHM – in refuge 2 sessions with hearing counsellor – therapy following crisis – self harming so severe had hospital admission – 10 sessions in a mainstream IAPT service – Assessment with BSLHM – treatment offered

9. BSL Healthy Minds First psychological therapy primary care service for BSL users in England Step 2 & Step 3 interventions Culturally Deaf aware therapists CCMS & CS provided by appropriately qualified & BSL fluent practitioners Open referral system Outcome measures (GAD7, PHQ9, WSAS) – translated into BSL Northumberland Guided Self Help materials – translated into BSL No BSL Interpreters Most therapy sessions in GP surgeries Delivered by a Deaf organisation

10. What we offer CBT/CfD Depression –Childhood difficulties –Power dynamics –Abuse Anxiety –Limited life skills –Limited information

11. ABC formulation Patient’s language/their words/their understanding Enabling exploration of –Thoughts –Feelings –Behaviour Frequently recapping sustaining positive change

12. Accessible website and self- efficacy

13. Evaluation Report National IAPTBSL IAPT Recovery44%76% Waiting Time to treatment Within 28 days64%61% After 28 days36%39% Declined treatment22%15% Drop-outs25%16% Not suitable/referred on/signposted7% Stepped up-18% Referred on after treatment8%9%

14. Evaluation Report Excellent recovery rates Low drop outs 61% access the service within 28 days High patient satisfaction (87%) Highlighted the importance of Deaf BSL therapists (North West BSL Healthy Minds Evaluation Report, 2014)

15. Cost Comparison BSL IAPTMainstream IAPT via Interpreter Access to Tertiary Services PWP – 1 episode of care Assessment + 8 sessions £180 x 9 Total: £1620 PWP – 1 episode of care Assessment +8 + Interpreter £255 x 9 Total: £2295 (N.B. does not include interpreter mileage/supervision cost) In the event that a client is not seen at the appropriate level at primary care, access to specialist tertiary services is at a cost of £550/day

16. Summary Only psychological therapy service in BSL in the country 107,000 BSL users in England – small number but can result in costly treatment because of numerous referrals into mainstream Deaf people twice as likely to experience depression Cultural and linguistic needs must be considered if therapy is to be successful Clinical and cost effective – 1 professional in the room

17. Questions?

18. Contact hflynn@signhealth.org.uk chulme@signhealth.org.uk Tel: 01494 687606 Mob: 07966 976 747 Email: info@bslhealthyminds.org.uk www.bslhealthyminds.org.uk – @bslhealthyminds Referrals: –Sign language user –Aged over 16 years Self referral GP referral Professional referral

19. References Conrad, R. (1979) The Deaf School Child. London: Harper & Row Glickman & Gulati (2003) Mental Health Care of Deaf People: A culturally affirmative approach. Mahwah, NJ; Lawrence Erlbaum Associate. Harper, A. & Connell, M. (2007) The role of deaf staff and interpreters in preventing challenging behaviour. In S. Austen & D. Jeffery (eds) Deafness and Challenging Behaviour: A 360 o Perspective, Chichester, John Wiley & Sons, Ltd pp 208-222 Hulme, C, KTP Associate (2014) North West BSL Healthy Minds Evaluation Report SignHealth. (2014 ). Sick of It. Available: http://www.signhealth.org.uk/health-information/sick- of-it-report/sick-of-it-in-english/ Vernon & Andrews (1990) The Psychology of Deafness: NY; Longman Publishers Williams, C. & Austen, S. (2000) Deafness and intellectual impairment: Double jeopardy? In P. Hindley & N. Kitson (eds) Mental Health and Deafness. London: Whurr Publishers