Hazel Flynn – Clinical Management Lead Celia Hulme – KTP Associate UCLan/SignHealth

1. Hazel Flynn – Clinical Management LeadCelia Hulme – KTP Associate UCLan/SignHealth Providing a World Class Psychological Therapy Service for Deaf BSL Users 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

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

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

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. 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 Contact

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 360o 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