Mental Health Services: Sign Language Users

Lord Ponsonby of Shulbrede Excerpts

Monday 2nd February 2015 Lords Chamber

Asked by

[Lord Ponsonby of Shulbrede]

To ask Her Majesty’s Government what assessment they have made of mental health services for deaf people using British sign language.

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, the current provision of mental health services for British Sign Language-using deaf people is poor and it is likely to get worse if the Government do not wake up to the problems which will be caused by the move towards using co-commissioning groups for specialised services within the NHS.

Last March, I held a similar debate on the physical health of deaf people. This debate is about mental health services for BSL-using deaf people. It draws on similar research, namely that 40% of deaf people are likely to experience mental health problems in their lifetime, compared to 25% of the hearing population. Indeed, recent research by the Sick Of It campaign suggests that the figure for deaf people could be much higher than 40%.

What makes deaf mental health different? The incidence of schizophrenia among the deaf population is about the same as for the hearing population, but for more common mental health problems such as depression and anxiety the incidence is much higher. This is believed to be due to a variety of factors but particularly to social isolation and also difficulty communicating with parents when deaf people are growing up. I find it interesting that deaf people who have deaf parents are less likely to experience mental health problems.

A deaf person with a broken leg should be able to receive good care at their local hospital, provided a BSL interpreter is used. However, for mental health provision a deaf or signing clinician is needed. A therapeutic relationship needs to be established one-on-one and not via a third party. A specialised therapist would be in a much better position to spot visual clues that are relevant to diagnosis and treatment—for example, pressured signing and alternative signs, where some signs have a double meaning.

Unfortunately, access to specialised support is not available in most parts of the country. This leads to a second-rate and sometimes dangerous service. The current tiers of service within the United Kingdom are as follows: for in-patient services there are currently three units, in Manchester, Birmingham and London, as well as secure private units. This means for most deaf patients that their nearest in-patient unit is a considerable distance away.

Community provision is supposed to be commissioned by NHS England, but in practice there is a postcode lottery. Deaf people in most parts of the country have no access to a specialised community service. The result is that deaf people are dependent on assessment and treatment from non-signing hearing professionals. This frequently leads to misdiagnosis, which can in turn exacerbate the initial problem. The lack of community teams also means that, when deaf people are in-patients, they often have to stay longer than necessary in hospital as discharge is difficult because of the lack of community support.

For psychological therapies, the national Improving Access to Psychological Therapies, or IAPT, programme worked with strategic health authorities and primary care trusts to train deaf IAPT therapists. These therapists were employed by the charity SignHealth and commissioned by PCTs to provide a regional and/or local service. However, since the transfer of commissioning, these contracts have started to come to an end as co-commissioning groups have not been renewing the contracts. As I speak, the BSL IAPT service in Bristol, B&NES, South Gloucestershire, Swindon and Wiltshire has announced that it will close at the end of March. It seems that the CCGs are going back to commissioning IAPT services individually. As a result, there is no mechanism for them to join together again to commission a BSL service as part of IAPT.

In this situation, deaf people are usually told by their IAPT provider that they can book an interpreter if needed. This is a retrograde step, akin to offering an English speaker therapy with a foreign-speaking therapist, with an interpreter if needed. While the BSL component may be a minor issue for commissioners and providers, it is a huge issue for deaf people. Most will now go back to suffering in silence. This step backwards also means that deaf people can no longer self-refer to IAPT services and must go through their GP, who in practice is often a barrier to accessing the service. It is interesting and revealing that SignHealth’s IAPT service had a recovery rate of 76% compared to the 44% achieved by hearing mainstream IAPT services. Adding an interpreter to a therapeutic dynamic lessens the chance of a good therapeutic relationship and adds to the cost.

I understand there has been a meeting between SignHealth and the Minister, Norman Lamb, in recent weeks. It is not yet clear whether a solution to this problem can be found by the Department of Health or NHS England. The important thing—and the purpose of this debate—is for deaf people to have access to a BSL service wherever they live in the country.

I also mention the pilot service dealing with dementia in deaf people. The Deafness Cognition and Language Research Centre works in partnership with the National Hospital for Neurology. This service is threatened with closure as it appears it does not fit in the commissioning structure we currently have. This is another example of services being so specialised and niche that co-commissioning groups, even clustered ones, have too few patients to make it viable. The problem is that the number of patients in each co-commissioning group is too small to commission effectively and there is no mechanism for the groups to co-operate nationally. There has never been national success in commissioning deaf mental health services at a local or regional level. Deaf mental health services have always been considered a low priority, no doubt because deaf people are a largely silent minority. Co-commissioning would be a backwards step from where we are now, which is bad enough. If anything, psychological therapies need to move up to a national approach, with responsibility remaining local. Moving specialised services down would leave them in the same poor position as deaf IAPT services.

I gave the Minister notice of a couple of questions. First, what progress is there with moves to commission a BSL IAPT service? Secondly, would the Minister commit to addressing the problem I have outlined with BSL community and secondary services available to all BSL-using deaf people? It has been suggested that a working party be set up as appropriate to address the issues I have raised today.

Every BSL-using deaf person deserves a care pathway. Currently, the pathway is broken and getting worse, and this would not be acceptable for any hearing person in the United Kingdom. There is wide acceptance among experts as to what is needed. I hope the Minister will use this opportunity to set out the Government’s plans for addressing the mental health needs of BSL-using deaf people. I beg to move.