The coronavirus pandemic has been the cause of widespread psychological problems because of the lockdown, amid growing stresses over isolation, job security, relationship breakdown and bereavement. In fact, it has been said that if the economic impact is similar to that of the post 2008 recession, we could expect 500,000 additional people experiencing mental health problems, with depression being the most common
These figures are a stark warning that we are likely to face a mental health crisis following the pandemic, and the situation could be even more serious for the Deaf community, who are more likely to suffer from mental health problems than the hearing population. It is important that we understand the barriers facing Deaf patients in access to mental health services and do all that is needed to address them now before it is too late.
Mental health and the Deaf community
The first research of its kind in 1994 found that 40 per cent of the Deaf or hard of hearing population were affected by mental health issues, compared with 25% of the hearing population, and Deaf people, in particular Sign Language users, have an increased vulnerability to mental health problems compared with the general population.
Added to this, Deaf people find it difficult to access healthcare, and research has shown that they have more adverse experiences and negative outcomes within mental health care compared to the hearing population. They face communication barriers and, as a result, their mental and physical health can suffer.
The problem with current care
Deaf people in general are a hard-to-reach group as they are geographically dispersed and live in low numbers per area. As such, mainstream mental health services are often unaware of the Deaf population in their locality. The specific challenges faced by Deaf people also create different needs in relation to mental health and treatment compared to the hearing population and, therefore, many mental health workers lack an understanding of how to meet their needs.
Deaf people are excluded from many forms of mental health primary care, and GPs simply do not provide the same direct support that they provide to hearing patients who are experiencing mental health problems.
Deaf people risk being marginalised by society unless steps are taken to educate mental health service providers on their needs. Failure to do so could even risk Deaf patients being misdiagnosed – something that is worryingly common in the current state of play.
Access to services is a right
In line with the Equality Act 2010, everyone who uses mental health services should have equitable access to effective interventions, and equitable experiences and outcomes. Under Section 20, Clinical Commissioning Groups [CCGs] are required to make “reasonable adjustments” so disabled people [including Deaf patients] are not placed at a substantial disadvantage compared with non-disabled people. It stipulates that service providers are expected to anticipate the requirements of disabled people, and the reasonable adjustments that are needed before any disabled person attempts to access the service in question. It is not acceptable for health services not to be equipped to provide communication support for those who need it.
Improving mental health provisions
Mental health service providers need to be able to provide effective care that matches the Deaf community’s complex language profile and cultural linguistic identity. They must be Deaf aware, Deaf friendly and accessible, and professionals need to be educated about Deaf culture, identity, language, values and beliefs.
Just like everyone, Deaf people are unique and have their own individual communication needs and preferences and, therefore, practitioners must give patients an initial assessment to determine their choice of tailored care. They must respect their communication preferences, whether this be Sign Language interpretation or other types of communication support, and ensure respect and dignity.
Psychological measures should be adapted to provide an accurate reading of a Deaf patient’s wellbeing and, in addition to providing accessible information and communication, preventative measures must be put in place, for example introducing self-help techniques in BSL for low mood, as well as self referral to mental health services that are accessible to Deaf patients through email and SMS [not just by telephone].
BSL video interpreters
Practitioners should also give Deaf patients the option to use a BSL interpreter. This can be set up via video if an appointment is taking place during lockdown when face-to-face appointments are limited. Some patients may even prefer to get the counselling or treatment they need using this method, as it allows them to join the session from the comfort of their home in more familiar and relaxing surroundings. In most cases, video interpretation services can be provided and funded by the NHS Trust or CCG.
Where an interpreter is required, care providers must ensure they are of a high standard and that any video consultations are conducted using an appropriate and secure platform. For example, the InterpretersLive! service, powered by Starleaf, delivers real-time access to qualified and registered British Sign Language [BSL] interpreters using a secure encrypted and ISO27001 accredited, HD quality video platform.
The Starleaf platform has millions of users worldwide and is already familiar to the Deaf community in the UK, who use it to contact a range of organisations free of charge in their first or preferred language of BSL.
Whilst many Deaf people have come to accept poor healthcare provisions as their ‘norm’ it is not excusable, and more work needs to be done. By learning about the unique requirements of Deaf patients and the best way to communicate and fulfil their needs, mental health practitioners can ensure they provide a high quality of care that is effective and inclusive for all.
Clare Vale is managing director of Sign Solutions