Deaf Service Model

Deaf people who communicate through the use of British Sign Language (BSL) as their only or preferred means of communication are recognised as a cultural and linguistic minority group. They have a shared language, experiences, norms and cultural values as individuals and as part of a wider group; The Deaf Community.

The Department of Health guidance 'Towards Equity and Access' (2005) acknowledges the fact that Deaf people with mental health problems have not received accessible and appropriate assessment and treatment at all levels of service delivery and are over represented in secure mental health settings.

In addition, the TEA report recognises the role of Deaf staff in supporting service developments and recommends services "actively strive to increase the numbers of Deaf employees at all levels".

Since the development of the National Service Framework for Mental Health in 1999 the government has called for responsive services which see service users in the full context of their lives, as people in society with a greater emphasis upon their social needs. Involving service users and carers in treatment and service development is no longer an optional extra.

One of the basic requirements of service users within any care setting is the right to have their needs met according to a common standard taking full account of their ethnic or cultural needs.

Within specialist mental health services for Deaf people this has not previously been possible. Existing services have developed following a non-deaf model; few Deaf staff and non-deaf staff with low levels of competence in BSL, failing to match the cultural needs of the service users.

Although developments now provide medium secure care for Deaf forensic patients, there still exists a gap in service provision as regards people moving out into open and community settings.

"A culturally competent mental health service will be prepared to adapt the conventional ways of working to meet the needs of culturally diverse groups of people" (NIMHE 2004)

The challenge for St. George will be to provide a service which, whilst meeting the holistic therapeutic needs of the service users effectively, also manages legal, risk and public safety issues.

For a substantial group of Deaf service users change may not be possible, due to Cognitive Impairment. These individuals, and their carers and commissioners need to make a conceptual shift away from expecting change and towards services and staff attitudes changing to accommodate and compensate for difficulties in order that the person can experience success. This often necessitates a creative and non-traditional model of service provision. We propose that a social rehabilitative model, using a Cognitive Rehabilitation model to compensate for impairment, acknowledging individual's strengths, limitations and needs, is more appropriate for delivering a service which makes sense to the person themselves.

Guiding principle

In accordance with legislation and guidelines the guiding principles of St George Healthcare Group provisions for Deaf patients are as follows:

To provide a first language BSL service which enables full access to assessment and treatment in the first or preferred language of the individual, values the language and culture of service users and thus enhances self esteem and self efficacy
To provide a therapeutic milieu in which staff are trained to interact in a therapeutic manner with service users and consider their role, values and attitudes as crucial creating an environment conducive to therapeutic change.
To involve the Deaf community and service users in the planning and development of the service, via the BDA reference group
To enhance the quality of life of service users by means of the social rehabilitation model, allowing socially valued experiences and community integration as far as is possible without compromising the overriding need to manage risk.
To value Deaf service users with cognitive impairment, either due to the etiology of deafness or acquired brain injury, according to the principles laid out in the DH document 'Valuing People'

The Care Programme Approach

Throughout the care pathway service users will have access to the CPA process. This will be ensured using a variety of means. Care plans will be signed onto DVD, reports by professionals will be discussed with the person prior to the CPA. Since the CPA is a review of progress in relation to specific targets outlined in care plans, the individual concerned will be aware of the content of the meeting. Access to the meeting may be via staff with a high level of BSL skill or via and interpreter. Issues which are not related to the care plan such as funding concerns can be discussed at a separate professionals meeting prior to the CPA.

The Therapeutic Community

At St George Healthcare Group we believe that 'therapy' is something that should happen 24 hours a day. Staff attitudes and values are crucial in helping people change and develop to their maximum potential. Conversely, if staff attitudes and values are unhelpful, Deaf patients can be retraumatised by the experience of being in hospital or residential care and this can adversely affect their mental health and behaviour.

In order to put this into practice, at St George:

There will be a high percentage of Deaf staff.
All staff will be trained or receive training in mental health and deafness
All hearing staff will receive Deaf Awareness training, regular assessment of their communication skills and needs and ongoing BSL training.
The first language of the service is BSL. This means staffs are expected to sign at all times to the best of their ability.
Staff will all be trained in anti-discriminatory practice and working in accordance with therapeutic community principles.
All staff will be expected to interact with patients in a therapeutic manner and will receive feedback and supervision in order to ensure this.

At St George we recognise the importance of the community as an agent of change. Therefore,

There will be a daily community meeting with all staff and patients to discuss the working of the community, enhance problem solving and encourage open discussion about the effects of individual's behaviour on others.
Service users will be encouraged to be involved in decisions about the running of the community.
Service users will be encouraged and supported to take responsibility for aspects of community life

Individual and Group Therapy

At St George Healthcare Group service users will have access to a range of individual and group therapy in BSL, according to individual need. A range of packages are being developed which can be used by staff, with training and supervision. Groups to acquire basic skills, for example:

Thinking skills
Social skills
Understanding relationships
Learning how to relax
Understanding your own mental health

Groups to discuss how to manage emotional distress:

Coping with anger
Coping with stress

Groups aimed at reducing offending behaviour:

Substance misuse (drugs and alcohol)
Sex offender work
Violent offender work

Not everyone can cope with being in a group, so all of these interventions are available as individual as well as group therapy. Individual therapy will be available for a range of difficulties, such as:

Anxiety disorders
Depression
Childhood trauma and abuse
Coping with the symptoms of mental illness

Staffing

There is an operational policy for the nursing department, social work department and a strategy for the development of the Clinical Psychology service. The therapies department includes OT's, CNS and other therapists. A timetable for recruitment of staff included Induction. There is considerable interest from Deaf staff and hearing staff with skills in BSL. From the point of advertising it will be made clear that this is a first language BSL service and that staff be expected to:

Use BSL at all times.
Engage in training in relation to therapeutic approaches and receive supervision in this

Liaison with outside agencies

In developing the Deaf service, initially in relation to Deaf people with cognitive impairment, it is important to consult with key stakeholders in order to inform development according to need. These include:

NHS providers of Deaf services
Commissioners of services
Local authorities
High secure services
The voluntary sector providing services for Deaf people (e.g. SIGN and RNID)
BSMHD
Local Authorities