Transcript Slide 1

Providing a World Class Psychological
Therapy Service for Deaf BSL Users
Hazel Flynn – Clinical Management Lead
Celia Hulme – KTP Associate UCLan/SignHealth
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
Presentation Aims
• Mental Health and Deafness
• Consider cultural & linguistic needs of Deaf community
• Recovery/Outcomes
• Summary
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
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
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)
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
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)
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
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
What we offer
CBT/CfD
• Depression
– Childhood difficulties
– Power dynamics
– Abuse
• Anxiety
–Limited life skills
–Limited information
ABC formulation
• Patient’s language/their
words/their understanding
• Enabling exploration of
– Thoughts
– Feelings
– Behaviour
• Frequently recapping
sustaining positive change
Accessible website and selfefficacy
Evaluation Report
National IAPT
BSL IAPT
44%
76%
Within 28 days
64%
61%
After 28 days
36%
39%
Declined treatment
22%
15%
Drop-outs
25%
16%
Not suitable/referred on/signposted
7%
7%
-
18%
8%
9%
Recovery
Waiting Time to treatment
Stepped up
Referred on after treatment
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)
Cost Comparison
BSL IAPT
Mainstream IAPT
via Interpreter
PWP – 1 episode of care
PWP – 1 episode of care
Assessment + 8 sessions
Assessment +8 + Interpreter
£180 x 9
£255 x 9
Total: £1620
Total: £2295
(N.B. does not include
interpreter mileage/supervision
cost)
Access to Tertiary
Services
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
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
Questions?
Contact
[email protected]
[email protected]
Tel:
01494 687606
Mob: 07966 976 747
Email: [email protected]
www.bslhealthyminds.org.uk
–
@bslhealthyminds
• Referrals:
– Sign language user
– Aged over 16 years
• Self referral
• GP referral
• Professional referral
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/sickof-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