Transcript Dumb & Dumber: Hearing Services for Deaf People

Dumb & Dumber:
Hearing Services for
Deaf People
Sue O’Rourke.
Consultant Clinical Psychologist
Mayflower Hospitals, Bury
‘You have to be deaf to
understand……….’
Deafness
 1:1000,
 deaf,
HoH, deafened, hearing impaired,
Deaf
 50-70 000 BSL users
 Deaf people as a cultural and linguistic
minority : BSL, Deaf clubs, cultural norms,
shared experiences, Deaf humour, Deaf
Olympics, etc etc
 BSL as a recognised minority language
Deafness and Development
 90%
Deaf children have hearing parents
 Problems around diagnosis and
professional advice
 Oralism vs Total Communication
 Choices in education: mainstreaming/ deaf
units/ deaf schools
Underachievement ………
 Failure
of the education system for Deaf
children
 Lack of access to higher education
 Lack of access to professional training
 Training in a second language/problems
with written English
…………And successes
 Deaf
people in higher education
 Professional training
 Greater access eg via BSL interpreters
and notetakers
 Social workers and OT’s
 Salford University RMN training for Deaf
and hearing
 Clinical psychology training
Deafness and Mental Health

Few epidemiological studies
 Higher rates of behavioural problems than in hearing
children (Hindley 1997)
 Early descriptions eg (Denmark 1985) suggest not
higher rates of serious MI but methodological problems
 Now suggestions of higher prevalence of psychotic
disorders in deaf, possibly subgroups eg rubella
deafened
 More ‘ problems with life’ as a result of lack of
experience, poor coping skills - relating back to
developmental experiences
Deafness and Forensic Mental
Health
 Lack
of research
 Young et al (2001) looked at all Deaf
referrals since 1968
 High % referred for assessment had no
mental disorder
 High % referred for ‘fitness to plead’
assessment
 High % sexual offences
Issues for Specialist forensic
services for Deaf people
 Lack
of evidence base
 ?base rates of offending
 Issues in risk assessment
 Inability to use most psychometrics
 Adaptations of treatment packages
 Where to discharge to?
 Prisons!
Models of care
 Integration
 ‘Bolt
on’ support
 Specialist
services
‘Integration’
Placing a Deaf person in a service
designed for hearing people with little or
no additional support and no specialist
expertise.
‘we manage’
‘He understands when he wants to’
‘we write it down’
‘Bolt on’
The addition of support services such as an
interpreter to a service designed for hearing
people
 Problems securing funds for interpreter and to
teach staff deaf awareness and BSL
 How to assess when the interpreter is not there?
 Peer group?
 Access to treatment and therapy?
Specialist services
A service designed to be culturally and
linguistically appropriate for Deaf people.
 All staff Deaf awareness & BSL trained
 BSL as main language of the environment
including assessment and treatment
 Knowledge about cultural norms
 Development of treatments from a ‘Deaf
perspective’
 Employment of Deaf staff
Specialist services
 John
Denmark Unit, Prestwich Hospital,
Manchester
 ‘Old Church’ National Deaf Services,
London
 Denmark House, Queen Elizabeths
Psychiatric Hospital, Birmingham
 Rampton Hospital
 Mayflower Hospitals, Bury
Prisons
 How
many Deaf prisoners?
 ? 70-100 estimated at any one time
 Additional mental health problems? – how
are they assessed?
 No specialist services
 No strategic development
 No access to programmes
 Particular difficulties for ‘lifers’
Prison Inreach Project
 Rampton
and Mayflower Hospitals
 Assessment of all Deaf prisoners
 Rates of mental disorder
 Need for referral to mental health services
 Needs within the prison
 NSF, DDA and ‘Sign of the Times’
‘You have to be Deaf to
understand……….’