Response NHS Review of BSL Commissioning Arrangements
Recommendations acknowledge ineffective communication for deaf British Sign Language (BSL) users in health settings across England.
Report: Shaping the future of deaf mental health
We know there are unfair and avoidable differences between the mental health services available to deaf and hearing people. This doesn’t need to be the case.
Firstly, there are not enough mental health related self-help resources available in British Sign Language (BSL).
The specialist mental health services provided by NHS for deaf people, across all ages are not consistent in England. We have seen cases where deaf people are placed in inappropriate settings due to a lack of suitable specialist services.
We are aware that many deaf people face difficulties in accessing existing mainstream services. Clinicians do not understand the deaf experience and deaf culture, in many cases BSL interpreters or other communication professionals are not booked, or clinicians do not know how to work with BSL interpreters or other communication professionals.
At an event on Monday 3 July 2023, our colleagues at SignHealth and Dr Sophie Roberts, Clinical Lead for Deaf Mental Health presented the co-produced report with our recommendations about what needs to happen for there to be true equality to NHS England and other key professionals. Our report outlines the stark inequalities and gaps in mental health provision for deaf people in England. It was created with input from deaf service users, the wider Deaf community, families and carers and staff who work within the services. We are optimistic that NHS England will take action on these recommendations. We will continue to work closely with NHS England to improve the quality of mental health services for all deaf people.
SignHealth has shared a copy of these letters below for the purposes of transparency.
Key findings
- There are unfair and avoidable differences between the mental health services available to deaf and hearing people. Deaf people do not receive equitable healthcare.
- Mental health related self-help resources are not readily available in British Sign Language (BSL).
- There is a lack of consistent, accessible early intervention services for deaf people, across all ages.
- There is a lack of consistent and universally available community specialist provision for deaf adults across England and not enough deaf specialists.
- Deaf people are unable to access community mental health teams, resulting in:
- many deaf people remaining in secure provision or inpatient care without ability for discharge,
- high attrition rates with deaf people not attending appointments, or dropping out of the support system due to barrier fatigue,
- referrals to higher tier support at a later stage after symptoms have escalated due to not receiving support needed earlier.
- There are inconsistent and disjointed referral pathways with gaps in planning across deaf services for people who use BSL and those who have language deprivation / delays.
- Poor deaf awareness and cultural competency is evident across the NHS resulting in incorrect referrals and misdiagnoses among deaf patients.
- The communication needs of people who are deaf are being neglected.
Recommendations
- A strategic/policy lead in NHS England with responsibility for deaf mental health
- Given the clear case around the need for change, for the Clinical Reference Group to be redesignated as a Lead and Inform CRG.
- For colleagues within Public Health to be commissioned to do a needs assessment looking at the demographic and epidemiological evidence of need and demand for an all age full pathway specialist mental health service for deaf people on a regional footprint
- Integrated Care Boards to action the recommendations made to them by NHS England on the commissioning of BSL Interpreting and the involvement of deaf people in the development of services.
- Mandatory deaf experience/cultural awareness and Accessible Information Standard (AIS) training for under- and post grad training for all medical, nursing and Allied Health Professionals and to be included as part of trust inductions.
- To ensure NHS providers comply with the AIS, including, for example, ensuring an alert pops up when booking appointments that a BSL Interpreter is needed to make the appointment accessible and that this is booked prior to the appointment.
- For the NHS Workforce Plan to include a focus on deaf staff to enable accessible and supported training and development opportunities.
- To identify national research priorities within deaf mental health and support teams to develop research capability across the university and health sector.
- For a website to be developed bringing all the service information together with a wide range of resources to build understanding and resilience around mental health, information about self-help and positive strategies for both deaf children, young people and parents (hearing and deaf).
- National Deaf CAMHS has had no uplift in funding since it was set up. This should be rectified given the increase in demand and activity over the years.
- For the agreed proposal around provision for young people aged 18 – 25 to be funded and set up.
- Working alongside social care there is a need to map out specialist community residential placement options for deaf young people and scope the need for more provision.
- Commitment to the development of a regionally based specialist mental health hub for deaf people which provides equitable care across the country. For this service to include neuro-developmental and neuro-psychological assessments for deaf people alongside mental health.
- Ensure access to mental health crisis teams through text, email, and video relay, and provide training to staff to ensure they recognise the specific needs of deaf people.
- Ensure that more deaf-led community services are commissioned so that deaf people who are ready to leave secure services can be discharged and supported to live independent lives.
- Provision of specialist deaf forensic mental health services and accommodation
- Deaf prison in-reach available to all deaf prisoners
- A coordinated, collaborative pathway for deaf patients (including women) in forensic services with specialist commissioners who have knowledge of deaf forensic mental health, and specialist assessments by experts in deaf forensic mental health.
Share the report
#DeafMentalHealth
Thank you
Thank you to everyone who shared your experiences and expertise to highlight the changes we need in deaf mental health services.
Photos from the event on 3 July 2023 launching the report:
For media enquiries or comment please contact Philippa Wynne, Head of Communications, communications@signhealth.org.uk
Related resources
Report Review of the NHS Accessible Information Standard
Urgent priorities for change, informed by patients’ lived experience and NHS professionals.
Service Psychological Therapy Service
The only NHS therapies service delivered in British Sign Language (BSL).
Report Guidance for commissioners of primary care mental health services for deaf people
2017 report from the Joint Commissioning Panel for Mental Health and SignHealth.
