No one listens
has no psychiatrists, psychologists or community psychiatric nurses
who have a working knowledge of sign language. This demonstrates
how deaf people are systemmatically excluded from equal access to
mental health care. It's time we did something about it, says Willie
of you who were critical of the short-comings of the previous (Scottish)
mental health legislation, or who feels that the new act could have
been tightened up or better resourced, may be surprised to learn
that there is a whole community in Scotland who would long to have
the access and services that legislation has brought to the rest
of the community, but who are still effectively denied equality
- I refer here to the population of deaf people in general, and
sign language users in particular.
is it that deaf people can still feel excluded, especially at a
time when "inclusion" has been banded about as a primary
buzzword for so long? The answer to that is communication.
is acknowledged that effective communication must be the basis to
any meaningful mental health diagnosis and treatment, and so when
there is a barrier to communication, such as deafness, it obviously
raises major questions about the appropriateness of any action taken
or treatments offered.
England there are now four hospital-based services offering a range
of inpatient and outpatient services specifically for deaf people.
There is even a unit for deaf people at Rampton Special Hospital.
these units, all staff are required to learn to communicate in sign
language and to be 'Deaf Aware'.
are now opportunities for deaf people to train as psychiatric nurses.
Social workers with deaf people are encouraged to become accredited
social workers in the mental health field. Additionally, many other
European countries now accept the need to have fully accessible
services for their deaf population, and many of these, especially
in Scandinavian countries, encourage deaf people to take up opportunities
to train in all the mental health professions.
do we have in Scotland? Practically nothing!
the time of writing it is thought that there is one mental health
officer (MHO) and two counsellors, who have experience of working
with deaf people.
are no psychiatrists, psychologists, community psychiatric nurses
(CPNs), or other professionals, who have even a basic working knowledge
of sign language, and no training courses for mental health professionals,
which include any aspects of awareness of the communication or cultural
needs of deaf service users.
reality of mental health treatment for deaf people in Scotland is
generally a case of 'take it or leave it.'
The nearest hospital-based service is in England (The John Denmark
Unit, at Prestwich Hospital in Salford), which operates a monthly
outpatient clinic for patients in Edinburgh or Glasgow, and is staffed
by a psychiatrist and a CPN.
also take referrals for inpatient treatment in Salford, if the money
is available from the service user's health board. Other than that,
deaf patients are forced to make do with trying to access mainstream
services, which generally do not give attention to their particular
health boards will pay lip service to the possibility of involving
the services of a sign language interpreter (definitely a second,
or even third-best option). They ignore the fact that there are
only 45 registered sign language interpreters in the whole of Scotland,
and none of them have a specialist mental health background. It
can often take days or even weeks to get an interpreter by appointment.
may then ask, exactly what are the authorities doing about this
situation? I'm sad to say, very little.
the first specialist service for deaf people was established in
England in the 1960s, there was a flurry of interest in setting
up a similar service in Scotland.
the previous Scottish Office system, this was rejected on the grounds
that the initial Deaf Psychiatric Service was a national service
covering the whole of the UK. Even when the English services expanded,
with the opening of additional units in Birmingham and London, and
the fact that these came under local health board control, there
was still a reluctance to consider any developments in Scotland.
the re-establishment of the Scottish Parliament in 1999, there was
new hope that the Executive could break the emotional and financial
log-jam which many suspected had hindered progress for so many years.
this optimism was misplaced. Lobbying groups, on the advice of the
Scottish Executive, spent over three years developing research proposals
that would try to identify the extent of the deficiencies in services,
and make recommendations for future improvements. At the last minute,
and without any explanation, the Executive refused any financial
support for the research and effectively pulled the plug on the
whole scheme. Despite continuing attempts at restarting the lobbying
process, the whole matter remains in a political and bureaucratic
a time when the NHS is facing allegations of institutional racism,
it is interesting to note that there is a significant group of indigenous
citizens, who are effectively being excluded from equality of access.
At the same time that leaflets and forms (including material about
the new act) are rightly being made available in a range of ethnic
languages, it is noticeable that government agencies, including
the NHS, repeatedly refuse to make such information available in
sign language formats. It would seem that, in terms of political
acceptability, discrimination is literally only skin-deep.
remains to be done in Scotland. In talking to deaf service users
it is apparent that they are not looking for any special attention,
but merely seeking some sort of equality, so they might have the
same chances of accessing appropriate diagnosis and treatment as
their hearing peers.
anyone feels they have been faced with no support or back up in
trying to offer services to deaf people, or who would like any additional
information on this subject, please contact me for further discussion.
MacFadyen is a social worker and vice-chair (Scotland) of the
British Society for Mental Health and Deafness (BSMHD)
* This article
appears courtesy of the Point
magazine, published by the Scottish Association for Mental Health
28, 2005: All mental health staff working with deaf people should
learn sign language, government announces - Health Minister
Rosie Winterton also wants sign
language translation to be available in every GP practice
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