No one listens

Scotland 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 MacFadyen

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Those 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.

Why 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.

It 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.

In 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.

In these units, all staff are required to learn to communicate in sign language and to be 'Deaf Aware'.

There 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.

What do we have in Scotland? Practically nothing!

At 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.

There 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.

The 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.

They 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 needs.

Most 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.

You may then ask, exactly what are the authorities doing about this situation? I'm sad to say, very little.

When 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.

Under 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.

With 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.

Unfortunately 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 limbo.

At 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.

Much 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.

If 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.

Willie 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

See also:
Feb 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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