First of the few

There are an estimated 50,000 deaf people in the UK who use British
Sign Language as their main means of communication. Up to half of
these are likely to suffer from mental health problems (emotional,
behavioural and adjustment disorders) compared with one in five of
the hearing population, claims Sign, a charity for deaf people with
mental health problems.

Last month saw the first sign language-using deaf registered mental
nurses (RMN) in the country complete their qualification. Deaf
Access, a project run at Salford University, and funded by the
Greater Manchester Education and Training Confederation, has made
this possible. The deaf students study alongside their hearing
classmates on the three-year Diploma in Nursing Mental Health, with
access to interpreters and notetakers.

Naomi Sharples, the professional lead for mental health nursing at
the university, and one of the people who initiated the course,
says: “Qualified RMNs who are deaf are needed because deaf units
are a signing environment. You walk in and immediately clients will
start to sign, and it’s rare to find a qualified hearing nurse who
can also sign.

“Deaf RMNs bring with them the ability and experience to adjust
their sign and cultural communication very quickly to suit the
client’s needs.”

Before the advent of Deaf Access, deaf people were confined to
lower grade jobs, despite their wealth of experience and knowledge
and so deaf clients with mental health problems were denied access
to qualified deaf professional staff.

Susan Eagling and Jennifer Meek, two of the three qualified deaf
nurses, come from an experienced mental health background. Before
studying for the diploma, Eagling worked at Falcon House, a day
centre for deaf people experiencing mental health problems in
London. After four years, she began to get frustrated at the lack
of promotion prospects. Since finishing the diploma course, she has
had three job offers and has plumped for the Old Church, a unit for
deaf adults with mental health problems in Balham, south
London.

Meek had worked for 10 years as a nursing assistant and community
support worker in deaf mental health services in Birmingham before
joining the course. With encouragement from her boss, she decided
to do the nursing diploma. Now she has successfully completed it
she is to become a staff nurse at the John Denmark unit in
Prestwich, Lancashire, working with deaf offenders.

Both Eagling and Meek say that deaf people are responded positively
to the news that they are now qualified RMNs, which not only
reassured the clients but also provided an, as yet unseen,
professional deaf role model within mental health services and for
the wider community.

A study carried out in the mid-1990s by the Joseph Rowntree
Foundation showed that nearly 90 per cent of deaf staff were
employed in unqualified posts, compared with only 13 per cent of
hearing staff.

The study indicated that although the majority of deaf staff worked
in unqualified posts, in most cases they could communicate better
in sign language with deaf service users than their hearing
colleagues. In addition, they were valued for their understanding
of deaf culture. Deaf and hearing colleagues alike perceived these
skills as essential, in order for the teams to function.

Eagling cites one such case: “A deaf patient who was being assessed
by a hearing nurse with fluent BSL, signed to her that he was a
rabbit, and she wrote this down in her notes. Anyone reading those
notes would assume that the man had serious mental health problems.

“I felt something wasn’t right, because deaf people express
themselves very differently from hearing people. I wanted to
clarify with the patient exactly what he meant. He then explained
that he’d been prescribed many different tablets, none of which had
suited him. He meant that the hospital kept giving him so many
different tablets to try that he felt they were experimenting on
him like a rabbit. If I hadn’t asked the patient to clarify what he
had meant, he could have been easily misdiagnosed.”

Beverlea Forsaw, the third qualified deaf RMN, says: “We had one
client who had become quite psychotic. He saw a hearing registered
medical officer, who had not met the client before, and hadn’t read
his notes. The officer just wasn’t interested in him because he was
deaf, and that sort of thing happens a lot. Deaf people get the
rough end of stick, they are virtually ignored, or treated as
hearing people, which doesn’t facilitate access to the help they
need.”

She says that a deaf unit may draft in social services from one
area and care services from another area. The people drafted are
likely to have limited or no experience of deafness and often do
not understand that trying to treat mentally ill deaf people in a
hearing environment is just not going to work.

“I was born hearing but became deaf, so I am in the middle of two
cultures. I feel that I can take from both worlds. I have insight
into the pitfalls where deaf people lose access, because I am deaf
myself,” she adds.

Since finishing the diploma course, Forsaw has taken up a job at
the medium secure deaf unit at the Mayflower Hospital in Bury,
working with deaf women who self-harm.

A Department of Health consultation document, A Sign of the Times,
states: “Given the provision of effective care is fundamentally
underpinned by the need to communicate, people who are deaf present
a unique challenge to a mental health service primarily organised
on the basis of hearing. The application of mental health policy to
this group requires explicit consideration if we are to meet the
challenge of providing them with an effective and equitable
service.

“The current provision relies heavily on a small community of
dedicated expert staff, and many service developments have occurred
as a consequence of enormous effort. To a large extent, specialised
mental health services for people who are deaf have developed at a
national level in an ad hoc fashion,” says the report.

Matthew James, deputy chief executive officer of Sign, says: “It is
hoped that these deaf RMNs will go a long way to altering the
culture within their profession. At primary and secondary care
levels there is a need for more resources, training attendance, and
a cultural shift towards providing deaf patients with greater
choice and responsiveness.”

Just three deaf RMNs may not be a high number, but with five more
deaf people enrolled on the RMN diploma course, it is sure sign
that, in time, mental health services for deaf people are poised
for big changes. 

– A report on the Deaf Access project is on the Greater Manchester
Confederation website at www.gmconfed.org.uk.  For
information on the charity Sign go to www.signcharity.org.uk