Five ways AMHPs can improve Mental Health Act assessments with deaf people

I recently attended an excellent session at the College of Social Work’s approved mental health professional (AMHP) network conference on Mental Health Act assessments with people who have hearing loss.

The session was run by Christine McPherson, an AMHP who has been deaf since the age of 12. I scribbled down notes furiously at the time, as it was a fascinating presentation. Here are five key things I took away from Christine’s talk that could help with your practice.

1. Book an interpreter yourself

It is an AMHP’s responsibility to book an interpreter or signer if needed, the Mental Health Act Code of Practice is clear on that (check out section 4.106 to 4.110 for the details).

The temptation might be to ask someone to sort out a booking on your behalf. But Christine recommended that AMHPs should book interpreters themselves, rather than relying on others. This is because you need to feel confident that the interpreter is qualified in mental health and comfortable in dealing with these issues.

Christine said she’d had some excellent experiences with interpreters but warned that there a lot out there that aren’t good. Above all, you need to be confident the interpreter you use will get you the information you need to do a good assessment.

Where there are a number of languages involved (for example, if the person’s first language is a different sign language to British Sign Language) or other communication difficulties, you might want to consider using a deaf relay interpreter.

The Association of Sign Language Interpreters describes a deaf relay interpreter’s role as follows:

“For example, a Deaf interpreter may interpret into British Sign Language (BSL) from a presenter using ASL (American Sign Language), where the BSL is then interpreted into spoken English by a hearing BSL/English interpreter. 

“This sequence is known as a relay and the interpreters forming the middle link in the chain are sometimes referred to as relays or relay interpreters.”

2. If your interpreter isn’t comfortable with mental health issues it could spell trouble

An interpreter who has no knowledge of mental health is unlikely to have experience of the way deaf people express psychotic symptoms, Christine said. 

Someone who is psychotic may talk in a confused way. When they communicate in that way to the interpreter, you need a very confident, experienced interpreter to realise what is going on.
 
If an interpreter is not confident in working in mental health they may be afraid to say “I can’t understand this person” – so they cover for it. The interpreter may see it as their job to make sense of what the person is saying so you end up with a very skewed picture of what is actually happening. The result is that important risk factors might be missed.

3. Don’t put your back to the window

You need to consider more than the sign language/interpreter issues when carrying out assessments with deaf people. The lighting and environment that the assessment is being done in is key.

Good lighting is really crucial. Don’t have an assessment in poor light and don’t have your back to the window because in either case your face will be in the dark.

4. Look out for subtle signals

Christine said that it’s crucial to be aware of the strategies that people with hearing difficulties will use to cope with difficult situations, such as a Mental Health Act assessment. They might cover up the fact that they haven’t heard you properly, and pretend that they understood. That can create problems in the assessment.

Pay attention to eye contact. If someone is looking away from you, maybe that’s a cue. It’s vital to think about all of these issues. The important thing to remember is that you can communicate. It’s just finding out how.

5. Don’t make assumptions based on your experience of the hearing world

People with hearing often make assumptions about people who are deaf that are wide of the mark.

For example, they often assume that people with hearing loss have problems communicating. But Christine pointed out that when you see people who are deaf together, they have no problem communicating.

The communication problem isn’t with the deaf person. It’s a problem in communication between the hearing and non-hearing worlds.

This page outlining common ‘myths’ about hearing loss by Action on Hearing Loss may prove useful in busting some other common misconceptions.

Edit (18/12/13): I’ve also had this suggestion sent to me by an AMHP for inclusion: “I know this may be rather obvious, but please don’t shout at the person being assessed. I went out with one of our recently qualified amhp’s about two years ago, and the person being assessed had a hearing impairment. I had to ask the amhp to come outside after ten minutes and ask her not to yell at the poor woman.”

Related articles:

• 10 ways service users want AMHPs to improve Mental Health Act assessments