This article comprises of excerpts taken from a guide on Community Care Inform Adults about working with adults who are d/Deaf, written by Alys Young, Jacqui Bond and Erin King. Inform Adults subscribers can read the full guide, which covers deafness and health, access to services and mental capacity.
Generalisations about ‘deaf people’ are rarely helpful because the term covers such a vast range of differences, preferences, abilities and challenges. It is common to see a range of terms used to describe people who do not hear in the same way as the majority of the population. These include ‘deaf’, ‘Deaf’, ‘hard of hearing’, ‘hearing impaired’, ‘hearing loss’, ‘sensory loss’, and ‘partially hearing’ among others.
It is important to realise that these are not synonyms but may imply genuine preferences on the part of service users about how they/we may wish to be described. They also imply in some cases significant distinctions regarding language use and personal or cultural identity. For example, Deaf with a capital ‘D’ marks out people whose first or preferred language is a signed language such as British Sign Language (BSL).
It is too easy to presume that the same good practice that works with one client group will also work with people who are d/Deaf because they are the same as everyone else, it is just they do not hear in the same way. In reality, Deaf people who use BSL should be regarded primarily as a linguistic and cultural minority in the UK. The challenges in appropriately meeting their rights and needs is similar to working with other cultural groups who use a minority language. People who are deaf but who have been spoken language users all their lives, or who have lost their hearing, face different challenges in assessment and provision of services.
Both the Care Act 2014 (section 42) and Social Services and Well-being Act (Wales) 2014 (section 126) have included a duty on councils to make or commission enquiries when it has reasonable cause to suspect that an adult with care and support needs is experiencing or at risk of abuse or neglect and, as a result of those needs, are not able to protect themselves.
A research review (Hughes et al, 2012), while not conclusive, has demonstrated that disabled adults are more likely to experience abuse or neglect than those without disabilities. Although d/Deaf people specifically are not differentiated in the review, they are included in the definition of ‘disabled’.
Key issues in adult safeguarding with respect to d/Deaf people include:
- Lack of or reduced opportunities for direct communication without an intermediary. Deaf people who use a signed language may have far fewer opportunities to communicate with hearing people without an intermediary and are likely to have more limited understanding of written English (or Welsh). While interpreters are bound by a professional code of ethics, others who might fulfil this role are not. This creates opportunities for inappropriate dependency and exploitation, for example with regard to financial arrangements. If someone else is always the gatekeeper of information and communicative transactions, they may exert unacceptable levels of control or frank exploitation of another.
- Reduced opportunities to report concerns and experiences to an independent other. Complexities of being understood and understanding (whether in signed or spoken languages) reduce the possibilities for self-report of concerns and experiences that may be abusive. The lack of awareness of other people concerning the communication support needs of a person who is d/Deaf, or over-confidence by the hearing person that they can fully understand the d/Deaf person, also create reporting barriers.
- Deliberate targeting of d/Deaf people; d/Deaf adults may be regarded as vulnerable because of the communication complexities that exist and therefore may be deliberately targeted by abusers as they are less likely to be reported/found out.
- Deafness, particularly in connection with older age, intensifies other risks of neglect/abuse and vulnerability that people may experience. This may be for a range of reasons. For example, Deaf people may experience communication deprivation if placed in non-signing care environments. Their needs may be neglected through non-recognition because of limited communication. The Social Services and Well-being Act (Wales) 2014 (section 197) defines neglect as “a failure to meet a person’s basic physical, emotional, social or psychological needs, which is likely to result in an impairment of the person’s well-being”. Physical means of communication such as pushing, rough handling or shouting may be used inappropriately and consistently if it is perceived a d/Deaf person cannot understand. Without adaptations such as visual fire alarms and alerters that do not depend on sound/speech, a Deaf person might be at greater risk of personal harm. If there is abuse and neglect within a care situation it is much harder for a d/Deaf person to report this because of the various communication barriers experienced.
- Deaf people may have less awareness of what constitutes abuse, neglect or unacceptable behaviour. Poor access to information and communication over a lifetime may result in deaf people being less aware than the general population of a range of issues including abuse and safeguarding. The deaf community in some parts of the UK is taking steps to make deaf people more aware of their rights, how to report abuse of another, and what support might be available. Information in video format in BSL (and audio description and subtitled formats) is available, for example, Deaflink’s ‘Safeguarding Adults’ (2013).
Where to go next
Accessible videos in BSL, or with subtitles or with audio description
Hughes, K; Bellis, M A; Jones, L; Wood, S; Bates, G; Eckley, L; McCoy, E; Mikton, C; Shakespeare, T and Officer, A (2012)
‘Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies’
The Lancet, Volume 379, Number 9826, pp1621-29