Community Celia Hulme - Psychological Therapies Project Manager - - PowerPoint PPT Presentation

Parity of Esteem in the Deaf Community

Celia Hulme - Psychological Therapies Project Manager Monday 10th October 2016 – Access Bedford

Overview

• Parity of Esteem
• Physical Health – Sick of It
• Mental Health – BSL Healthy Minds
• Way Forward

What is Parity of Esteem? ‘Parity of Esteem is the principle by which mental health must be given equal priority to physical health. It was enshrined in law by the Health and Social Care Act 2012'

Centre for Mental Health 2014

Physical Health – Sick of It

• 5 year study – SignHealth & Univeristy of Bristol
• Funded by Big Lottery Fund
• 533 Deaf people took part in the study
• 47 in-depth interviews with Deaf people who had

extensive experience of the health service

• Online survey and interviews

Bad Access

Bad Access

• Contacting GP surgeries difficult for many Deaf people as booking system is mostly telephone based
• If they go to the surgery, usually no one there is able to use BSL
• Surgeries do not note down how Deaf people like to communicate
• Do not have a system of booking interpreters
• 70% of Deaf people don’t go to GP - no interpreter
• Waiting room – loud speaker to Doctor
• Access to test results – English based
• Audiology, ENT departments – high number of Deaf patients (do they set an example to other departments?)

Poor diagnosis

Poor diagnosis

• Common for doctors not to spot and diagnose health conditions in Deaf people
• Study highlighted many Deaf people that should have been under treatment for

conditions that they did not know they had

• Deaf people twice as likely to have high blood pressure - they don’t know!
• 1 in 12 Deaf people had higher sugar levels – high risk of diabetes
• Deaf don’t go to GP’s – results in no treatment, high risk of conditions getting worse

& no knowledge to change their lifestyle

Poor treatment

• Diagnosed by GP – still receive poor treatment
• High blood pressure – 62% compared to 20% don’t have it under control
• Heart disease
• Diabetes – half of Deaf people received inadequate treatment
• High cholesterol – 1 in 3 Deaf are treated compared 2 in 3 for general population
• Deaf unsure why they are taking medication – high risk of stopping them
• Treatment clinics not accessible – interpreters not booked/lack of Deaf

awareness

Poor treatment

No information

No information

• Deaf people reported feeling excluded, marginalised - not treated equally
• Face many barriers to take control of their own health (information, interpreters, lack of

specialist (Deaf) access)

• Health information not routinely translated into BSL – miss out
• Rely on others to translate information i.e. friend/family
• 8 in 10 want to communicate in BSL ONLY 3 in 10 offered BSL
• There are thousands of health information and only less than 100 are translated in to BSL
• Lack of opportunity to self learn/improve health

Mental Health

• Primary care focus
• Mental health in Deaf community 30-60% - double compared to general population
• Little primary care mental health services accessible for Deaf people
• Psychological therapies (counselling, CBT & other therapy interventions) are probably the only

specialist primary care provision that is available to Deaf people

• Stepped care pathway (5 steps)
• System of delivering and monitoring mental health treatment - can step up or down
• Big difference between Deaf and general population

Stepped Care Pathway

Difficulties

• General health access issues – mentioned by Sick of It report
• Written word – low level of literacy
• Spoken word – format of many services
• Poor developmental understanding – lack of understanding from hearing perspective on Deaf

people’s upbringing

• Lack of cultural-linguistic matching
• Inconsistency of psychological therapy provision in England
• Must use interpreters (50%)
• Mainstream then specialist service (30%)
• Straight to specialist service (20%)

Psychological Therapy with a interpreter

• Therapist not experienced working with Deaf people – miss vital clues in treatment
• 3 people involved in the therapeutic relationship
• Different interpreter could be booked for each session
• Therapist culturally dependent on interpreter – seriously affects risk assessment
• Small pool of interpreters with mental health experience – used in other situations
• Deaf person relies on both interpreter and therapist
• Therapist may not have access to culturally adapted measures (PHQ9, GAD7, W-SAS)
• More costly (min. 3 hrs plus travel expenses)
• Interpreter unable to attend session – session has to be cancelled

Psychological Therapy with a BSL Therapist

• Therapy is direct
• Therapy is in BSL
• Information/resources is in BSL or BSL English if written
• Culturally and linguistically matched
• Risk detected sooner and managed appropriately
• Cost effective
• Possibly less sessions as issues identified and worked with more quickly
• Higher percentage of recovery
• General population – 49%
• BSL Healthy Minds – 75%

Way Forward

• General provision – both physical health & mental health
• Ask Deaf patients how they would like to communicate - make note of it
• Offer online booking for appointments or text messaging
• Book double length consultations to allow time for interpretation
• Calling for patients system – come up with something that does not rely on people calling

you

• Simple system for booking interpreters
• NEVER ask or request for a family or friend to interpret
• Routinely collect and record data on the Deaf person’s communication
• Set clear standards for access to healthcare – AIS

Way Forward

• General provision – both physical health & mental health continued…
• Nationally commission specialist services
• Commission more research and engage with Deaf community
• Offer Deaf awareness training to all frontline staff
• Test your services on whether they are accessible to Deaf people
• Collaborate with other services to provide value for money

Way Forward

• Improving psychological therapies for Deaf people
• Meet the clinical needs of Deaf people to provide equitable care
• Meet the linguistic needs of Deaf people
• Promotion of mental health awareness other than just providing accessible information i.e.

guided self-help

• Deaf people should be able to choose which primary care service they want – NHS Choices
• Deaf people need a clear care pathway to access care equitable to the general population
• Deaf people need evidence based and effective interventions
• Deaf people need sustainable services

To watch Sandra’s story in BSL go to https://youtu.be/DDXZk68r_ks

Parity of Esteem for Deaf people?

Questions?

Questions?