Deafness, Mental Health and Wellbeing

Deafness and hearing impairments

Information and support for members of the D/deaf community, their families and carers.

You might have come across terms such as ‘Deaf’, ‘deaf’, ‘hearing impaired’, ‘profoundly or partially deaf’, or ‘hard of hearing’, and possibly more.  Deafness is often an invisible disability.

The terms above have been used by professionals, services, and people themselves to highlight the heterogeneity of the citizenship of such communities and diversity of their communication, language and culture. Some of them might present with multiple disabilities e.g., dual sensory impairment and additional needs, such as neurodiversity.

Deaf citizens (with a capital ‘D’) often suggest that they are profoundly deaf from birth and a British Sign Language (BSL) user. They are a subgroup of deaf people with a distinct language and culture. They are usually exposed early to the opportunity of their preferred language and social environment. Such affirmation of community, culture and language is depicted as ‘culturally affirmative’ perspective on Deaf people (Glickman N & Hall W 2019).

Small letter ‘d’ is used to describe the rest of the group, such as partially deaf and hard of hearing. The Accessible information standard guidance (NHS England 2016) has recommended that service providers ‘ask’ the person their identity and their needs. Hence terms such as hearing impaired, hard of hearing, hearing aids or cochlear implant users will be identified with the person. They might also choose to ‘live in both worlds’ and take on a ‘dual identity or mixed heritage’ and adopt a multiple modality of communication.

What do we know about deafness?

• Hard of hearing: up to 70dbB loss: may use hearing aids.
• Severe deafness: 71-90dB hearing loss: may use hearing aids to understand speech.
• Profound deafness: 91dB+ hearing loss: can’t understand speech, even with hearing aids (but might use them to detect noise).

What do we know about Deaf culture or ‘Deafhood’?

Dr Paddy Ladd (Ladd P 2003) defines Deafhood as ‘a journey that a Deaf person undertakes to discover his, her or their identity and purpose in life.’ He further says this can be an empowering process for a Deaf person, among other people, to re-affirm Deaf people’s role and place in society, history, and the world.

The above has provided us different perspectives of D/deaf people and deafness and hearing impairments.

We have adopted the use of ‘D/deaf’ for the rest of the content.

Deafness, mental health and wellbeing

The barriers experienced by the D/deaf communities are quite universal and shared by other marginalised groups, such as people who are from the older generation, for whom English is not their first language, and/or those who are financially struggling. Those socio-economic factors could widen the gaps in their access. The failure in recognising those disadvantages could further increase the impacts of their experience of exclusion and poverty. The assumptions of individuals’ or community assets such as conversing orally, having a smartphone or access to Deaf centres or clubs or family or carers support might not be all valid,

Historically, D/deaf people have faced persistent inequality and inequity in their access to mental health services (Critchfield AB 2002, Fellinger J et al 2005, Pertz L et al 2018). This has been evidenced by the risk of misdiagnosis and relapse, longer stays in hospital, poorer concordance of their treatment and care, higher incidence of comorbidity, and negative impacts on carers and families (du Feu M 1999, du Feu M and Chovaz C 2014). It has been suggested that D/deaf people are more likely to develop mental health difficulties. Two in five might require mental health services in their life. Lack of communication support and accessible information could further widen their experience of health inequality and worsen their quality-of-life outcomes.

Communication and Accessibility

The Royal National Institute for Deaf People (RNID) suggests that people who are D/deaf or have hearing loss have individual communication needs and you should ask someone how best you can communicate with them. Not every tip available will be appropriate for every person who is D/deaf or has hearing loss. See their tips below.

What are the tips?

Do’s:

• A quiet room with good lighting. Mindful about the seating arrangement, for example don’t stand in the light.
• Face the person and speak normally and check patient has understood you.
• Do one thing at a time. One person speaks at one time.
• Keep language basic, avoid jargon and be aware that a deaf person may not be able to understand all the written information.
• Use preferred, qualified BSL interpreters, lip speak, SMS, e-mails, NGT (Next Generation Text Relay), Skype, Text phones (Minicom), Fax, palantypist.

Don’ts:

• Don’t assume someone can lip-read or hear because they use their voice.
• Don’t assume someone nods their head means that they understand you.
• Don’t assume when you give someone written English that they can read all the information.
• Don’t send letters saying ‘ring this phone number’. Provide text numbers.
• Communication can be tiring and offering “eye breaks” is a good practice.

Adherence to the actions required by the Accessible Information Standard (AIS) requirements (NHS England 2016) will help.  The Standard sets out a specific, consistent approach to identifying, recording, flagging, sharing, and meeting the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss.

You can access AIS training via the interactive E-Learning link below to familiarise yourself with the five steps above.

Who the communication professionals are and how they are booked?

• BSL / English Interpreters: work with BSL users.
• Lipspeakers: work with English users, some do Sign Supported English.
• Speech to Text reporters: verbatim output; good for conferences.
• Notetakers (electronic and manual): provide a summary of what’s said.
• Other Communication professionals e.g. Deafblind interpreters for dual sensory loss and Deaf relay interpreter is important for those experiencing language deprivation.

You can check online or contact your local leads responsible for equality, diversity, and inclusion about the details of booking. Do not forget to check the receipt of confirmation; booking sent does not mean they are available for the appointment.

More about language deprivation

Language deprivation, especially in D/deaf children, is a delay in language development that occurs when insufficient exposure to language, spoken or signed, is provided during the first few years of a D/deaf or hard of hearing child’s life, often called the critical or sensitive period. Glickman N (2007, 2019) suggested that language deprivation could have significant impacts on all cognitive and psychosocial developments and the D/deaf person’s subsequent perception of identity and emotional regulations.

Deaf mental health services and referral pathways

As a result, D/deaf people’s access to specialist D/deaf mental health services across all levels of care is key to offering them appropriate assessment and facilitating them to be engaged with a personalised wellbeing- and recovery-oriented care package. The specialist services often start with the communication and language profiling so that considerations such as reasonable adjustments for their accessible information standard requirements such as their communication passport are put in place prior to any clinical interventions. The services are either directly funded by the NHS England or the local Integrated Care Boards.

The specialist providers for D/deaf adults are usually tertiary services and the local secondary community teams will be responsible for the care management of the D/deaf users. The Deaf CAMHS (Child and Adolescent Mental Health Services) have their service specifications and referral systems that the referrals can come from any professional working with the child, young person, and family. This includes schools, mainstream and deaf, teachers of the deaf, CAMHS, GPs, paediatricians, and Children’s Services.

Self-help information and digital technology have become increasingly important especially since the covid19 pandemic started in 2020. Although more online services and information are now available for D/deaf citizens round the clock, they are still struggling to access crisis services or have their communication needs met during their health and care appointment (AIS review -Signhealth 2022).

Personal Experience: Deaf people and their supporters

• A Deaf user shared ‘I am particularly impressed with the communication passport prepared for me. Thanks for taking time to put all my needs of and recommendations together for better communication with me. I have shared it with other professionals involved as the passport is important to help me stay well.’

• A Deaf user said ‘I understand counselling services for deaf people was mentioned during the deaf wellbeing group and input from Deaf counsellors. Not all Deaf people would like to see another Deaf person, it is important that Deaf people are given choices in who they want to see including a hearing counsellor with skills and experience in mental health and Deafness.’

• A Deaf user said ‘It can be hard for me to understand and follow. I use face time with my family, but I don’t always understand what they are saying because of my deafness. I don’t want to talk with my hand alone.’

• Graham, a Deaf carer from Durham, North East England said: ‘The Mental Health and Deafness service has been really helpful in advocating concerns about my communication needs and helping me to get the support that I need. I’ve been able to access a Deaf personal assistant through social services, which now helps me to communicate without any barriers. I attend my wife’s care meeting and they help make sure that I’m understood and listened to, and this has allowed me to feel more informed in my wife’s care and the support available to me. I’ve even been introduced to more technology for Deaf people and how to access BSL information online, which is fantastic. The service has opened up a whole new world to me.’

• Suzie is a carer from Darlington, North East England. She is Deaf, a lipreader and an experienced deaf awareness trainer. She delivered a Deaf awareness session for the mental health services in Durham and Tees Valley in 2023. She has been a key member of the Deaf wellbeing network and supported the recognition of the diverse communication requirements for people who are D/deaf, deafened, deafblind or with hearing loss. She reminded us of the importance of both communication tactics and signing skills. More importantly, it is the positive attitude and respect for the providers who can successfully secure the engagement and participation with the Deafened and all communities. She was grateful to have had the opportunity to deliver the session and be a member of the wellbeing network as part of her carer support.