Transcript Slide 1 - Let`s Talk About…Mental Health and Deaf People

LONG AND WINDING ROAD
Dr Brendan T Monteiro
Consultant Psychiatrist
All Saints Hospital, Oldham – Tel: 0161 622 4237
St Mary’s Hospital, Warrington – Tel: 01925 423300
Email: [email protected]
LONG AND WINDING ROAD
STUDY THE PAST
IF YOU WOULD DEFINE THE FUTURE
CONFUCIUS
20th September 551 BC
COMMUNICATION
Communication is an influential determinant
of inequality of access to, engagement with
and benefit from psychiatric services
BHUI et al (August 2015)
BJPsych
THERAPEUTIC COMMUNICATION
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Diagnosis and Assessment
Discussion of treatment expectations
Understanding and empathy
Psychological interventions
Rely on conversation and challenging cognitive bias
BHUI et al (August 2015)
BJPsych
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COMMUNICATION
(Miller & Vernon, 2001)
• Deaf population have linguistic diversity:
– age of onset/cause of deafness
– organic/neurological dysfunction
– intellectual ability
– language deprivation
– age that language acquisition began
– educational background
– involvement in Deaf community
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SOME IMPORTANT FIGURES
(U.K.)
• 1/1000 born with profound bilateral Deafness
• 2.6 /1000 under 10 year olds – deaf (40+dbHL)
• 90% of Deaf children born to hearing parents
• 40% deaf people 25% hearing people experience mental
health problems (Ridgeway)
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CHILDHOOD
• Parent/Child interaction - hearing parents of deaf
children are more directive and discuss less
• Language development: speech v sign
• Implications for social and emotional development
• Major decisions about education
• Complex needs
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ADOLESCENCE
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Issues of identity – Deaf/Hearing
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Leaving school – HELP!!
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Poor understanding - Social, Moral, Legal, Emotional
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Poor access to training/employment
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Discrimination
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Relationships - How do these work?/Peer Groups
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Mental Health issues
Poor Access to FE
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YOUNG ADULTHOOD
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Maturational delays
Gaps in knowledge – Poorly equipped
Access: Health, Education, Employment - limited
Attitudes and discrimination
Additional stressors - MH matters
‘Low key’ support systems:
Family/Friends/primary care services ? Access
Psychosexual Issue
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Dysfluency Compared
Deaf
Hearing
Incoherent
MLS
Comprehensible
Proficient
Fluent
Eloquent
Professor Robert Pollard – University of Rochester
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MINIMAL SIGN LANGUAGE
Deaf people in mental health settings often have language dysfluency
Exacerbated by:
• Learning Disability
• Impoverished emotional environment/Deprivation
• Lack of access to appropriate education/poor incidental learning
• Poor social relationships
• Psychotic Process
Be aware of possible
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Limited emotional vocabulary
Limited world view and knowledge gaps
Don’t assume knowledge
Poor literacy
Misunderstandings
Nodding
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I.N.C.L.U.D.E.
• Intervention with
• No
• Communication
• Leads to
• Undermining the Rights of
• Deaf People to
• Equality
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POSSIBLE MISDIAGNOSIS
• Deafness mistaken for Intellectual impairment
• Mental Illness can be missed
• Mental Illness diagnosed where none exists
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EEC STUDY – CHILDHOOD DEAFNESS
T MARTIN ET AL
• 3000 – Children
• 29% – Disability
• 9.9% - Intellectual impairment
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DO DEAF PEOPLE HEAR VOICES
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Phantasmal Voices
Hallucinations of Communication
Analogous to Auditory Hallucinations
Hallucinations in Sign Language
Auditory Hallucinations
Tinnitus
J Atkinson
J Atkinson
J Atkinson
How to communicate with Deaf people
who are mentally ill
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Make questions specific not vague
Ask time questions carefully
Clarify name signs, placement and directional verbs
Ask what signs you don’t know mean
Check understanding
Use experienced interpreters and deaf relay interpreters
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ASSESSMENT OF DEAF PEOPLE
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Deafness
Developmental Issues
Modes of Communication
Family Dynamics
Intellectual Level
Educational Issues
Mental Disorder
Forensic Issues
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MDT ASSESSMENTS
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Mental State Assessment
Risk Assessment
Social Care Assessment
Psychological/Neuropsychological
Speech & Language Therapy
O.T. Assessment
Community Assessment
Family Assessments
My Shared Pathway
Psychiatrists
Nursing Staff
Psychologists
Support Workers
Art/Drama/OT
SALT
Social Workers
Administrators
EPIDEMIOLOGY
• Same incidence of Schizophrenia as hearing people
• PD and Behaviour/Adjustment problems increased
• More likely to have Organic Syndromes
• No more likely to suffer from paranoid psychoses
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TREATMENT ISSUES
Habilitation before Rehabilitation
• Pre therapy targeting deprivation of knowledge/experience
• Individually designed strategies
•Use pictorial methods, symbols, role play, puppets
• Interpreters are not always the solution
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HABILITATION
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Fill in the gaps
Identify the impact of deprivation
Develop skill areas/opportunities to practice skills
Target weaknesses
MDT provide nurturing with positive role models
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Rehabilitation Model
Recovery
&
Relapse
Offence Related
• SOTP
• Arson
• Violence
Anger
Trauma
Substance
Mental
Disorder
Psycho education
Assessment & Risk Assessment
PYRAMID: DEPRIVATION AREAS
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Age Line
Understanding Emotions Group Programme
Understanding Social Skills Group Programme
Basic Relationship Education Programme
Sexual Education / Relationship Intervention
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DEAF CENTRED THERAPIES
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Therapeutic Milieu
CBT Approaches
Psychoeducational
Psychological Interventions
 Sex Offender Treatment
A  Substance Misuse Work
D
A  Offence Related Work
P
T  Anger Management
E
D
Group
Individual
Emotion Posters: Definition
Emotion Big. You want shout, hit, punch,
kick, threaten.
Lowe, Gahir, MacDonald, IAFMHS April
2012
Anger Thermometer: Intensity
Trigger / Start
Anger less
Angry /
Upset
Build up
Anger Small/
Upset Big
Build up
Upset
Angry stay
Danger
Calmer
Calm
big
LONG AND WINDING ROAD
ANGER MANAGEMENT
STOP
THINK
GO
DON’T DO IT.
WHAT CAN I DO?
WHAT ARE THE OR COSTS?
MAKE A PLAN
THINK POSITIVE
BE CALM
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DEAF SERVICES
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Services from a Deaf cultural perspective
BSL with allowances for Dysfluency
Training for Deaf and Hearing staff
Adapted Treatment Programmes
Care Pathway for Deaf people with complex needs
Risk Management
The environment is a therapy
• We think of tablets and counselling as therapies
• The environment is a powerful therapeutic tool
• Deaf people are particularly attuned to visual inputs
• Environment can help Deaf people achieve wellbeing
H. Miller
Communication
• Deaf staff work on the ward
• All staff have Deaf awareness and Sign Language
• Signing Policy in Hospital
• Interpreters who have Mental Health expertise
H. Miller
Hearing hospitals do not promote
normalisation for Deaf people
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Visually very ‘noisy’
Confusing communication (writing)
No Deaf Awareness
Tired and stressed trying to concentrate
Feel isolated and frightened
Never know what is happening
No Sign Language Users
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Response to Treatment
Highly
Effective
Team
Real
Team
Potential
Team
Initial
Provision
Pseudo
Team
Team Effectiveness
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DEAF SECURE SERVICES
ST
ANDREWS
12
RAMPTON HOSPITAL
(10)
F
E
N
C
E
JDU
LONDON
BIRMINGHAM
48
ALPHA
24
ST
MARYS
4
ALL
SAINTS
6
F
E
N
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REHAB
ALL
SAINTS
14
• Map of England
Manchester
Nottingham
Birmingham
London
LONG AND WINDING ROAD
COMMUNITY
• Outpatient programmes
• CPN and Domiciliary Treatment
• Advocacy and Counselling
• Occupational Therapy and Home support
• Day Centres
• Residential Centres/Hostels
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D.O.H. – INITIATIVES
(England)
1987
- Supraregional Status
2002
- Sign of the Times - Consultation
2005
- Towards Equity and Access (TEA)
CURRENT
- NHS England, CRG and Commissioning
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COMMISSIONING
NHS England = Commissioning Board
Mental Health and Deafness Clinical Reference Group (CRG)
12 Clinical Reps (1 per senate area)
Commissioners
4 Patient Public Engagement (PPE) members
Third Sector/Independent Sector/Forensic
Meet every 2 months – Range of discussions
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Family
Social Worker
Local Doctor
Hospital Doctor
Hospital Ward
(Goldberg and Huxley 1980)
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Family
Social Worker
Local Doctor
Hospital Doctor
Hospital Ward
Social Worker
(Ken Checinski 1994)
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KNOWLEDGE AND SKILLS
MENTAL HEALTH AND DEAFNESS
• Awareness of:
• Cultural, Linguistic, Psycho-Social Aspects of Deafness
• Understanding of:
• Causes, Associated conditions, Deprivation, Development
• Facility in:
• Sign Language
• Communication Modes
OVER and ABOVE
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REFERRAL FROM A GP
1987
“This deaf man has been very aggressive and
challenging. He may be Schizophrenic,
mentally retarded or anything. Please do the
necessary.”
LONG AND WINDING ROAD
REFERRAL FROM A GP
2006
“As Ms Smith is profoundly Deaf, I would be
grateful if you could possibly arrange for her
to see a trained counsellor who is also Deaf
and able to do the sign language with added
knowledge of the deaf culture”
LONG AND WINDING ROAD
“DEATH BY POWERPOINT”
Nickname for the soporific effect the
visual aid has on meetings – and
now backed by research showing it
really can send you to sleep
LONG AND WINDING ROAD
THANK YOU
Dr Brendan T Monteiro
Consultant Psychiatrist
All Saints Hospital, Oldham – Tel: 0161 622 4237
St Mary’s Hospital, Warrington – Tel: 01925 423300
Email: [email protected]