Nov 25th 2007
Welcome to the latest newsletter and a warm welcome to the new members of the Star Wards’ community, including our first Scottish member – Carolyn Stewart at the Carseview Centre, Dundee. We’ve also had our first membership enquiry from America… and from a London medical (i.e. non-psychiatric) hospital. All very exciting! This fortnight’s featured hospital is Denmark House, part of Queen Elizabeth Psychiatric Hospital in Birmingham. This was a totally fascinating visit and I’d strongly recommend checking out the links at the end of the newsletter.
Denmark House, Queen Elizabeth Psychiatric Hospital, Birmingham
The rate of mental illness is higher in the deaf community, partly because of social isolation. Denmark House is one of only 3 specialist acute units in the country for deaf people and I very much appreciated the dynamic ward manager, Michael Galvin, spending the time showing me the ward. I also got the chance to visit the ward for people with eating disorders but asked so many questions on these wards that there was unfortunately no time for the planned visit to the mother and baby unit. (Another time I hope!)
I had no idea that providing services for acutely mentally ill deaf people would entail so much specialist input. I’d made a few (common!) mistakes. Firstly, assuming that all it takes is staff knowing some British Sign Language (BSL), whereas being able to effectively communicate with deaf people requires very advanced knowledge not only of BSL but also a full understanding of deaf culture. Not realising the extent of the specificity of deaf culture, and its relationship to mental health, was my second mistake. And I forgot that there has to be all sorts of design and facilities’ consierations to meet deaf people’s needs, from knowing if someone is asking to come into their room to being able to communicate with carers and others by minicom phone.
Management of actual and potential aggression
The issue which exemplifies how essential it is to have specialists units for deaf inpatients is physical intervention when someone is behaving aggressively. What’s usually referred to as ‘control and restraint’ (yuk) but Denmark House calls MAPA – management of actual and potential aggression. The norm when a patient is pinned to the floor is for staff to make sure that the patients’ arms and hands are incapacitated. But of course for someone who communicates by signing, this is the equivalent of tying a gag around a hearing patient’s mouth. And given that communication is the most important element of de-escalating an episode and freeing the patient, deaf people must be able to use their hands. Not only has Denmark House developed techniques for enabling this, but they always have an interpreter facing the patient to communicate precisely what the person is saying to staff with more limited understanding of BSL and deaf culture.
BSL interpretation is very complicated. Deaf people use a visual way of seeing the world – they’re much better at understanding different people’s BSL than hearing interpreters. As well as training hearing staff about deaf culture and BSL, one of the two communications’ officers is also very skilled at communicating with deaf people who either are not themselves fluent with BSL or use a different form of sign language eg Irish or American Sign Language or even something developed within a family. Hands-on signing with deaf-blind patients. One deaf blind patient uses old fashioned and idiosyncratic signs.
Mainly ‘neutral’ interpretation’ but can provide cultural information, or intent and presentation of what deaf patient is saying. For example, an upset person may use clipped signing, not articulated well. Interpreter has to convey the tone of what has been said eg ‘loud’, subdued, confused, sarcastic.
Many deaf people struggle with English literacy. Important implications re: provision of printed information. Denmark House translates important documents into printed BSL.
Being able to communicate with deaf carers and other visitors is also of course important. Similarly, when patients’ primary language and culture isn’t problematic for staff, it’s much easier for the ward to meet needs of deaf patients from ethnic and faith minorities. Anglican Chaplain who can use BSL attends once a month but it is a considerable challenge with regards to other faiths and denominations.
Interpreters are freelance. Access to Work pays for interpreters for deaf staff. Communications officers act as ‘relay interpreters’ and also as nursing assistants.
Recruit deaf staff onto bank. A deaf member of staff is a Trust ‘deaf champion’, alongside his official job of systems administrator. He recently did some excellent work going out into the trust to spread the word about deafness and deaf culture.
It’s essential to provide a culturally as well as linguistically appropriate service. Deaf community has as distinctive values, habits, prejudices, pleasures as other definable communities. To appreciate deaf culture, need to be part of a family or live among deaf people.
Individual rooms have door bells and alarms with flashing lights. Minicom, textphone, fax and Internet use for patients.
Social and recreational
Volunteers from local deaf association go out with patients. Sub-titles on TV are permanently on, although English literacy problems makes weekly See Hear programme (for deaf people) particularly popular.
RNID information about mental illness
Department of Health Mental Health and Deafness: Towards Equity & Access.
I wasn’t at all clear before I visited why a separate service for acutely ill deaf patients is needed. I hope I’ve been able to convey just how essential it is because of the complexity of meeting linguistic and cultural needs on top of all the challenges of providing excellent mental health services.
All the best