Mental Health Services: Sign Language Users
(9 years, 2 months ago)
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Lord Ponsonby of Shulbrede
To ask Her Majesty’s Government what assessment they have made of mental health services for deaf people using British sign language.
Lord Ponsonby of Shulbrede (Lab)
My Lords, the current provision of mental health services for British Sign Language-using deaf people is poor and it is likely to get worse if the Government do not wake up to the problems which will be caused by the move towards using co-commissioning groups for specialised services within the NHS.
Last March, I held a similar debate on the physical health of deaf people. This debate is about mental health services for BSL-using deaf people. It draws on similar research, namely that 40% of deaf people are likely to experience mental health problems in their lifetime, compared to 25% of the hearing population. Indeed, recent research by the Sick Of It campaign suggests that the figure for deaf people could be much higher than 40%.
What makes deaf mental health different? The incidence of schizophrenia among the deaf population is about the same as for the hearing population, but for more common mental health problems such as depression and anxiety the incidence is much higher. This is believed to be due to a variety of factors but particularly to social isolation and also difficulty communicating with parents when deaf people are growing up. I find it interesting that deaf people who have deaf parents are less likely to experience mental health problems.
A deaf person with a broken leg should be able to receive good care at their local hospital, provided a BSL interpreter is used. However, for mental health provision a deaf or signing clinician is needed. A therapeutic relationship needs to be established one-on-one and not via a third party. A specialised therapist would be in a much better position to spot visual clues that are relevant to diagnosis and treatment—for example, pressured signing and alternative signs, where some signs have a double meaning.
Unfortunately, access to specialised support is not available in most parts of the country. This leads to a second-rate and sometimes dangerous service. The current tiers of service within the United Kingdom are as follows: for in-patient services there are currently three units, in Manchester, Birmingham and London, as well as secure private units. This means for most deaf patients that their nearest in-patient unit is a considerable distance away.
Community provision is supposed to be commissioned by NHS England, but in practice there is a postcode lottery. Deaf people in most parts of the country have no access to a specialised community service. The result is that deaf people are dependent on assessment and treatment from non-signing hearing professionals. This frequently leads to misdiagnosis, which can in turn exacerbate the initial problem. The lack of community teams also means that, when deaf people are in-patients, they often have to stay longer than necessary in hospital as discharge is difficult because of the lack of community support.
For psychological therapies, the national Improving Access to Psychological Therapies, or IAPT, programme worked with strategic health authorities and primary care trusts to train deaf IAPT therapists. These therapists were employed by the charity SignHealth and commissioned by PCTs to provide a regional and/or local service. However, since the transfer of commissioning, these contracts have started to come to an end as co-commissioning groups have not been renewing the contracts. As I speak, the BSL IAPT service in Bristol, B&NES, South Gloucestershire, Swindon and Wiltshire has announced that it will close at the end of March. It seems that the CCGs are going back to commissioning IAPT services individually. As a result, there is no mechanism for them to join together again to commission a BSL service as part of IAPT.
In this situation, deaf people are usually told by their IAPT provider that they can book an interpreter if needed. This is a retrograde step, akin to offering an English speaker therapy with a foreign-speaking therapist, with an interpreter if needed. While the BSL component may be a minor issue for commissioners and providers, it is a huge issue for deaf people. Most will now go back to suffering in silence. This step backwards also means that deaf people can no longer self-refer to IAPT services and must go through their GP, who in practice is often a barrier to accessing the service. It is interesting and revealing that SignHealth’s IAPT service had a recovery rate of 76% compared to the 44% achieved by hearing mainstream IAPT services. Adding an interpreter to a therapeutic dynamic lessens the chance of a good therapeutic relationship and adds to the cost.
I understand there has been a meeting between SignHealth and the Minister, Norman Lamb, in recent weeks. It is not yet clear whether a solution to this problem can be found by the Department of Health or NHS England. The important thing—and the purpose of this debate—is for deaf people to have access to a BSL service wherever they live in the country.
I also mention the pilot service dealing with dementia in deaf people. The Deafness Cognition and Language Research Centre works in partnership with the National Hospital for Neurology. This service is threatened with closure as it appears it does not fit in the commissioning structure we currently have. This is another example of services being so specialised and niche that co-commissioning groups, even clustered ones, have too few patients to make it viable. The problem is that the number of patients in each co-commissioning group is too small to commission effectively and there is no mechanism for the groups to co-operate nationally. There has never been national success in commissioning deaf mental health services at a local or regional level. Deaf mental health services have always been considered a low priority, no doubt because deaf people are a largely silent minority. Co-commissioning would be a backwards step from where we are now, which is bad enough. If anything, psychological therapies need to move up to a national approach, with responsibility remaining local. Moving specialised services down would leave them in the same poor position as deaf IAPT services.
I gave the Minister notice of a couple of questions. First, what progress is there with moves to commission a BSL IAPT service? Secondly, would the Minister commit to addressing the problem I have outlined with BSL community and secondary services available to all BSL-using deaf people? It has been suggested that a working party be set up as appropriate to address the issues I have raised today.
Every BSL-using deaf person deserves a care pathway. Currently, the pathway is broken and getting worse, and this would not be acceptable for any hearing person in the United Kingdom. There is wide acceptance among experts as to what is needed. I hope the Minister will use this opportunity to set out the Government’s plans for addressing the mental health needs of BSL-using deaf people. I beg to move.
Baroness Tyler of Enfield (LD)
My Lords, I thank the noble Lord, Lord Ponsonby, for securing this debate and drawing attention to this important issue. A few weeks ago, I opened a debate in this House about the many challenges confronting mental health services as well as the important new policy and service development instigated by this Government. I particularly appreciate the chance to speak today about the problems that deaf people face in accessing effective mental health care.
It is really important to remember that when we speak of deaf people, we speak of a large and extremely diverse group. There are 9 million deaf or hard-of-hearing people and 700,000 severely or profoundly deaf people in the UK, 50,000 of whom use British Sign Language as their first or preferred language. While some deaf people were deaf at birth or from a young age, others become deaf late in life. The mental health needs of deaf people will differ depending on these factors.
Nevertheless, deaf people as a group share a disproportionately pressing need for mental health care. It has been estimated that 40% of deaf people have a mental illness. The prevalence of common mental disorders such as anxiety and depression in the deaf community is nearly double that of the hearing population and behavioural and personality disorders are between two and five times more common among sign language users.
Deaf children are particularly in need of mental health services as the particular challenges of their life make it more likely that they will experience mental health problems. More than 90% of deaf children are from families with no first-hand experience of deafness, which can lead to isolation and troubled relationships with their families. It is salutary to note that deaf children are twice as likely to be abused or neglected as hearing children.
Let me now turn to the issue of prevention. For many people who lose their hearing as adults, the experience of becoming deaf can adversely affect their mental health. For example, research shows that older people with hearing loss are twice as likely to develop depression as their peers without hearing loss as well as increased feelings of loneliness and social isolation. Like, I am sure, other noble Lords, I am conscious of this from the first-hand experience of close relatives. By providing people with hearing aids, we can reduce these risks. Those who wore hearing aids experienced less depression and anxiety, had more and better family and social relationships, and felt better about themselves than those who did not.
It is impossible to avoid the issue of funding and it is complex. To set the overall context, while very welcome additional funding has been made available for specific mental health initiatives, our recent debate made clear that mainstream mental health services have suffered from disproportionate cuts in comparison with physical health services for both adults and children. Within this context, specialist services for deaf people remain a particular concern, not least given the current architecture of health service commissioning. In short, while secondary and tertiary mental health services for deaf people are commissioned on a national basis, primary mental health care is the responsibility of local clinical commissioning groups, and this, of course, includes mental health services for deaf people. So while the specialist in-patient units for deaf people in London, Birmingham, and Manchester that we have already heard about may receive adequate funding, commissioning for community services is extremely patchy. That is mainly because the deaf community within the area covered by each CCG is relatively small and there is therefore little incentive for it to prioritise the needs of deaf service users. The result is that only a handful of services receive local commissioning.
Let me try to bring this to life. Until early last year, deaf service users were able to access a deaf therapist fluent in sign language through the British Sign Language Healthy Minds IAPT service developed by the charity SignHealth, which was referred to by the noble Lord, Lord Ponsonby, with funding from the Department of Health. The programme was extremely successful and nearly doubled the rate of recovery from 44% to 75%, which is extremely impressive and important. However, in the restructuring of the NHS, clinical commissioning groups were often hesitant to commission the service, preferring to use hearing therapists with interpreters, even though the evidence shows that this is not as effective. Meanwhile, the service was often considered too small scale to qualify for national commissioning. Because of these challenges, the service is rapidly shrinking and some staff have been made redundant. Can my noble friend the Minister say what the Government are doing to support CCGs to increase the data collected in their local community to help inform mental health commissioning for deaf people?
In such circumstances, deaf people seeking talking therapies, which I greatly support, often have little choice but to resort to mainstream services. Deaf people are often not given adequate access to interpreters, as we have heard. Indeed, a 2012 survey of British Sign Language users found that 68% of respondents did not get an interpreter for their GP appointment, despite having asked for one. Many others must wait longer for treatment and travel further in order to secure access to an interpreter. What plans do the Government have to increase the provision of medically skilled interpreter services?
Even when there is access to an interpreter, going through therapy with an interpreter can present significant challenges. The 2012 survey indicated that 41% of deaf patients felt confused following their appointment as they had trouble understanding the interpreter. This may be due to cultural reasons. It is important to recognise that the life experiences of deaf people differ in ways that go well beyond language, especially if they have been deaf from birth or a very young age. The relationship between a hearing therapist and a deaf service user can be made more difficult by cultural barriers as well as linguistic ones. It is no surprise or indeed criticism that mainstream mental health service providers often lack the specific expertise necessary to understand the unique life experiences of deaf people and work effectively with deaf clients. It is just that a specialist service requiring specialist expertise is needed.
Moreover, the inclusion of an interpreter, as the noble Lord, Lord Ponsonby, said, inevitably changes the dynamic in a therapeutic situation in ways that can be detrimental. For example, the sorts of topics discussed in therapy can be difficult enough to tell to a therapist without having to wonder whether one’s words will be faithfully conveyed by the interpreter. As the deaf community is small and close knit, there is a real chance that the patient will know the interpreter, and because qualified interpreters are hard to come by, the options are limited and there are few alternatives if a patient is uncomfortable with his or her interpreter.
As we have heard, there are specialist in-patient psychiatric units for deaf people in London, Manchester, and Birmingham, but the quality of care that deaf people receive is adversely affected by a lack of community resources. A recent report by the National Deaf Mental Health Service has shown that deaf adults in specialist and general in-patient programmes were in hospital for twice as long as hearing patients, not because of actual clinical need but because the community services they would need on discharge were not available. The current dearth of specialist services for deaf people is not inevitable. As Dr Sally Austen, a specialist for deaf people with mental health problems and a former chair of the British Society for Mental Health and Deafness has pointed out, if specialist deaf services were to include partially deaf people, the economies of scale would change. Dr Austen has also suggested that what is called “tele-mental health”, including online services, may also provide a solution for deaf patients with poor access to appropriate providers having to travel very long distances.
This is an extremely important discussion, and yet is not one that we often have. The last government strategy on the topic was back in 2005. If nothing else, what we have already heard—and more is to come—about the wide array of challenges that deaf people face in securing access to mental health care should surely convince us of the importance of updating our aims for this type of healthcare provision. I therefore, finally, ask my noble friend the Minister what plans the Government have to update the 2005 Mental Health and Deafness: Towards Equity and Access document so that it can become the cornerstone of all our work.
The UK has had a proud history of providing excellent mental health services for deaf people. It would be a tragedy to neglect that history by failing to give deaf people the access to therapy that they so clearly need and deserve.
Lord Borwick (Con)
My Lords, I declare an interest as a trustee of the Ewing Foundation for deaf children.
I am grateful to the noble Lord, Lord Ponsonby, for again raising for debate important issues on deafness, but I rather disagree with the noble Lord on the definition of deafness. It should not be defined as the characteristic of those who use sign language, because there are a host of elderly deaf people who do not use BSL and many children born with a profound hearing loss now have cochlear implants which, although leaving them still with a significant hearing impairment, enables them to communicate in spoken languages. Similarly, improvements in hearing aid technology have made it easier for other deaf children to communicate in a spoken language. The Oxford English Dictionary defines “deaf” as lacking the power of hearing or having impaired hearing. That is the definition we should use; a definition that depends on BSL implies that BSL is the only characteristic, and that is problematic.
Today’s debate is particularly important because there is a lot of evidence of depression and mental health issues among deaf people, including those who use sign language. All the evidence suggests that hearing loss can substantially increase the risk of mental health problems. Anxiety, paranoia and depression are particular risks. Those with hearing loss are overrepresented among samples of patients suffering from paranoid psychoses in later life. Older people with hearing loss are more than twice as likely to develop depression as their peers without hearing loss. It is therefore important that the appropriate mental health services are available for deaf people and that the right steps are taken to improve outcomes.
I know that some will argue that, because not everyone can use sign language, deaf people who use it may experience depression and mental health issues even more acutely. Deaf people using sign language to communicate may have fewer opportunities to access appropriate special services too, and there are still a few children who use BSL as their only language who would struggle to access mainstream mental health services because of language barriers. This no doubt accentuates the feelings of frustration. There is research showing that deaf children who live in families where BSL is the only language are less likely to experience mental health problems than deaf children in families who use English. If you cannot communicate with your family, it is little wonder that you feel isolated. However, that research is dated.
New technology, such as digital hearing aids and cochlear implants, is reducing the need for the BSL language, and early detection is further breaking down the reliance on BSL. We have to remember one crucial point in this debate: there is a whole range of deafness, and not all the people on the spectrum use BSL, but new technology and early detection mean that many more can take a full and active part in a hearing society while still being able to use sign language if they choose. Doors are opening and many deaf people or partially deaf people can enjoy the best of both worlds rather than becoming frustrated by the limitations of just one. Being able to access both deaf and hearing communities is going to be good for the mental health of those with hearing difficulties.
Much more care is being taken to focus on the mental and emotional health of deaf children. The National Sensory Impairment Partnership has worked with the National Deaf Children’s Society to produce documents for teachers of the deaf on emotional well-being. The website for the National Sensory Impairment Partnership has published guidance for teachers on how to deliver a course called Think Right Feel Good. This helps teachers to understand and develop emotional resilience in deaf children.
There are a host of foreign languages in the UK. All speakers of unusual languages have the same problem: the inability to communicate except in their own community. The number of deaf young people who are reliant on BSL to communicate and access teaching and learning has declined significantly, and this will be reflected over the next few years in the adult population. I am full of admiration for the wonderful children who use BSL while learning to read and write English at the same time, but technology is changing that and we have to embrace it. It is so exciting that we can bring deaf people into the speaking world. Look at the new apps available on smartphones nowadays. Google Translate and Skype Translator both instantly translate foreign languages. Siri is starting to do so on Apple products. The app Mimix says that it will simultaneously translate from English into American Sign Language. MotionSavvy will translate the other way. I am sure it is not yet perfect, but a great start would be for BSL users to carry this sort of technology when having a vital conversation with a doctor. This is a story of success—not perfect by any means but apparently getting better.
It is, of course, very sad that the situation was so bad in the past, but the important thing is that things get better, and it will be ameliorated by technology, not by government expenditure. The overall priority should be to integrate deaf children into society, and as a fully integrated group they will no doubt have a similar incidence of mental illness, tooth decay and cancer as the rest of society. Any incidence of mental illness is appalling, but I am not sure that it is sadder because the victim is deaf than because the victim speaks Pashto or Welsh.
I ask my noble friend the Minister if he is able to publish data on the characteristics of children referred to specialist deaf mental health services. What percentage of the children are lip-readers, use BSL or have cochlear implants? I believe that more information will only help us to learn and improve. It would be very helpful to see the data on the characteristics of children referred to specialist deaf child and adolescent mental health services to see what we can learn. If we were aware of the most common profiles of children referred to the specialist services, perhaps this would inform preventive work and where it should be targeted.
Lord Addington (LD)
My Lords, in a short debate like this it is not uncommon when you come in at the end for much of what you want to say to have already been touched on, but in this debate I am afraid there has been the banging of guns and the falling of foxes all over the place. I am left with saying, as my noble friend who has already spoken has said, that much of what we are discussing here was touched on in our debate on mental health. I spoke then about the fact that all disability groups are overrepresented in the mental health sector—end of story. Anybody in those groups who has problems in the outside world and suffers more stress will have mental health issues, as night follows day; the question is what we do to ameliorate the situation.
The noble Lord, Lord Ponsonby, has rightly pointed to a particular group here, because the whole question is brought into focus when you look at a particular group: you see the specifics as opposed to the general. The whole spectrum here is made up of a series of specific points. British Sign Language users are going to have their own specific problems. They are specific, as the noble Lord, Lord Borwick, has just said, to a section of those who have hearing problems, such as hearing loss. The group has quite profound problems, and the question we are looking at here is how we make sure that they can access and receive support. Even if the noble Lord is right and they are a declining group, they are still going to have problems in the future that must still be addressed, because if you do not address them you store up problems, costs and inconvenience for the rest of society in an ongoing process. I therefore congratulate the noble Lord on raising this issue, because unless you concentrate on the problem in this way it becomes a generality, and I very much commend him for raising it.
Then we come to technology, and here I must declare an interest as chairman of a company called Microlink, which deals with technology. There is a lot of interesting stuff out there that can be of some assistance to those with varying degrees of hearing loss. As has already been said, there are dozens of ways in which you can play with language and translate it. There are things that can be used, and we have probably only just started to touch on this. There is something that can translate language into text; I use it myself as a dyslexic. There are dozens of bits of technology out there.
However, as was pointed out to me with considerable force when I started doing research on this, the deaf community across the spectrum is already using an incredibly widespread piece of technology called texting. This had not occurred to me at all. Mobile phones? I am part of the generation that regards a phone as something you talk to. I am apparently in the stone age here. Phones that you can text on that use a simpler, less elaborate grammar are actually a very common way of communicating in the deaf community. Do health workers and mental health workers actually know—the noble Lord, Lord Ponsonby, spoke about the same problems—that this is a way of establishing communication that might well mean that you find an easier path through to therapy than using sign language interpreters? It might well be some form of back-up to the primary talking cures for all forms of mental health treatment, which are generally regarded as better, longer lasting, more maintainable than simply pumping somebody full of drugs, even if drugs have to be used at the same time. Unless there is some way of bringing all these things together to get the best outcome, we are going to miss a trick.
Unless we learn to use the technology coming through, which is increasingly available—here I am probably shooting my own company in the foot—we will incur more on-costs. A little awareness training—asking people in casualty if somebody comes in who is in a very distressed state, “Have you tried communicating with them by text?”—may well relieve some of the stress, it may identify some of the symptoms more quickly. Could not a little bit of guidance here and there be worked in?
There are other forms of communication. My favourite one is called the UbiDuo. I like not only saying the word but the fact that it is instant typing to another screen that translates straightaway. The whole thing is about the size of a traditional laptop, so you can carry it around. That would be more appropriate for those who have good written skills, but there are lots of established pieces of tech that we are not getting the best out of. For the foreseeable future, we will need councillors who are skilled at using the specific sign language, with its rules of grammar, nuance and cultural references, but we may well need to support them and take some of the stress off them by using technology at the same time.
When all is said and done, the technology is generally cheaper. If we concentrate on that and make a funnel through to those very valuable—at times, irreplaceable—people, we will surely be doing all of us a favour.
Baroness Hollins (CB)
My Lords, I would like to add a couple of points to the debate from my experience as a psychiatrist. We have heard that deaf people continue to face unacceptable inequities in access to mental health services, and that is particularly the case for the estimated 25,000 deaf people in the UK who use British Sign Language as their first or only language. Deaf BSL users from black and minority ethnic communities, or who have additional needs arising from co-morbid visual impairment or intellectual disability, encounter even greater obstacles to accessing mental health services.
We have heard that deaf children are more likely to experience emotional, physical or sexual abuse, which contributes to later mental health problems. Deaf adults are much less likely to know how to report suspicions of abuse. Thus, children living in deaf communities are more likely to have their experience of abuse go unnoticed and unreported. The community interest company, Books Beyond Words, which I chair, has been commissioned by the NSPCC to help it develop pictorial resources to improve the reporting of such abuse to organisations such as the NSPCC.
We have heard that many deaf people leave GP consultations with no understanding of what went on, and consequently avoid going to see their GP altogether. Research has shown that a shocking one in seven people with hearing loss has missed a healthcare appointment because they did not hear their name being called in the waiting room. Those access problems continue despite the Disability Discrimination Act’s requirement for reasonable adjustments to be made, and they are compounded by a lack of deaf awareness training for professionals working in healthcare settings.
Within mainstream mental health services, few staff possess the BSL skills and experience needed to work effectively with deaf BSL users. Mental health services frequently fail to arrange for BSL interpreters to be present at appointments, often relying on family members, including children, to act as informal interpreters. That practice is unjustifiable, particularly in mental health services, where sensitive and personal issues, sometimes including abuse, may be disclosed. There is also an ongoing shortage of BSL interpreters in healthcare settings and a lack of specialist training for those who wish to work with people with mental health needs. What steps will the Government take to increase the number of BSL interpreters within mental health services?
The Sign Health charity highlights that over the past three years, it has trained 18 deaf and three hearing BSL users to work as psychological well-being practitioners in several geographic regions, but only seven are currently employed, reflecting a lack of recognition of the need for their services. Does the Minister agree that such provision would constitute a reasonable adjustment, and can he assure the House that action will be taken to improve deaf people’s access to IAPT services provided by therapists sufficiently fluent in BSL?
Deaf people are also overrepresented in secure mental health settings, and are thought to be overrepresented in the prison population, which may reflect a prior failure to address their mental health needs. It suggests the need for specialist prison in-reach services, so that deaf people with mental health needs can be identified and supported.
I highlight the importance of addressing the social determinants of mental well-being in deaf people. The exclusion, isolation and barriers that deaf people experience in education, employment and the community can negatively impact on their social and emotional well-being, along with their education and employment outcomes, thus perpetuating the cycle of adversity which puts them at greater risk of mental health difficulties. Can the Minister assure the House that recommendations to address those factors will be included in the Government’s forthcoming action plan on hearing loss?
A couple of examples were given to me by a psychiatrist working in one of the national deaf mental health services of children who he visited in mainstream schools. One child was using only BSL in a mainstream school where nobody else knows BSL. A young person in a special school whose only language was BSL was in a class with seven young people with learning disabilities, none of whom was deaf or knew BSL. That is clearly unacceptable. I look forward to the Minister’s response and thank the noble Lord, Lord Ponsonby, for raising these important matters.
Lord Hunt of Kings Heath (Lab)
My Lords, I, too, thank my noble friend for instituting this debate and Sign Health for its valuable briefing. I welcome the input of the noble Lord, Lord Borwick, but my noble friend’s Question was quite specific. I fully accept that however widely you define deafness, the scale of mental health problems is serious and deserving of attention. I thought that the noble Lord, Lord Addington, put it well. The focus on British Sign Language users is valuable in itself, but it is also a signal of more general problems.
Interesting work published recently in the British Medical Journal has shown, first, as is well known, that deaf adults in the UK occupy poorer socioeconomic positions, have poor literacy and have limited access to communicate through speech. Their health is generally poorer than that of the general population, with probable underdiagnosis and undertreatment of chronic conditions. As for mental health, other research shows that 40% of deaf people are likely to experience a mental health problem. Although the incidence rate of schizophrenia is probably similar to that of the hearing population, the rate of common mental health problems is much higher. Going back to the BMJ research published only a week ago, the rates of depression self-reported by deaf participants was 24% overall—32% for women and 14% for men.
In any response to the mental health issues facing many deaf people, it is abundantly clear, as the noble Baroness, Lady Tyler, said, that there is no national strategy to which one can turn to describe what services deaf people could expect from the NHS. That is related to confusion about what should be commissioned at national and local level. We see lots of indications that clinical commissioning groups find it very difficult to commission services for what inevitably will be a small population in their area.
Equally, I fully accept that not all of that can be commissioned at the national level. We need to find a way that will help clinical commissioning groups to commission services locally for these smaller population groups so that there is much more of a cohesive approach. I do not think that CCGs will do it if left to themselves. That is the real problem that we face, alongside the funding issues around commissioning at a national level for speciality services. This is not an easy issue, but we have to do better than at the moment.
A number of noble Lords referred to the position facing speciality services, and I want to add to the points that my noble friend made about this. I want in particular to raise the question of the Deafness Cognition and Language Research Centre at University College London, which I understand is putting together a costed business case for a national neurological service for British Sign Language deaf users. I understand that it has met Norman Lamb; it has also met my colleague Andrew Gwynne. This has clear cross-party support. The centre is putting a business case forward to secure the presence of a clinic beyond 2015; I do not know if the Minister will be able to update me on progress in that area.
My noble friend and other noble Lords have mentioned the Improving Access to Psychological Therapies service, which showed very promising results from the date of its introduction. Other noble Lords referred to the outcome measures. This has clearly fallen foul of the problem of being delegated to CCGs to commission; they are clearly not going to do so. I had the privilege of meeting SignHealth with Mr Norman Lamb. We had a very good hearing and I was left with considerable optimism that some way would be found to fund this. Again, if the Minister were able to give us some updates on the progress of that, I would be very grateful.
We come back to the point that, if this is left to local CCGs, there is no hope for services that need a contribution from each CCG to make it viable. One way or another, we have to find a way for there to be some kind of national leadership. Indeed, if I were to ask for one thing above all else, it is that the Minister would see if his department was prepared to produce some kind of cohesive strategy around deaf issues and mental health issues for deaf people. That would then give us some encouragement that we would be able to tackle these issues in a coherent way. I always thought that national service frameworks were a very good idea; I am not sure that the current Government think so but, if we are not to have them, we need something in their place.
I want to ask the Minister about the equality duty in relation to deaf people. Is he satisfied that the NHS understands its responsibilities under the equality duty? The noble Baroness, Lady Hollins, suggested that many staff in the health service are very much unaware of the issues for deaf people and the barriers that they face. The issue here is that we lack national standards against which local NHS bodies could judge their performance. The noble Baroness raised the question of reception and waiting room experience. The fact is that work has been done showing that 90% of deaf people have missed many GP appointments through not hearing their name called out in the surgery. That is just one example of the kind of communication problems that they face. At this point it would probably be better if I sat down and gave the Minister even more time to answer the questions.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I thank the noble Lord, Lord Ponsonby, for securing this short debate on the mental health of deaf people who use British Sign Language. Over 10 million adults in England live with some degree of hearing loss and, while some will be among the one in 700 babies born with hearing loss, many of us will develop hearing loss over our lifetime. With an ageing population, this figure is only going to increase, with the World Health Organization predicting that by 2030 there will be an estimated 14.5 million people in the UK with hearing loss, with adult-onset hearing loss predicted to be among the UK’s top 10 disease burdens.
We know from research that deaf people are at a much higher risk of mental ill health than the general population, with 40% of the hearing-impaired population and 50% of the profoundly deaf expected to experience mental health problems during a lifetime, compared with around 25% within the general population. It is therefore vital that we provide deaf people with appropriate services that support their mental health needs.
The Government are committed to improving mental health services and ensuring that those services have equal priority with those for physical health. Our mandate to NHS England makes it clear that everyone—I emphasise “everyone”—who needs them should have timely access to evidence-based services. Over £400 million is being invested over the spending review period to make a choice of psychological therapies available for all those who need them in all parts of England. We have put in place for the very first time waiting-time standards for mental health, a significant milestone on the road to parity.
The NHS is a universal service. I listened with care to the remarks from the noble Lord, Lord Hunt, about equality. NHS England is under a specific legal requirement in relation to tackling health inequalities and advancing equality. The Government will hold NHS England to account for how well it discharges this duty. We recognise the importance of deaf people being supported and enabled to communicate through British Sign Language where they wish to do so. Section 20 of the Equality Act 2010 requires CCGs to make “reasonable adjustments” so that disabled people are not placed at a substantial disadvantage compared with non-disabled people. The reasonable adjustment duty is an anticipatory duty, meaning that service providers are expected to anticipate the requirements of disabled people, and the reasonable adjustments that may have to be made for them, before any disabled person attempts to access the service in question. Simply put, it is not acceptable for health services not to be equipped to provide communication support to those who need it.
Equality legislation means that service providers and public bodies must provide a reasonable adjustment to their services to meet the needs of clients when it is reasonable to do so. This may be the provision of interpreters or services delivered in BSL. In September 2013 the Prescribed Specialised Services Advisory Group, PSSAG, considered a proposal from SignHealth for NHS England to commission psychological therapies for deaf sign language users. The PSSAG felt that although the provision of IAPT services using BSL was clearly complex, it did not meet the requirements for a specialised service commissioned directly by NHS England, and therefore responsibility for commissioning psychological therapies for deaf sign language users should remain with clinical commissioning groups. The PSSAG recommended that CCGs be signposted to the relevant organisations and informed about the services and support that they can provide to deaf patients.
From his remarks, the noble Lord, Lord Ponsonby, was clearly in favour of community and secondary deaf mental health services being commissioned as a specialised service. I am sure he will understand that any proposal of that kind would need to be considered by the PSSAG. However, with regard to NHS England retaining responsibility for existing specialised deaf mental health services, even if co-commissioning were introduced I can assure him that NHS England will retain the responsibility as set out in the mandate and the Manual for Prescribed Specialist Services for the specialised deaf services. Future collaborative commissioning arrangements have not been confirmed as yet, but that will not alter NHS England’s responsibilities as the responsible commissioner. However, we know that more needs to be done.
As the noble Lord, Lord Ponsonby, mentioned, my right honourable friend the Minister for Care Services, Norman Lamb, recently met SignHealth. At this point, I pay tribute to the exceptional work of SignHealth in promoting the same sort of access to healthcare and health information for deaf people as hearing people receive. I have visited SignHealth on more than one occasion. SignHealth impressed upon my right honourable friend the importance of psychological therapies for deaf people through the Improving Access to Psychological Therapies service. Since the meeting, officials have been working to develop proposals in support of the commissioning and provision of psychological therapies for deaf people in England. The noble Lord, Lord Ponsonby, asked whether a working group could be established to look at this issue further. I believe that is a sensible suggestion, and I am happy to commit to it. In the mean time, we will remind clinical commissioning groups of the importance of commissioning IAPT services that are accessible to British Sign Language users.
We are committed to delivering health outcomes that are among the best in the world for people with hearing loss. We have made considerable improvements over recent years, including the rollout of a national screening programme for newborn children, significantly reducing waiting times for assessment and treatment and greater choice of hearing aid services—for example, through independent high-street providers.
NHS England is developing a new accessible information standard which will provide clear guidance to health and social care organisations on the steps they need to take to ensure that disabled patients, carers and service users receive information in appropriate formats, and communication support if they need it. This will include the provision of interpreters or BSL users for deaf people. NHS England has worked closely with SignHealth in the development of the standard, and SignHealth has offered advice about aspects of the standard which relate to deaf people. It is anticipated that the standard will be published in the spring and that organisations would then have 12 months to implement it. Alongside the statutory information standard, NHS England will publish guidance on making reasonable adjustments to meet the communication needs of service users with disabilities.
As well as an information standard, NHS England, alongside the Department of Health, is developing an action plan on hearing loss which will identify the key actions that will make a real difference to improve the lives of all those with hearing loss. The action plan is in its final stages of development with a view to being published soon. I hope that goes some way to address the question asked by the noble Lord, Lord Hunt, about a national service framework or the equivalent thereof.
I shall, of course, write to noble Lords whose questions I am unable to answer in the debate. My noble friend Lady Tyler asked me several questions. One was about the 2005 document Mental Health and Deafness—Towards Equity and Access. There are no plans to update that document. She also asked me, as did my noble friend Lord Borwick, about what we are doing to support CCGs to increase the data collected in their local communities to help inform mental health commissioning for deaf people. Our goal is to create the most open and transparent healthcare system in the world. To support this ambition, we need to build a truer, more up-to-date picture of mental health and well-being, both nationally and in each area. The current level of information collected on IAPT represents the gold standard of data collection. We have robust information on the numbers of people accessing services, how long they wait, how many recover or improve as a result of treatment and the cost of these services, which is a genuine world first in mental health. Our ambition is to bring the same standard of information to all mental health services over time.
My noble friend and the noble Baroness, Lady Hollins, asked about the supply of medically skilled interpreter services. It is clear that we need to work across government and with the voluntary and public sectors to encourage more people to come forward to train and qualify as BSL interpreters. We know that it takes at least three to five years to train a person in BSL to level 3, which is a basic requirement for a therapist/clinician. NHS England advises us that this will be addressed within a framework for workforce planning.
My noble friend Lord Borwick spoke with tremendous authority about the mental health needs of deaf children. Children and young people’s mental health is a key priority for the Government, as I hope he knows. In August 2014, we launched the children and young people’s mental health and well-being task force. That task force brings together a range of experts. It is looking at how to improve the way children and young people’s mental health services are organised, commissioned and provided and at how to make it easier for young people to access help and support, including in schools, through voluntary organisations and online. That very definitely includes deaf children with mental health problems.
My noble friend Lord Addington spoke very powerfully about the use of technology. As he will understand, this is a decision for individual providers, but the NHS’s ambition is to embrace technology as part of its drive to offer modern, convenient and responsive services to patients, their families and their carers. General practices are leading the way on that. The NHS is working with local commissioners and is undertaking a number of pilots to redefine and improve the design of the future NHS 111 service, which includes improvements to the text relay service, making it easier for text relay users to navigate to a service provider. As regards the delivery of psychological therapies to deaf people, we are currently exploring the commissioning of online BSL or text-based models of delivery.
The noble Lord, Lord Hunt, asked me about the UCLH project. University College, London, has developed a case with the Deafness Cognition and Language Research Centre on what a deaf cognitive service should look like. We understand that proposals for the future of the services are under discussion.
I hope that in the time available I have been able to reassure the noble Lord, Lord Ponsonby, and indeed the House, of this Government’s continued commitment to meeting the specific needs of deaf people and that we take this issue very seriously.