National High Secure D/deaf Service

The National High Secure D/deaf** Service is currently located on Grampian ward within the Mental Health Directorate at Rampton Hospital. We provide a comprehensive multi-disciplinary assessment, treatment and recovery within a high secure setting for a maximum of 10 D/deaf males, irrespective of their diagnosis or treatment pathway.

Our patients are a diverse group with common themes:

Language
Culture
Development
Mental disorder
Offending behaviour

Due to the diverse health, social and risk needs of the patients, the care and treatment of D/deaf patients includes patient involvement whenever possible, support for families/carers and other Trust departments and outside agencies wherever practicable.

The MDT aims to work towards transferring patients to a lesser secure environment as safely and quickly as possible.

Philosophy of care

Our aim is to provide a National High Secure D/deaf Service to D/deaf patients and their families, enabling equitable access to the services that hearing patients and their families/carers can expect.

We recognise and value the use of BSL and acknowledge the importance and existence of D/deaf culture. We also recognise the wide range of communication methods other than BSL used by D/deaf people. These include, but are not limited to, Sign Supported English, the use of technology (such as a Lightwriter), Signed English and Total Communication.

We recognise, respect and treat patients and staff as individuals regardless of illness, disability, age, diagnosis, culture, religion, classification under the Mental Health Act, race, background, gender identity, sexual orientation or language.

Our MDT consists of highly specialised individuals that are not only experts in their field, they are experienced in D/deaf mental health. The team includes the psychiatrist, nursing team (qualified nurses and nursing assistants), pharmacy, psychology, social work, art psychotherapy, speech and language therapy, education, and occupational therapy. Members of the Register of Sign Language Interpreters (MRSLI) enable us to engage effectively with the D/deaf patients.

We believe that there must be open and honest dialogue among practitioners, with all views being equally acknowledged and equally valued to ensure effective MDT collaboration.

We acknowledge that care and treatment must be delivered to the highest possible standard of care. To this end all members of the multidisciplinary team engage in ongoing training and supervision to enable them to use basic BSL, to have an understanding of D/deaf Culture and of mental health presentation and/or offending behaviour in D/deaf people.

We believe that there must be open and honest dialogue among practitioners, with all views being equally acknowledged and equally valued to ensure effective MDT collaboration.

We recognise the need to maintain a balance of security and therapy to ensure the physical, procedural and therapeutic safety of the patients, staff and the public.

The D/deaf prison in-reach service

The service was set up (and funded by NHS commissioners) in 2011 after it became apparent that the specific, distinct needs of D/deaf offenders with mental health difficulties were not being met within mainstream prisons to offer them equitable access to support, psychological intervention and rehabilitation. That is by no means a criticism of the prison service – D/deaf individuals have unique and specific needs that require a specialist service and that is something that we hope to offer D/deaf offenders within the prison estate.

Dr Kaler (Consultant Forensic Psychiatrist), Jason Lowe (Clinical Nurse Practitioner), Janette Dobson (Psychologist) and a qualified BSL Interpreter offer and provide in-reach support to prisons, prison staff and D/deaf offenders within prisons. We provide assessment of D/deaf prisoners to identify treatment needs and risks, including care-planning/CPA, structured risk assessments. Our D/deaf assessment is specialist in nature and will include an assessment of communication style as well as mental disorder, personality difficulties, trauma and risk, along with a collaborative psychological formulation that is used to inform an individually planned treatment pathway that will address risk reduction. Our treatment pathways are tailored to individual needs and adopt a trauma informed strategy that typically includes Eye Movement Desensitisation Reprocessing (EMDR), Schema therapy, sensorimotor psychotherapy, Compassion Focussed therapy (CFT), Dialectical Behavioural therapy (DBT) and Cognitive Behavioural therapy (CBT). These specialist interventions are used with the aim of reducing individual risks and enabling the individual to manage their presenting problems. We assess if treatment is best served in the prison setting or if a secure hospital referral is required. Provision of specialist assessments and reports for those service users which will help inform sentence planning and progress against that sentence plan is part of our role. We aim to develop and support the local prison workforce towards best practice for the D/deaf population and where necessary, develop a range of training initiatives to increase the knowledge base and skills of the existing (prison) workforce, such as Deaf Awareness Training.

**The cultural model (‘D’) defines Deafness as an identity, something which has its own language (British Sign Language) and own customs. People who align with this model would usually be immersed in the Deaf culture and would often embrace their Deafness such as attending Deaf Clubs and socialising within the Deaf community. It is also a term usually used to reference a group of people who were born deaf or became deaf early on in life, often pre-lingually.

On the other end of the continuum is the medical model which perceives deafness (‘d’) as a medical issue or pathology that requires intervention or treatment in order to ‘fix’ it. People who align with this model may have lost their hearing as opposed to being born deaf and may seek to ‘cure’ their deafness by utilising assistive technology such as hearing aids or cochlear implants. Whilst the model outlines the two distinct positions regarding D/deafness and ascribes the onset of deafness to where an individual would be placed on the continuum, positioning can be fluid.