Service changes and visiting during the COVID-19 pandemic

During this COVID-19 pandemic there may be changes in the way some of our services work. Contact the service directly to check how services are being delivered and follow their advice.

Some of our services now offer video consultations. You should speak to your clinician if this is something you would like them to consider. You can find out more about video consultation here.

 

Visiting

Contact the ward you wish to visit in advance for guidance and instructions for a safe visit.

You can read some general  NHS guidance on visiting healthcare inpatient settings.pdf [pdf] 89KB

If you need help in a mental health crisis during the COVID-19 pandemic outside office hours please contact our crisis team: Help in a crisis

For other medical advice and support contact your GP or visit NHS 111

Only visit your local Emergency Department for serious life-threatening conditions that need immediate medical attention including persistent severe chest pain, loss of consciousness, acute confused state, severe breathlessness, severe blood loss, serious burns or suspected stroke.

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.  It provides a comprehensive MDT assessment, treatment and recovery for a maximum of 10 D/deaf males irrespective of their diagnosis or treatment pathway within a high secure setting.

The 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 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 not only are experts in their field, they are experienced in D/deaf mental health. The team include 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 (MDT) engages 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 and so as 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 their 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 their individual needs and adopts 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 enable the individual to manage their presenting problems.  We asses 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.

 

 

Lead clinician

Dr GS Kaler
Consultant Forensic Psychiatrist
Medical Lead, National High Secure Deaf Service

Tel: 01777 247709
Email: gurpreet.kaler@nottshc.nhs.uk

 

 

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