British Sign Language (BSL) National Plan 2017-2023: analysis of consultation responses

Health, mental health and social care

Goal: Users will have access to the information and services they need to live active, healthy lives, and to make informed choices at every stage of their lives.

Steps to be taken by 2023 are:

30. Ensure that information on national health screening and immunisation programmes is routinely translated into BSL and is readily available and easy to access.

31. Improve access to, and the availability of, professionally approved health information in BSL by ensuring that it is located in a central place online.

32. Develop and roll out BSL awareness training for health and social care staff across Scotland ensuring that it is readily accessible at the point of need and tailored to a health setting.

33. Consider ways to improve individual patient health records so that a person's records clearly indicate when a patient's first or preferred language is BSL.

34. Ensure that information about people's rights to directing their own social care and support (Self-directed Support) is available in BSL.

35. Ensure that a national source of mental health information, advice and support is developed for BSL users.

Question 16: Do you think these are the right steps under Health, Mental Health and Social Care?

In total, 102 people or groups answered Question 16. Of these 73% agreed that these are the right steps under Health, Mental Health and Social Care, 11% disagreed, and 17% said they did not know.

Question 17 - Please tell us why you think this.

Question 18 - If there are there any additional steps, or potential solutions that you think could be added to the Health, Mental Health and Social Care section, please tell us.

Around 80 people or groups made a written / BSL comment about Health, Mental Health and Social Care and it was discussed at around 65 events.

Many people noted the critical importance of Deaf and Deafblind people being able to access good quality health and social care-related information and services which meet their particular needs.

Other comments included that it will be very important to ensure that the needs of children and young people, older people and of Deafblind BSL users are taken into account. For young people, this might be about ensuring there are people of their own age they can talk to, especially about mental health issues. For older people, there were a number of concerns about the lack of appropriate provision for older people, both in terms of services provided in their own home and around specialist housing or care provision.

A number of people commented on the availability and qualifications of interpreters. These comments included that interpreters are being used at GP and hospital appointments less than 20% of the time and that there are clear barriers facing Deaf / Deafblind BSL users in Scotland. Another issue which people talked about across this theme was that high-quality translating and interpreting services will be key, including in emergency situations. The need for interpreters with particular experience and skills relating to mental health and dementia was also highlighted.

Suggestions included that only Registered Deaf Relay translators or BSL / English interpreters should be used and that Deaf / Deafblind BSL users should be allowed to choose preferred BSL / English interpreters. Another comment was that Communication Support Workers ( CSWs) can also be very important.

Other general comments included that:

• The Access Support Card and use of contactSCOTLAND- BSL needs to be promoted.
• There can be problems with booking and confirming appointments across a range of services but especially for GP services. For example, people may be asked to phone to confirm an appointment or if services need to change or cancel an appointment, they will often phone. This approach does not work well for Deaf / Deafblind BSL users.
• Advocacy services need to be available. These should be centrally funded and not reliant on charitable or other funding.

Information on national health screening and immunisation programmes (Step 30)

Comments people or groups made about this step included:

• People need comprehensive and not just summary information.
• Both Health Scotland and Health Boards have the role of providing health information for patient groups, including Deaf / Deafblind BSL users. Better signposting arrangements should make this clear for the BSL community.

Suggestions made or ideas people or groups had included:

• Exploring the role of the national Boards in providing information.
• Providing information on screen in GP surgeries and Hospital waiting areas regarding immunisation and any new epidemics, annual or seasonal illnesses and where to seek more advice.
• This information should also be available centrally, including on a national website and there should be clear signposting to this information.

Access to and the availability of health information (Step 31)

Comments people or groups made about this step included:

• Feedback from BSL communities in one area is that they would rather have a Deaf person signing resources than a BSL / English interpreter.
• It may be that translated information needs to be sent as an MP3 link or uploaded to YouTube and holding this type of information on a central site would be sensible.
• Some people are concerned about understanding prescriptions and medicine. After getting prescriptions from GPs, Deaf / Deafblind BSL users find communication difficult with pharmacists. They find medicine instructions difficult to understand.
• Plans are being looked at to set up a Deaf Zone – a website for Deaf people in the West of Scotland. This would be a social zone as well as for the public and third sectors to use.
• Although a central online hub with professional health advice available is welcome, it is not a substitute for one-to-one support within communities, primarily within GP surgeries and local hospitals.
• Not everyone has access to or likes getting their information online.

Suggestions made or ideas people or groups had included:

• Supporting a Scottish wide social enterprise organisation run by and for Deaf people where the health service and other public sector could go to get information translated.
• Rolling out of Video Relay Services ( VRS) at the initial point of contact would provide the patient with immediate information and language support as well as assisting the staff in 'triaging' the patient more efficiently.
• GP practices should install visual displays in their surgeries so that Deaf patients are alerted when they are due to see their GPs.
• Deaf / Deafblind BSL users also need access to healthy living groups, such as groups offered to people after heart attack, or Dementia support groups or carers groups.

Develop and roll out BSL awareness training (Step 32)

Comments people or groups made about this step included:

• This also needs to cover Deafblind awareness, including Tactile BSL.
• It will be important to include social care settings as well as health services, particularly given that the population is ageing.
• Health care professionals may in the course of their careers never provide a service for Deaf / Deafblind BSL users. It is important for training to be targeted to those staff who are most likely to need it.

Suggestions made or ideas people or groups had included:

• Awareness-raising and/or BSL learning should be key parts of the training and qualification phases across all health and social care roles, including being covered on University courses. It could be a mandatory training unit for some courses, including medical and nursing degrees.
• BSL awareness should also be a required element of induction and refresher training across health and social care positions.
• The BSL awareness training should cover all ethnicities, faiths and cultures.
• Consideration should be given to funding support organisations to provide BSL training as there is already significant pressure put on limited financial resources.

Consider ways to improve individual patient health records (Step 33)

Comments people or groups made about this step included:

• This could build on the work Health Boards and the Scottish Government have been developing on additional needs, through the Access Support Needs Short Life Working Group.

Suggestions made or ideas people or groups had included:

• This step should apply not just to the health sector but also to social care services.
• Individuals' health records should flag up that the patient is Deaf and should set out their communication needs. This would allow the service to ensure an interpreter is always available when required.
• There should be better partnership working around passing on required communication needs as part of referrals between services.

Ensure that information about Self-directed Support is available in BSL (Step 34)

Comments people or groups made about this step included:

• This is a very important right and it is very important for Deaf / Deafblind BSL users to be able to access Self-directed Support. However, many Deaf / Deafblind BSL users may not know about the SDS option.
• A small number of people talked about the problems they had experienced when applying for SDS funding. This was sometimes about the process being difficult but was sometimes about not being receiving any funding.
• There are already resources on SDS available in BSL and these resources should be used rather than duplicating effort.
• The application forms for SDS are inaccessible and the application process is likely to be difficult for most Deaf / Deafblind BSL users.

Suggestions made or ideas people or groups had included:

• Staff assessing Deaf / Deafblind BSL users for SDS must have Deaf culture and BSL awareness training in order to perform any assessment of need.

Ensure that a national source of mental health information, advice and support is developed (Step 35)

Comments people or groups made about this step included:

• A number of Deaf / Deafblind BSL users talked about very difficult experiences which they, their family members or their friends had been through. A common theme was being unable to access the necessary support.
• A national resource on mental health would be a great way to ensure equitable access to information. Each Health Board could have a micro site that explains their services and pathways into services.
• Telephone led services are inaccessible for Deaf / Deafblind BSL users and there are no comparable immediate access services for Deaf / Deafblind BSL users experiencing a crisis.
• Current access to the information and services relating to Cognitive Behaviour Therapy ( CBT) are not 'Deaf friendly' and/or BSL friendly.

Suggestions made or ideas people or groups had included:

• This step could be changed to 'Ensure that a Scottish national centre for mental health information, advice and support is developed'.
• This step could be changed to 'Ensure that the national source of mental health information, advice and support developed for BSL users is readily accessible in digital and other forms of communication'.
• There should be funding for BSL training for counsellors and psychotherapists who intend to work with Deaf / Deafblind BSL users.

Other comments on health, mental health and social care

People also raised a number of other communication-related issues which did not relate to any of the specific goals or steps in the Draft BSL National Plan. These included:

• There were questions about how the ambition, goals and associated steps set out in the Plan will fit with the activities of Health and Social Care Partnerships.
• The Interpretation and Translation Services Improvement Plan, which was developed by the Equality and Human Rights Commission ( EHRC) for NHS Tayside, should be rolled out across every health board and NHS Scotland.
• Access to services for Deaf / Deafblind children whose first or preferred language is BSL needs to be improved. Having access to BSL/ English interpreters who are fluent in BSL would provide Deaf / Deafblind children with the support they need from the child protection system and improve long term outcomes.
• The services covered under this theme should be extended to cover dentistry.

• Deaf / Deafblind BSL users should have text or email options for making appointments.

Other comments focused on wider health, mental health or social care issues and these included:

• There is no dedicated Deaf health organisation in Scotland – like SignHealth and BSL Healthy Deaf Minds.
• There should be a Deaf 'Healthwatch' with powers to intervene when the system is failing.
• Home helps or carers who visit Deaf / Deafblind BSL users must be Deaf BSL users themselves. A good model is the service by DeafCare Services at Deaf Connections in Glasgow.
• There is a lack of Deaf mental health services in Scotland. In particular, there is currently no Deaf / Deafblind CAMHS service and this gap needs to be addressed.
• Deaf / Deafblind BSL users need role models with Attention Deficit Hyperactivity Disorder ( ADHD) or autism to understand more about their disorders.
• We cannot continue to isolate our Deaf / Deafblind elders in care homes, which have not been designed to meet their needs, whose first or preferred language is BSL, and who are cut off from their language and community. We need Deaf care homes and provision specially for Deaf / Deafblind BSL users who have dementia.