Deaf and Deafblind People (Mental Health)
The final item of business is a members' business debate on motion S2M-3971, in the name of Adam Ingram, on mental health and deaf and deafblind people.
Motion debated,
That the Parliament acknowledges and supports the campaign by the Scottish Council on Deafness (SCoD) for equal access to mainstream and specialist mental health services for deaf and deafblind people in Scotland; notes the widespread lack of provision for deaf and deafblind people who have specific language and communication needs and that presently their rights under the Mental Health (Care and Treatment) Scotland Act 2003 and Disability Discrimination Act 2005 are not being met, leading to misdiagnosis and unsuitable treatments being applied; further notes with concern the complete lack of consultant psychiatrists in Scotland who are trained and experienced to work with deaf and deafblind people who have mental health problems and that the nearest available specialist mental health service for deaf and deafblind inpatients is Manchester whose outreach service, which is currently used by Scots deaf and deafblind people, is now under threat of closure; endorses the campaign for a specialist mental health service for deaf and deafblind people in Scotland, funded through the NHS, and SCoD's aim of providing support for training and recruiting of deaf and deafblind people to enable them to work with deaf and deafblind patients; backs SCoD's call for additional resourcing for mainstream psychiatric services in both hospital and community settings which would lead to greater accessibility for deaf and deafblind people with mental health problems, and recommends the establishment of a specialist Scottish centre for deaf and deafblind people with mental health problems in the south of Scotland or other suitable region.
At the outset, I pay tribute to the Scottish Council on Deafness, several of whose members are in the public gallery for this evening's debate. SCOD has a long history of raising awareness of issues affecting deaf and deafblind people. Right at the top of its campaign priorities is the need to establish specialist mental health services for a disadvantaged group of our citizens who are being denied access to the help and treatment that they require and which other national health service patients who are not sensorily impaired receive as a matter of course.
The Executive, which supposedly is committed to social inclusion and has designated mental health as one of its national clinical priorities, has signally failed to deliver for deaf and deafblind people. The minister will no doubt argue that the Executive is aware of the problem and that last June it issued guidance in the shape of Health Department letter 27 to all Scotland's health boards on making access to services easier for deaf and deafblind people. However, the obligatory rider to such guidance is that it is for each NHS board to meet the health care needs of its resident population from within the funding that is available, taking account of national and local priorities. There is the rub: no new money is available to fund service development, and neither deafblindness nor mental health—which is often called the Cinderella service of the NHS—features prominently on the list of health board priorities. That is a recipe for continued inaction or, at best, ad hoc and piecemeal service development, which leads to postcode lotteries for access to and delivery of services. The situation is crying out for national leadership and initiative. I do not understand the Health Department's reluctance over many years to step in and solve the problem. It surely cannot be because of a lack of finance, given the vast increase in funding that the NHS in Scotland has enjoyed since devolution.
I will return to what precisely ministers should do, but first I will define the nature and scale of the problem. The fundamental problem that deaf and deafblind patients face at every level in the NHS is a communication barrier. Effective diagnosis and treatment are predicated on a clear understanding of the patient's symptoms and state of mind. Deaf patients continually report that there is a lack of understanding on the part of doctors, that, because of restricted access to counselling, medication is the only treatment option that is offered and that they are underreferred to specialist services.
The system failure is compounded by the fact that the NHS in Scotland provides no specialist mental health services for deaf and deafblind people. The only specialist service available is an outreach service that is delivered by the John Denmark unit from Manchester under Professor Paul Anderson, a consultant psychiatrist who is skilled in sign language. The unit also provides a hospital-based service, which can be accessed by Scottish patients if their health boards sanction the cost of treatment. In England, there are now four hospital-based services that offer a range of in-patient and out-patient services specifically for deaf people. There is a medium-secure unit at Bury and even a unit for deaf people at Rampton hospital. In those units, all staff are required to learn to communicate in sign language and to be deaf aware. Indeed, there is a drive to recruit and train deaf people to staff the units. In so doing, England is following best practice that has been adopted elsewhere in Europe.
The contrast with Scotland is stark. We have no specialist mental health officers and only two counsellors who are deaf and experienced in working with deaf and deafblind people. We also have only one registered mental health nurse who is deaf, but that nurse does not work specifically with deaf and deafblind patients. There is one consultant psychiatrist and one community psychiatric nurse who have worked with deaf patients before, but they do not officially provide a specialist service. They are currently seeking funding for an out-patient service in Glasgow.
To be frank, the lack of provision and the absence of planning for the future are scandalous and will be thrown into sharper relief if the John Denmark unit is forced to withdraw its outreach services to Scotland under pressure from its local mental health trust, which is a real and current threat. I urge the minister to cut through the bureaucratic inertia that seems to be afflicting his department on the matter. He has a golden opportunity to make a significant difference to the lives of many in our deaf and deafblind communities, who are much more prone to mental health problems than are people in the wider community because of their sensory impairment and the isolation that it brings.
We require the creation of a small centre of excellence in Scotland to not only provide specialist services but take the lead in breaking down the barriers to access for deaf and deafblind people across the whole NHS system. The costs would not be great. The cost of the John Denmark unit's services in 2004-05 was only £326,000. That is a mere drop in the ocean of funds that are going into the NHS. What is more, there is already a blueprint for implementation to hand, in the form of a paper that Dr John Loudon, the former principal medical officer for mental health in the Health Department, commissioned from Dr Ken Black, of the national services division of the NHS in Scotland, on a strategy for developing mental health services in Scotland for people who are deaf. The Scottish Executive Health Department promised to distribute that paper for consultation, but it has failed to do so, despite repeated requests. I ask the Deputy Minister for Health and Community Care why that report is sitting on a shelf somewhere in his department, gathering dust. Is he going to allow the deplorable lack of service provision for our deaf and deafblind citizens to continue indefinitely? After seven years of the Scottish Parliament and the current Executive, they deserve answers and action.
I am pleased that Adam Ingram has secured the debate, which highlights the serious lack of provision for deaf and deafblind people in Scotland and their right to equal access to mainstream and specialist mental health services. Deafblind people number around 5,000 in Scotland, and that group forms—[Interruption.] I apologise, Presiding Officer. I did not realise that I had my mobile phone with me. That group of people forms a small proportion of the population. However, most of them are over 60 years of age, and as their dual sensory impairment is the result of age-related problems, we can reasonably expect their number to grow in future as the population continues to grow older.
The increasing deafness—[Interruption.] I am sorry. The increasing deafness and visual impairment that often come with old age can lead to people becoming isolated, depressed and unhappy at being unable to communicate their thoughts and feelings in a world that seems to be passing them by. I had an uncle who became increasingly hard of hearing in his 80s. In his early 90s, he rapidly lost his eyesight due to age-related macular degeneration. Until then, he had played golf and bowls and had been able to drive. Mentally, he was as bright as a button but, because of his communication problems, he found it extremely difficult and depressing to keep up with what was going on around him. Indeed, he was depressed in the end. That was not helped by repeated delays in getting his hearing aids fixed when they went wrong. The pressurised audiology service was a major contributor to his frustrations and difficulties. That needs to be addressed.
I first encountered deafblind resources manager Drena O'Malley when I attended an event in Glasgow at the start of the Equal Opportunities Committee's inquiry on disability. I vividly remember the admiration and amazement that I felt at the communication skills that she displayed with the deafblind person to whom she introduced me. Such skills are rarely found. They can make such a difference to people with dual sensory impairment. Without the services of a trained guide communicator, I do not see how a deafblind person could possibly communicate with health service personnel at all, let alone if they were trying to get help with a mental health problem, when one-to-one dialogue can be all important.
I can be persuaded of the need for a specialist centre in Scotland, where staff have the skills to deal with deaf and deafblind patients who are also mentally ill. I also see a need for more guide communicators at a local level. The availability of staff with special communications skills is important for local psychiatric services, as the ability to access mainstream services in the community is key to the effective diagnosis and appropriate treatment of deaf and deafblind people.
We need an outreach service to help people. I hope that one might appear in the Aberdeen area, where there is currently great demand. I hope that the guidance that is to be published by the Executive will soon help to remove obstacles and provide barrier-free access to services. I hope that the report that the Executive has requested from health boards, which is expected this summer, will result in services being put in place with the minimum of delay.
I apologise for my phone going off and for the fact that I have to leave before the end of the debate, which means that I will miss the minister's response. I have had to curtail my speech significantly, but I look forward to reading the Official Report in anticipation that the minister will lend his support to the motion's necessary and worthy proposals.
I congratulate Adam Ingram on securing this debate on an important issue. Like other members, I will make extensive reference to a meeting that was held by the cross-party group on mental health and the cross-party group on deafness. If I repeat some of what Adam Ingram said, it is because he and I were both at the meeting.
The information that was presented to the cross-party groups was quite chilling. There is no dedicated service for deaf people with mental health problems in Scotland. A welcome but inadequate service has been provided part-time on an outreach basis from Manchester. In Scotland, no mental health officers work specifically with deaf people and only one psychiatrist and one psychiatric nurse work with the deaf on an unofficial basis, although I understand that there is talk of a pilot service. There are only two deaf counsellors in the whole of Scotland. Unless a patient is able to access the outreach service from Manchester, he or she will be obliged to use the general mental health services, which are not geared towards the needs of deaf or deafblind people.
It was made clear to us that deaf and deafblind people are looking not for special treatment but for equality of access. Effective communication is the key to successful treatment, but that is often where the problem lies. Health service or social work managers often feel that the way to address the problem is to provide British Sign Language interpreters, but it was made clear to us that the clients see that as only the third-best option. The ideal would be to have deaf people trained as professionals in mental health. That happens elsewhere, but it has never been promoted in Scotland—it should be.
The next-best option would be to have services provided by professionals with good skills in communication with deaf and deafblind people and an awareness of deaf issues.
Interpreters are only the third-best option and there are problems with it in that there are only 42 registered BSL interpreters in Scotland. Those interpreters carry out all sorts of duties and none is a mental health specialist. Availability is a problem, as getting hold of an interpreter can take ages. All too often, clients and professionals resort to using written notes or family members, even children, as interpreters, which is clearly not acceptable. If a patient needs to be sectioned, it is even worse. The Mental Health (Care and Treatment) (Scotland) Act 2003 states that a professional must make the patient aware of his rights in relation to consent to treatment. Deaf patients are, in effect, being denied those rights.
In England, even Rampton hospital has a deaf unit. The Department of Health is now giving deaf people the chance to train as psychiatric nurses. The National Assembly for Wales is considering services and Northern Ireland is considering an all-Ireland service. Scotland is falling behind.
I have spoken mainly about the needs of deaf people, but we have also to consider the small group of deafblind people, who need highly specialised services. About 10 per cent of deaf people have a severe visual impairment. That group forms about 40 per cent of those who have been accessing the outreach service from Manchester. Given their problems of isolation, they are at greatest risk of developing mental health problems. They need a lot of specialised input just to maintain good mental health.
I do not have time to talk about services for children. There are no services for deaf children or adolescents with mental health problems. The nearest in-patient unit is in London.
At the time of the meeting of the cross-party groups, there had been a series of meetings with the Executive about getting a service, in view of the possible withdrawal of the Manchester outreach service. I hope that the minister will be able to update us on that in his speech.
I congratulate Adam Ingram on bringing the debate to the Parliament and note that the Scottish Council on Deafness suggested that the subject should be raised here. I hope that the debate will advance the cause of deaf and blind people throughout Scotland, who suffer from very severe handicaps compared with those from which the rest of us suffer. Adam Ingram suffered from a substantial handicap when he was speaking. I think that I am allowed to say that one of his teeth fell out during his speech. It is a tribute to him that he was not deflected from his task by that inconvenience, which was very minor in comparison with the substantial difficulties that deaf and blind people face. I will make no comment on mobile phones.
I have read a range of material on the subject. The Scottish Council on Deafness's leaflet "Advice for GPs on Counselling Deaf and Deafblind Patients" states:
"40% of deaf people compared with 25% of hearing people have a mental health problem at some point in their life".
The focus of the debate is therefore extremely relevant and important. The leaflet also states:
"The average length of stay for a hearing mental health patient in psychiatric hospitals is 148 days; deaf mental health patients spend an average of 19.5 years"
in mental health hospitals. We can see the relationship between the social isolation that is associated with people with dual sensory deprivation and the increased risk of suffering from mental ill health. More critically, there is the reduced capacity of the NHS and wider social support to respond to mental ill health in people who suffer from dual sensory deprivation. Therefore, the campaign is an excellent start. I hope that the minister will say something of value in that context.
For various reasons, I have a medical every year and can see from my annual reports over the past 15 years the deterioration that age has brought in my hearing and indeed in my sight, with my move from single-capacity specs to bifocals—I am now thinking about trifocals. Figures that are before me suggest that a million people in Scotland have difficulty hearing whispers or faint speech and some 2,000 deaf people use sign language. A wide range of hearing disabilities exists.
On communicating with the health service, 15 per cent of people with the problem said that they would avoid going to see their general practitioner—the figure doubles for sign language users. Almost no GPs are sign language users or interpreters. I once knew around three sign language symbols simply because my Sunday school taught them to me, but I have forgotten everything else that I was taught about sign language. Not many of us know much about sign language.
A high proportion of severely or profoundly deaf people have other disabilities. Among those who are under 60, 45 per cent—nearly half—have other disadvantages.
I feel this personally. In 1964, when I was 17 and worked in a psychiatric hospital, one patient in the ward in which I worked was deafblind. My training was limited and the only communication that I had with that person was when I touched a spoon on their lip. They would then open their mouth so that I could feed them.
A test of our ability to call our society civilised lies in our support for those who are least able to support themselves. I say to the minister let us hear about more action.
Like Stewart Stevenson, I congratulate Mr Ingram and thank him for securing the debate, which is on an important issue. I am pleased that a number of colleagues have remained and hope that they will take part in such an important debate and learn more about the many difficulties that our deafblind citizens encounter in their daily lives.
We have heard that it has been estimated that some 5,000 people in Scotland are registered as deafblind. Some of those people were born with the condition and others acquired deafblindness later in life. As members will appreciate, the needs and problems of those two groups are very different. It is important to recognise that deafblind people are people first and foremost. Their needs, skills, aspirations and daily challenges will be just as varied and complex as those of any other group of people in society.
Our knowledge and understanding of ourselves and the surrounding world comes to us mainly through our vision and our hearing. Deafblind people, who lack those senses, find their mobility, communication and access to information greatly hampered in their daily lives. I am pleased to support the suggestion in Mr Ingram's motion that more appropriate medical provision should be made available in hospitals and community settings for our deafblind people, especially those who, unfortunately, suffer from mental illness.
I enthusiastically support the concept of a purpose-built facility in Scotland to cater for the treatment and help of our deafblind population. I understand Mr Ingram's desire to have such a facility established in the south of Scotland. I have no preference other than to see the facility established at the earliest opportunity in an appropriate location, which must be convenient and easily accessible by deafblind people from all areas of Scotland.
I thank Adam Ingram for bringing this important subject to the Parliament. I am concerned that deafblindness should be diagnosed in people at an early age, so that we know exactly who is coming through the system. I spoke to some people before I came into the chamber, and the emphasis was on communication. That is what I would like to deal with.
Communication is fine if someone knows how to read and write English, but I am told that many people do not know how to read and write English. I did not come across any deaf or blind people who could not communicate with me when I was a general practitioner; however, I had to cope with patients who were deaf. I would have loved to have been able to take a course in sign language. As it was, my patients were very good at lip-reading and my attempts at communication were good enough. If we could not communicate between ourselves, a family member would get involved, but that takes me to another point. When someone goes along to see their GP, that is a private thing. They want to be on an equal footing with every other member of the community in having a private consultation with their doctor. If someone cannot have that because their doctor does not know sign language and cannot communicate with them, they have to introduce somebody else.
At another stage in life, as people get older and go into nursing homes—there is one near my constituency in which people who are severely deaf and severely blind are nursed—their nursing staff need to have the appropriate communication skills. However, we have a long way to go, and we need to train doctors, nurses, psychiatrists and even people in the allied professions. It is a little bit embarrassing that our deafblind people have to go down to Manchester.
Depression and mental ill health form a large part of a GP's caseload. If someone cannot communicate, they tend to slip into their own little world. My mother was deaf in one ear, and a very close doctor friend of ours was also deaf. I would watch them and, if two or three people were talking, they would sit back and not take part in the conversation. They would become quite anxious about the whole thing because they would feel that people were laughing at them when they answered inappropriately; there would be a little giggle and my mother and her friend thought that that was dreadful.
The nearest that I came to dealing with people who had profound communication problems was when we had Kosovan refugees who had to have interpreters. I was lucky because I had very good interpreters. A man once came to get his hearing aid and, because we created a good rapport through the interpreter, who interpreted exactly what the man was telling him, I found out that he was also epileptic and should have been receiving treatment.
Doctors need to be able to communicate with their patients. They need to know exactly what the patients are saying, but they might not always get that through an interpreter. We need a Scottish service and we need to train an awful lot of people because we are way behind, but it would do no harm to start. I support Adam Ingram's motion and every aspect of what he said. I hope that we can get something. I do not think that it would cost an awful lot of money to make a start and to get a service up and running. I support the motion and I expect the minister to accept what it says.
I congratulate Adam Ingram on securing the debate and I thank the Scottish Council on Deafness, particularly Drena O'Malley and Lillian Lawson, for their tenacity. The Scottish Council on Deafness is based two floors below my constituency office in Hope Street—bumping into Lillian every day and being told that we must push this issue forward can sometimes be too much to bear. Lillian knows exactly what I mean, because I have been to her office quite often.
I first came across the issue when it was raised at the Public Petitions Committee, of which I am a member. I have the petition with me and I will confine my remarks to the subject of the petition and to Adam Ingram's motion. The petition asks that deafblind people should receive a decent service. It does not just want services to be provided in the community; it wants there to be a unit for deafblind people, in particular for those with mental health problems.
When Drena O'Malley gave evidence to the Public Petitions Committee, some of the stories that she told were horrifying and heart-breaking. She told of deafblind people with mental health problems who had been taken to prison because there was no one in the police station or anywhere else who could tell exactly what had happened. Those people were put into prison or psychiatric hospitals, and some of them were never given an explanation of why they were there. Sometimes it was 24 hours or a couple of days before an interpreter could be found. I commend Drena O'Malley for all the times that she has responded when she was called out in the early hours of the morning because she was the only interpreter whom people could rely on. There is a great dearth of people who can help with the communication problems of this branch of the community in our country.
I cannot understand why the John Denmark unit, which has been providing services—they might not have been the best services, but at least something was being provided—is under threat of being taken away, with nothing to replace it. I know that the minister has mentioned to the health boards that access should be made easier, but as Adam Ingram pointed out, access is subject to a postcode lottery—it depends on the health board area in which someone stays. We need to give these people a decent service. No other members of our community would put up with such totally inadequate psychiatric, mental health or health services. I appeal to the minister to take that on board. We are here to represent all our communities, but deafblind people, particularly those who have mental health problems, are being served the least well.
I remind members of the evidence that was given to the Public Petitions Committee. We heard about people who did not know what was happening suddenly being taken to a psychiatric hospital and not having a clue why they were there; there was no one there to interpret for them and to tell them that they could contact their family. I ask the minister to put himself in their shoes and imagine what that must be like. Stewart Stevenson highlighted the length of time that deafblind people, in comparison with other folk, spend in institutions. Please try to imagine what it must be like if access to services is not available.
Finally, I ask the minister to say tonight when we will get a replacement for the service that is currently provided by the John Denmark unit. It is surely inadequate that deaf and deafblind people are required to make appointments on an ad hoc basis with specialists who come up from Manchester.
I, too, congratulate Adam Ingram on securing this important debate. I also commend him for completing his speech despite the little local difficulty that he encountered along the way.
Adam Ingram and other members have raised some important issues, and it is important that people understand how those issues are being addressed. Care and support for those with both sensory loss and mental ill health are founded on the principle of inclusion, as we seek to secure barrier-free access to services for all. Where deaf and deafblind people and others with a sensory loss have mental health issues, they clearly have particular needs that must be addressed. The key to our policy approach is that we do not separate those who have particular needs but aim to ensure that they are given the best possible access to mainstream services.
That will not happen overnight, but I am clear that it must happen. I believe that we have made a significant start, not least through the progress that has been made in taking forward the initiative that was set out in "Fair for all" and through our sensory impairment action plan for community care services. Our research into those issues, which will be published next month, will further inform the development of future policy.
The progress that we have made has relied on, and will continue to depend on, input and support from people with sensory impairment and their representative organisations. I thank those organisations for their on-going input, support and commitment to the plan.
Let me respond to some particular points. The Loudon and Black report to which Adam Ingram referred is not, as he implied, gathering dust. The report formed part of our early consideration of policy development for change and improvement and informed investment and the direction of policy. The report has also played a part in the formulation of the current guidance. If Adam Ingram believes that other recommendations in the report should be taken further forward, he is welcome to let me know of them and I will seek to respond in the most appropriate way. However, the report has informed our process and I think that in some respects we may have moved on from when the report was produced.
One thing that has changed in that time is that the Mental Health (Care and Treatment) (Scotland) Act 2003 has begun to be implemented. The act has implications for the care of those who face both mental health and sensory loss issues. As a consequence of the implications of the act, we conducted a review last year of all the published material on services and approaches for those with mental ill health and sensory loss. We wanted a pragmatic document that would help to identify the key issues and offer workable solutions.
As the minister has mentioned a review of the impact and implementation of the Mental Health (Care and Treatment) (Scotland) Act 2003, I should mention that it has been brought to my attention that there are a number of problems with the community treatment orders for deaf people. As the minister is aware, a key principle of the new act is reciprocity. In other words, where there is an element of compulsion in the medication that a patient receives in their home, they should receive services in return. The feedback that we have received is that deaf people with mental health problems who are subject to such compulsion are not receiving those services. That is the nub of the problem.
As I said, we are keen to understand as much of the validated information as we can obtain about the way in which people receive services so that we are able to improve and further develop them. The guidance that we have issued focuses on improved access, better communications, better training and a better understanding of needs and how services are received. As part of that, we will also promote on-going review. That includes a commitment to undertake a national survey on progress. The survey is well under way and will be completed in the next few weeks and published. We will follow it up as necessary to secure the level of service that will be required.
The issue of a specialist mental health service was raised. It is for NHS boards and their local partners to keep all service options under review. I take issue with the proposition that we should remove such discretion from health boards. Ministers do not support that. We believe that it is right for local decisions to be made on how to meet local needs and, year on year, we are providing record resources for NHS boards and local authorities to invest in services that improve access and outcomes. Health spending will reach more than £10 billion next year. In 2004-05, more than £670 million was spent on mental health by health boards or local authorities. It is for partners to set local priorities for that expenditure.
The minister spoke about not interfering in local health boards. However, will he intervene if he receives evidence from groups such as SCOD that provision is not being made?
The Scottish Council on Deafness and other representative organisations are part of the on-going work. We expect them to feed any concerns that they have into the review process and consideration of the sensory impairment action plan.
Reference was made to the John Denmark unit and concern was expressed about the future of that in-patient service. We were in touch with the Bolton, Salford and Trafford Mental Health NHS Trust in advance of the debate. I understand that there are no plans to withdraw the in-patient services that are available to Scottish patients and that no changes will be made until suitable alternative arrangements have been put in place.
The issue of training in sign language was raised. We are keen to take that forward. Significant investment is being made in a graduate diploma in teaching BSL tutors. As part of the sensory impairment action plan, we are funding and working on a basic awareness and communication training package, which will encompass all three areas of in-patient care and is geared towards both social care and health care staff. We believe that all staff who deal with persons with sensory impairment should be able to meet the basic communication needs of those patients in an appropriate way. That is why the package is encompassed in our national training strategy, which we aim to have in place by 2007.
One member referred to the good example of NHS Greater Glasgow and Clyde, which is planning the development of a multi-agency, multidisciplinary specialist team, with members based in mainstream community mental health teams, who will be trained to BSL stage 3, with special emphasis on mental health. The approach that is being rolled out in Glasgow can be applied profitably elsewhere.
A number of significant issues have been raised. A good deal of continuing attention is being given to those issues by Government, the NHS and local partners. We have issued robust guidance and taken specific initiatives to tackle exclusion head on and have put in place a framework for developing better and more responsive services. We recognise that there is still more to do, but future development will be informed both by our national survey of the current situation and by our continuing research. It will also be informed by those who experience these challenges in their daily lives, which is absolutely essential. The service user and the carer must be at the heart of health care and social care policy. I look forward to continuing engagement with deaf and deafblind people and the organisations that represent them as we develop accessible mainstream services over the months and years ahead.
Meeting closed at 17:44.