Working with people who are Deaf British Sign Language (BSL) users, oral deaf, Deafened, Deafblind and Hard of Hearing

PPN North West is committed to raising awareness of and improving access to psychological interventions for people who often find themselves marginalised or excluded from existing services.

This section focuses on the deaf community. You will find information that explores the needs of people who are deaf, guidelines for best practice and useful contacts.

Mental Health & Deafness

The term 'deaf' is a wide term and it is important that the type of deafness is identified before a service or communication support is offered. It is crucial not to make assumptions on types of communication needed.

Deaf BSL users

Deaf BSL Users use British Sign Language as their first or preferred language and communication method. Deaf BSL users are recognised as members of the Deaf Community and have a strong Deaf identity.

Oral deaf
Deaf people (identified with a lower 'd') usually have a wide range of hearing loss (mild to profoundly) and generally communicate orally by using speech and sometimes gesture. They commonly do not see themselves as part of a Deaf Community and would not describe themselves as Hard of Hearing.

Deafened people are born hearing and lose their hearing either through illness or injury.

Deafblind people have vision and hearing loss which ranges from mild to total loss. Every Deafblind person has different communication/coping strategies – some use sticks and some have a hands-on interpreter.

Hard of Hearing
People who are Hard of Hearing usually have mild to severe hearing loss and can gain some benefit by wearing a hearing aid. They can function in a hearing world with additional aids/equipment such as a loop system, TV amplification and others.
There are fluctuating numbers of Deaf Sign Language users in England as there are no reliable statistics available at this time. SignHealth uses the IPSOS MORI GP Survey (2009/10) which recorded 101,107 Deaf Sign Language users in England, however many professionals within the Deaf Sector believe that the figure is likely to be double. Access difficulties mean that many Deaf people do not present at their GP or utilise any other supportive services. For the other types of deafness highlighted it is usually 1 in 7 of the total UK population.

Number of Deaf Sign Language users in England - 101,107
Number of Deaf Sign Language users in the North West – 12,738

North West Deaf Population by CCG

 CCG  Deaf Population
 Blackburn with Darwen  329 
 Blackpool  427 
 Central Manchester  493 
 Chorley and South Ribble  337 
 Cumbria  661
 East Cheshire  146 
 East Lancashire  497 
 Fylde and Wyre  175
 Greater Preston  337 
 Halton  335 
 Heywood, Middleton and Rochdale
 Lancashire North  176
 North Manchester
 Oldham  590 
 Salford  413 
 South Cheshire  147 
 South Manchester  494 
 Southport and Formby  201 
 South Sefton  201 
 St Helens  334 
 Tameside and Glossop
 Vale Royal  146 
 Warrington  298 
 West Cheshire  281 
 West Lancashire  336 
 Wirral  535 
 Total  12,736

Deaf people are regularly marginalised or excluded from establishments and services that the hearing population take for granted. This begins with education where the standards are typically low. As a result many Deaf people leave school with little or no qualifications which mean many have problems understanding English and obtaining employment or are underemployed. This leads to social exclusion and isolation which in turn fosters vulnerability to poor mental health.

Deaf people experience the same proportion of mental health issues as the general population, but have higher rates of common mental health problems. They suffer from a wide range of problems ranging from anxiety, depression to more severe problems such as PTSD, OCD and at worse more psychotic illnesses such as schizophrenia.

The cause of such problems can start from a bereavement, loss of job, family problems, relationship issues, alcohol/drug abuse, domestic violence, computer game addiction and identity issues to name a few.

Deaf people do not have equal access to the additional support services who work with these problems and as such the difficulties become entrenched and emerge later, which impacts on the length of time needed to provide appropriate treatment to aid recovery. There are many reasons why Deaf BSL users are not fully accessing services, the main ones are: 

  • lack of access
  • poor or non-existent communication
  • cultural awareness

There are limited mental health resources for Deaf people in some parts of England, which has led to Deaf BSL users accessing services at an inappropriate level. For instance if a hearing person were experiencing low level anxiety/depression they would access an IAPT service that provides Step 2/3 services. In comparison, Deaf people who experience the same problem would access a service at Step 4/5 which is wholly inappropriate because of lack of accessible services. Fortunately, this is slowly changing with the expansion of IAPT throughout the country and in the North West a full stepped care approach is available for Deaf, sign language users because of the development of BSL Healthy Minds.

Lack of access
This is because mainstream mental health services are unable to meet the needs of Deaf people through the lack of availability of qualified BSL interpreters with experience of working in mental health settings. However, should a service be able to locate an appropriate sign language interpreter, the practitioner would more often than not experience difficulties because of not having the cultural awareness that impacts on the treatment provided.

Using resources/materials that are translated into BSL is vital, if the client is going to benefit from treatment. Often there is an assumption that Deaf people can read written English, and so leaflets and worksheets are provided to complete for the next session. This is a problem for the majority of the Deaf community, as English is not their first language. This lack of understanding from the therapist can unintentionally increase the anxiety/depression of the client, as they feel they have not been understood and can at this stage disengage from the process.

Should a BSL interpreter be used by a mainstream service it is important to ensure the same interpreter is booked for every session as they do become part of the 'therapeutic alliance' as a third party. Funding needs to be in place for the interpreter before any treatment commences.

However, there are many Deaf people who do not fully engage with the treatment when an interpreter is present as they feel that they do not want to expose their vulnerabilities to someone who 'might' tell everyone about their issues. Confidentiality and trust are huge issues within the Deaf Community.

Culture and Language Understanding and Acceptance
This is crucial to the therapist understanding and their ability to provide a meaningful therapeutic experience for the Deaf client, and a positive outcome. Without this in place, treatment takes more sessions over a longer period of time or the client disengages, feeling they are not being understood and therefore not receiving any benefit.

Service User Perspectives

Every Deaf BSL user wants full access to the services. They would like:

  • Equal access
  • Choice of treatment
  • Good communication – if necessary qualified, mental health BSL interpreters be available
  • Cultural and linguistic awareness from staff

Gaps in provision

Mental health services for Deaf BSL users in England are inconsistent and as such do not have the same benefits as the general population because of:

  • Lack of professional Deaf expertise in mainstream services
  • Lack of primary care services available to meet the needs of Deaf BSL users
  • Lack of understanding amongst commissioners/funders which means little or no services commissioned
  • Lack of appropriate communication support
  • Lack of Deaf, BSL people trained to work in Mental Health because of limited training/education opportunities
  • Lack of cultural Deaf people trained to deliver Step 3 treatments i.e. Counselling for Depression/High Intensity Therapy

Current Mental Health services for Deaf BSL Users in England

There are specialist mental health services throughout England based in London, Birmingham and Manchester. They offer an in-patient and out-patient service including clinical nurse specialists and outreach community services.There are also low, medium and high secure units available for Deaf people with severe and enduring mental health problems – St Georges HealthCare (All Saints, Oldham), Alpha Hospital (Bury), Rampton (Nottinghamshire) and St Andrews (Northamptonshire).For Deaf people who need support in the community and who may have been discharged from any of the specialist hospital settings above there are outreach services provided by SignHealth, residential supportive tenancies and mental health advocates (IMHAs).SignHealth also provide a counselling service throughout England and an IAPT service (BSL Healthy Minds) in the North West, East Midlands, South East, Yorkshire and Humber and the North East.

All the above are for Deaf adults, Deaf children and young people that are managed by National Deaf CAHMS. More details are available on their website

Best Practice

Highlighted below are guidelines for a mainstream service to make their service accessible for a Deaf, BSL user at the first point of contact.

For oral deaf, deafened and Deafblind people please contact SignHealth for advice on how to provide an appropriate service.

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  • Information – ensure information about your service is available in British Sign Language, has subtitles and is in plain English.
  • Environment – i.e. fire safety - having flashing lights; alternative plans if door entry system is sound based. TVs should have subtitles on. Consider where the Deaf person is sitting as sitting directly towards sunlight affects their ability to communicate.
  • Communication support – the Deaf person has a right to a qualified BSL interpreter. It is essential that the correct communication support is provided in the individuals preferred language. You must be consistent in providing communication support and make the language needs clear to other services you are referring onto.
  • Health promotion – any health promotion you do must include Deaf people and must have sign language information available. This can be done by working in partnership with Deaf organisations who can help you with dissemination of information.
  • Assessment, care and treatment – Deaf BSL users have the right to be assessed by a trained practitioner who is culturally aware and experienced regarding the mental health needs of Deaf people. It is also important if undertaking an assessment and/or ongoing treatment with a Deaf BSL User that the translated and validated outcome measures are used. For more details contact SignHealth.
  • Placement – any placement/service referral decisions must be based on the needs of the Deaf BSL user i.e. their preferred communication and in an environment that has an understanding of their needs and background.
  • Advocacy – Deaf BSL users have the right to independent advocacy in health and mental health services. This is to ensure that the person can fully participate in any assessment and discussion of services to make an informed choice. Contact SignHealth for further information on Deaf advocacy services.

(The above information was adapted from a Deaf Mental Health Charter that was devised by SignHealth and Mental Health Foundation)

Materials suitable for Deaf BSL clients

Deaf BSL users have the right to be assessed by a trained practitioner who is culturally aware and experienced regarding the mental health needs of Deaf people. If this is not possible – you must seek support from a specialist service/worker for advice.

BSL Healthy Minds

Under Useful Resources/Links there is a list of videos to watch on:

  • Anxiety
  • Bereavement
  • Depression and low mood
  • Obsessions and compulsions
  • Panic
  • Post-traumatic stress
  • Shyness and social anxiety
  • Sleep problems
  • Stress

The Royal College of Psychiatrists

  • Coping with stress
  • Depression in young people
  • Understanding autism
  • When bad things happen
  • ADHD
  • Worries and anxieties
  • Good parenting


At the bottom of the page under 'Animations made by young people' you'll find:

  • Top 5 tips for communicating with Deaf young people
  • Survival tips for Deaf teenagers
  • Top tips for Health professionals working with Deaf young people

Other resources such as booklets, articles, self-help guides are available on the internet. You should pick the ones with the least text possible. As materials are identified and developed they will be uploaded here.

BSL Healthy Minds

BSL Healthy Minds is an IAPT service that provides Step 2 and Step 3 interventions in the North West specifically for Deaf BSL users and has an open referral system. The referral criteria are that the client must be over 16, a sign language user and suffering from depression/anxiety. Referrals can be made by anyone with the main focus being from the individual themselves.
Contact: Dr Sarah Powell - Clinical Psychologist
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Twitter: @bslhealthyminds

First Step

First Step is an IAPT service that provides Step 2 and Step 3 services for adults with a common mental health problem such as depression or anxiety.

D/deaf adults are able to refer into the service as above by the GP, or through email, or text on 07807818 075466. Some basic information will be collected and they will then be offered a face to face assessment appointment. Choices will be using lip speaking, using a sign language interpreter or with a therapist who uses BSL.

Contact: Jane Shaw
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John Denmark Unit (JDU)

The JDU is a Step 4/5 service provides a comprehensive Mental Health Service based in Manchester to deaf people of all ages who may experience emotional/behavioural issues, personality difficulties, drug and alcohol abuse, learning difficulties and many more. The service provides in-patient, day-patient, outpatient and community based services care.

Contact: Mel Russ – Clinical Nurse Specialist
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Alpha Hospital Bury

The Deaf service for men provides assessment and treatment for patients from the age of 18 years in both medium and low secure settings. A medium secure service is available for Deaf women from the age of 18 years.

Telphone: 0161 7627250

St George Health Care Group

The service focuses on low secure or open rehabilitation within a comprehensive care pathway including individual hospital flats with support to achieve independence for Deaf people with the following mental health conditions; Personality disorder; Learning disabilities; Autistic spectrum conditions; Developmental Disorders.

Telephone: 01925 423300
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Deaf Health Champions

The Deaf Health Champion project works with Deaf people in Merseyside, Cumbria and Greater Manchester to support them in improving health services for Deaf people through empowerment, education of the Deaf community regarding health issues and to support Deaf people in health related placements.

Contact: Jonathan Swift
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Special interest groups

SIGs linked to mental health and deafness are currently being sourced and if suitable they will be uploaded here.

Equality Act 2010
The Equality Act came into force from October 2010 providing a modern, single legal framework with clear, streamlined law to more effectively tackle disadvantage and discrimination.

United Nations (UN) Convention on disability rights
The UN Convention on disability rights has been agreed by the UK to protect and promote the rights of disabled people.

Healthy Lives, Healthy People: Our strategy for public health in England (2010) White Paper
This white paper outlines the commitment to: protecting the population from serious health threats, helping people live longer, healthier and more fulfilling lives, improving the health of the poorest, fastest.

Commissioning IAPT for the whole community (2008)

This document is intended to assist commissioners (including practice-based commissioners) to deliver Improving Access to Psychological Therapies (IAPT) services that are effective and appropriate for the whole community, using innovative ways of meeting the needs of local people.

Talking Therapies – A four year plan of action (2011)
This plan accompanies the cross-government mental health strategy, No health without mental health. It outlines how the Government's commitment to expanding access to psychological therapies will be achieved in the four years from April 2011.

No Health without mental Health (2011)
This mental health outcomes strategy looks to communities, as well as the state, to promote independence and choice, reflecting the recent vision for adult social care. It sets out how the Government, working with all sectors of the community.

Improving Access to Psychological Therapies (IAPT) Commissioning Toolkit (2008)

This toolkit is designed to help PCTs improve or establish stepped-care psychological therapies services following NICE guidelines. It is intended for all PCTs, whether or not they will receive additional national funds in the initial stages of the programme, to help them prepare to do so. It brings together a wide range of existing tools and guides in the Annex, including the NICE commissioning guide on cognitive behavioural therapy (CBT) for common mental health problems.

Improving Access to Psychological Therapies (IAPT) Equality Impact Assessment (2008)

This Equality Impact Assessment (EqIA) examines the impact of the Improving Access to Psychological Therapies (IAPT) programme, on different groups in the community, to inform future policy development in this area. It anticipates and recommends ways to avoid any negative consequences for particular groups who may be subject to discrimination on the grounds of: race, gender, disability, faith, sexuality or age.

Improving Access to Psychological Therapies (IAPT) Equality & Diversity Toolkit (2008)
This document complements the IAPT Equality Impact Assessment (EqIA). . It gives service providers and commissioners a useful reference guide to undertaking their own EqIA and engaging with groups in their local community. A comprehensive commissioner focused toolkit "Commissioning for the Whole Community". 

Everyone Counts: Planning for Patients 2014/15 to 2018/19

This is a 5 year plan by NHS England addressing Patient provision within the NHS looking at quality, innovation, access and value to improve patient outcomes.

Social Return on Investment and commissioning
Social Return on Investment (SROI) is a practical tool that helps commissioners focus on the impact of their decisions. Its use can help commissioners to demonstrate and improve their contribution to important policy objectives including meeting the needs of end-users and other stakeholders. Indeed, its use can help commissioners to ensure they fully meet the principles and guidance on value for money, including aspects such as considering "wider costs and benefits" prior to procurement in a way that is manageable and proportionate.

A Sign of the Times
A Sign of the Times is a Department of Health consultation document about the development of a national strategy for mental health services (both health and social care) for people in England who are Deaf or Deafblind.

Mental Health & Deafness – Towards Equity & Access (2005)

This document shows how mental health services for Deaf people can be improved using the template of the National Service Framework for Mental Health as a starting point. It provides practical examples of how access to services can be made easier and it brings into focus the needs of a group of people whose access to services have, for too long, been fraught with difficulty.


SignHealth is leading organisation dealing with issues of Deaf health and mental health. SignHealth has a wide range of services throughout the UK such as SignTranslate, Supported Living, Health Champions, Domestic Abuse, BSL Healthy Minds, Advocacy, Psychological Therapy, Outreach, Health promotion, Housing support, Campaigning and Research.

BSL Healthy Minds

BSL Healthy Minds is an IAPT service for Deaf BSL users.
Professional information about BSL Healthy Minds

Deaf Mental Health Charter
SignHealth partnered up with Mental Health Foundation to produce a Mental Health Charter specifically for Deaf people. It outlines good practices to follow to ensure Deaf people get a fair chance of treatment.

British Society of Deafness and Mental Health

The British Society for Mental Health and Deafness (BSMHD) is the leading UK charity for the promotion of the positive mental health of deaf people in the UK. The website has a lot of comprehensive resources that is very useful for anyone who is looking into mental health and deafness.

Action on Hearing Loss (AOHL)

Action on Hearing Loss provides support for people with hearing loss and tinnitus. AOHL is alos a research and campaign organisation. They have done some research into mental health and deafness and have reports available on their website. It is recommended to visit their website and type in Mental Health in the search box.

Sick of It Report
This is a report on a 5 year study by SignHealth on the health of Deaf people. The reports highlights issues that Deaf people face when acessing health services and offers recommendations to improve access.

BSL Healthy Minds Evaluation Report
This is a Evaluation Report based on services provided by BSL Healthy Minds from October 2011 - November 2013. The report compares BSL Healthy Minds IAPT figures alongside national IAPT figures and highlights issues that Deaf people face if there was no specific services for Deaf sign language users.

BSL Healthy Minds BSL IAPT Training Report 2014
This report evaluates the BSL IAPT training course with feedback from Cohorts 1 & 2, Tutors, University Course Leaders and BSL Healthy Minds management team. The report highlights successes along with areas for improvement with recommendations offered.


Signature is a national charity which campaigns to improve the standards of communication with deaf and deafblind people in the UK. They are also an awarding body for British Sign Language qualifications. Visit their website to find out more about the standards of British Sign Language.

NRCPD (The National Registers of Communication Professionals working with Deaf and Deafblind People)

NRCPD regulates communication professionals who work with deaf and deafblind people. Their job is to safeguard the wellbeing and interests of people who rely on those professionals. This is where the interpreters obtain their yellow badge which is the accreditation that they are qualified.

Celia Hulme - KPT Associate
Dr Sarah Powell - Clinical Psychologist, SignHealth
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