Judy Worrell is one of only a handful of social workers across the UK with the specialist skills to support deaf children who have mental health issues.
It is vital work. If you are one of the country’s estimated 8,500 profoundly deaf children, research suggests you are more likely to develop mental health problems than hearing children. You are also more at risk of child protection issues.
Yet despite the increased risks, a string of official reports have acknowledged that deaf children often struggle to access mainstream children’s mental health services. Even if services can be accessed, staff are often ill-equipped to handle the complexities of cases involving hearing loss and mental health.
“One of the biggest issues is that there’s a lack of knowledge on how to communicate with deaf children and their families, whether that is through signing or oral communication,” says Judy.
“There’s no doubt accessibility needs to be improved and not just around mental health needs. On the safeguarding side, research has found many local authorities don’t recognise deaf children as children-in-need, so they don’t get the benefits and protection of that legislation.
“There are some generic social services that are really amazing in their response to deaf children but there are others where, if a deaf child or deaf adult wants to disclose abuse, the services don’t have the right equipment at their duty desk or immediate access to interpreters to respond to that. If the only way to make a referral is by telephone then that might immediately rule out the possibility of a deaf child or concerned deaf adult from being able to make it.”
A national service
It was a desire by policymakers to address these types of issues that led to the creation of the NHS’s national deaf CAMHS service, a nationwide service that operates from four outposts in different parts of the country. Judy is the principal social worker at the branch hosted by South West London and St George’s NHS mental health trust.
The service takes referrals from across the UK. It offers community support and an inpatient unit that accommodates up to six deaf children with mental health issues. Judy’s team also supports hearing children of deaf parents and children with complex needs, including aspergers and autism.
As the only social worker in a multidisciplinary team, Judy says her caseload is dominated by safeguarding issues and social care issues. Typical tasks involve arranging ‘team around the child meetings’ to raise the profile of the needs of the deaf child and engaging their local social services; advocacy work in safeguarding cases and, perhaps inevitably, “lots of reporting writing”. Much of her time is spent in the community, supporting children and families to access statutory and voluntary sector support.
“But it’s not just about referring someone to social services so that they can get technological aids, like a flashing door bell, installed in their homes. I try to work in a systemic way and quite creatively. I like to really involve the deaf community and link people in to deaf-related services and social events in the community,” she says.
“Cochlea implants and other audiological aids also have a place but we need to be aware of the risks of taking an overly medicalised approach where the focus is all on the idea that the child has a sensory impairment that needs ‘fixed’. That is a narrow view and misses the fact is that being deaf is not just about not being able to hear. It is about having a positive self identity as a deaf person, with your own language as a deaf person, your own cultural norms and community.”
The importance of visual communication
So what are the key differences between this service and the mainstream support on offer? One key factor is that the staff at the national deaf service can all use British Sign Language. Some are deaf themselves (“They are an amazing resource. I think their experience of being deaf and negotiating the obstacles of a hearing environment means they have a unique way of being able to relate to children who have been marginalised,” says Judy). Unlike many mainstream services, the team also have access to specialist interpreters skilled in assisting in mental health assessments.
The service also uses a lot of visual communication, Judy explains. When assessing children, the team make huge use of visual resources, such as games and pictures to assess a deaf child’s awareness of themselves and their environment. When it comes to discharge, the fact that most deaf school leavers will have a reading age equivalent to a nine-year-old hearing child, means traditional NHS letters can be inappropriate. In those cases, Judy and her colleagues can give children a discharge DVD with the team communicating key information in whatever way suits that child best. They’ll also use Skype to follow-up.
“We also have a sensory room. So when a child is very agitated and we need to bring them down, we can’t just rely on spoken language to do that. Or let’s say that deaf child has autism or a visual impairment and can’t even sign, then we can take them to a sensory room so that sense of touch becomes self soothing,” says Judy.
In addition to her social work training, Judy also brings a unique perspective to the service through personal experience. Her oldest son is deaf and uses sign language. The way services responded to her son’s needs and Judy’s needs as a parent “really awakened” her to the issues facing deaf children and their families and eventually led to her applying for her current role.
“I became more and more involved in advocating for my son’s needs and more involved in the deaf community and deaf services. I’d worked in mental health and substance misuse for a long time and just when I thought there’s not much more I could do, I saw this job. I applied and gave an honest account of my experiences of mental health and substance misuse and also safeguarding, and also an honest account of my experiences as a parent,” she says.
So having got the job, what are its hardest and most rewarding parts?
“The hardest part is generally the public sector being so stretched because so much of our work is systemic and, well, a lot of those support systems are being cut back. So that is a challenge but it has also really motivated me to be mindful of legislation and more creative, particularly when working with other agencies,” says Judy.
“The best bit of this job is when you see children feeling more confident in expressing themselves and becoming more autonomous. And the parents as well. Inevitably we see cases where parents are struggling. Being able to support them to make some difference to their quality of life is incredibly important.”
CC Inform subscribers can read our Guide to working with deaf children with mental health issues for more information on this topic.