BSL-114 Royal College of Psychiatrists

Senedd Cymru | Welsh Parliament

Bil Aelod Arfaethedig – Mark Isherwood AS | Proposed Member Bill - Mark Isherwood MS

Datblygu'r Bil Iaith Arwyddion Prydain (BSL) (Cymru) | Development of the British Sign Language (BSL) (Wales) Bill

Ymateb gan: Coleg Brenhinol y Seiciatryddion | Evidence from: Royal College of Psychiatrists

About RCPsych Wales

The Royal College of Psychiatrists is the professional medical body responsible for supporting psychiatrists throughout their careers, from training through to retirement, and setting and raising standards of psychiatry. The College aims to improve the outcomes of people with mental illness and intellectual disabilities, and the mental health of individuals, their families and communities.

To achieve this, the College sets standards and promotes excellence in psychiatry; leads, represents and supports psychiatrists; improves the scientific understanding of mental illness; works with and advocates for patients, carers and their organisations.

Nationally and internationally, the College has a vital role in representing the expertise of the psychiatric profession to governments and other agencies. RCPsych Wales represents more than 600 consultant and trainee psychiatrists working in Wales.

The need for legislation

The British Sign Language Act 2022 requires the UK Government to issue guidance about the promotion and facilitation of the use of British Sign Language (BSL). This however only applies in England and not to the Welsh Government or public bodies in Wales such as councils or the NHS. The British Sign Language (BSL) (Wales) Bill aims to place equivalent specific duties on the Welsh Government and public bodies in Wales.

Question 1: Do you think there is a need for this legislation? Please provide reasons for your answer.

Yes, we believe there is a need for this legislation. Wales is the only UK country without a deaf mental health service, meaning that deaf patients in Wales currently have to travel to England for mental health inpatient provision. This is particularly unacceptable given that deaf people are twice as likely to experience mental health problems compared with the general population (Terry et al, 2021). The proposed Bill offers a right-based approach to addressing this.

References

Terry, J, Redfern P, Bond J, Fowler-Powe M, Booth C. 2021. Deaf people Wales: Hidden inequality. Available at: www.swansea.ac.uk/media/Deaf-People-Wales_Hidden-Inequality-2021.pdf

Question 2: Do you agree or disagree with the goals that the Bill seeks to achieve? Please provide reasons for your answer.

We agree with the aim of the Bill to institutionalise the promotion and facilitation of BSL, thereby ensuring that BSL is integral to public services and removing barriers to access. The barriers faced by Deaf people using mental health services are manifold, persistent and well documented (Terry, 2024; Shank & Foltz, 2019). Although well-intentioned, existing measures, such as the All Wales Standards for Accessible Communication and Information for People with Sensory Loss first introduced in 2013, have fallen short in delivering much-needed improvements for their intended population.

More needs to be done to ensure that Deaf people can access mental health information in an accessible format and communicate with services through inclusive systems. Greater Deaf awareness training is also required among health professionals, alongside an increase in the capacity of, and training provision for, BSL/English interpreters. Through the creation of BSL Commissioner with powers to set standards, policy and guidance on health boards, the Bill offers an important opportunity to right long-standing inequities faced by Deaf mental health patients in Wales.

We are pleased to have been asked to work with the All Wales Deaf Mental Health and Well-Being Group through our Dyfodol Programme, in collaboration with the NHS Wales Joint Commissioning Committee. We endorse the group’s aim of achieving effective and high-quality mental health and wellbeing services for Deaf individuals in Wales. To that end, we believe that a future Deaf Mental Health Service for Wales should be commissioned on an all-Wales or regional (north/south) basis, as opposed to by health boards individually. This would help to deliver consistent strategic and operational planning, and ensure economies of scale in resourcing.

References

Shank, C. & Foltz, A. 2019. Health and wellbeing for deaf communities in Wales. Scoping for a Waleswide survey. Bangor University. Available at: http://deaf-communities-wales.bangor.ac.uk/index.php.en

Terry, J., Meara, Rh. & England, R. 2024. “They still phone even though they know I'm deaf”: exploring experiences of deaf people in health services in Wales, UK. Journal of Public Health. Vol. 46, No. 3, pp. e520-e527. Available at: https://doi.org/10.1093/pubmed/fdae112

British Sign Language

Question 3: Do you agree that the Bill should include proposals to promote and facilitate the use of BSL and its tactile forms?

Yes

Question 4: Do you agree that the Bill should support the various Welsh regional dialects of BSL?

Yes

Question 5: Do you think that the term ‘BSL users’ should be replaced with ‘BSL signers’, recognising that BSL is a language which includes both deaf and hearing signers? Please provide reasons for your answer.

Don’t know

Question 6: Do you think that the term ‘deaf BSL signers’ can be used when referring to BSL users/signers who are medically or audiologically deaf? Please provide reasons for your answer.

Don’t know

Deaf Communities

Question 7: Do you agree or disagree that deaf communities:

a) currently have a voice in the design and delivery of the public services that they use? Please tick the answer that most applies and provide any comments.

Disagree.

The lack of progress made over recent years in improving Deaf people’s access to, and experiences of, mental health services indicates that the voice of lived experience has not been sufficiently reflected thus far in the design and delivery of said services. Welcome efforts are being made to address this, such as through Bangor University’s Deaf Health and Well-being Wales project, launched last year, which aims to co-design, co-construct, implement, and evaluate community-led solutions for the Deaf community in Wales. The College’s National Collaborating Centre for Mental Health has also produced guidance on co-production in mental health commissioning, which may offer further useful information on which to draw (NCCMH, 2019).

References

National Collaborating Centre for Mental Health. 2019. Working Well Together: Evidence and Tools to Enable Co-production in Mental Health Commissioning. Available at: https://www.rcpsych.ac.uk/docs/default-source/improving-care/nccmh/working-well-together/working-well-together---evidence-and-tools-to-enable-co-production-in-mental-health-commissioning.pdf

b) should have a formalised voice in the design and delivery of the public services that they use, especially ones targeted at deaf people. Please tick the answer that most applies and provide any comments.

Strongly Agree.

We consider that the BSL Commissioner for Wales would be best place to decide on the formal mechanisms for involving Deaf communities in the design and delivery of the public services, including through the proposed BSL Advisory Panel. In terms of mental health services, this should include Deaf people having a voice at the commissioning stage.

Question 8: Are there any specific communication methods used by deaf people that you would like the Bill to reference/include?

We defer to the All Wales Deaf Mental Health and Well-Being Group on this point.

Barriers that exist for deaf people

Question 9: What do you believe are the main barriers that currently exist for deaf people and/or their families in the following areas. Please tick all that apply and provide information/examples on each area:

Health.

As stated previously, the barriers faced by Deaf people using mental health services are many and well evidenced (Terry, 2024; Shank & Foltz, 2019). Wales is the only UK country without a deaf mental health service, meaning that deaf patients in Wales currently have to travel to England for mental health inpatient provision. The situation is further compounded by ineffective communication systems, a lack of flexible booking arrangements, and a lack of Deaf awareness training for health professionals.

References

Establishing a BSL Commissioner for Wales

The Bill proposes to establish a BSL Commissioner who would promote and facilitate the use of BSL, and would have the same powers as other minority language Commissioners such as in the Welsh Language (Wales) Measure 2011.

Question 10: Do you agree or disagree with the proposal to establish a BSL Commissioner for Wales, and, do you have any different suggestions or alternatives? Please provide reasons for your answer.

Agree.

The proposed model is complementary to Wales’ existing Commissioner landscape and offers a clear governance approach.

Question 11: The proposed remit of the Commissioner would be to:

§ formulate BSL standards;

§ establish a BSL Advisory Panel;

§ produce reports every 5 years in BSL, Welsh and English on the position of BSL in that period;

§ provide guidance and a process for public bodies to promote and facilitate BSL in their respective domains;

§ establish a procedure for the investigation of complaints.

Do you agree with the proposed remit of the Commissioner, and are there any other provisions you would like to include in the Commissioner’s remit? Please provide reasons for your answer.

Yes.

We consider that the proposed remit is clear, well-defined and appropriate. It will be important to ensure that the Commissioner is sufficiently resourced and empowered to fulfil their role.

Question 12: Do you agree that the BSL Commissioner and the BSL Advisory Panel members should be fluent users/signers?

Yes

Question 13: Do you think that the proposed BSL Commissioner and Advisory Panel should prioritise the following. Please tick all that apply and provide reasons for your answer.

Enabling deaf users/signers to lead the development of policies and implementation of services for BSL users/signers; Access to interpreters in public services.

Involving Deaf people in the co-design and co-development of mental health services is key to tackling the inequalities experienced by this population in terms of access to those services and health outcomes. Engaging Deaf users in the implementation of services should also support the development of culturally sensitive health services, thereby enhancing the Deaf cultural competence of health professionals and administrative staff.

Additionally, significant improvements need to be made in relation to interpreter provision. Effective communication is critical to mental health treatment, but the current shortage of interpreters renders Deaf people vulnerable to misinformation and misdiagnosis.

Question 14: Do you agree or disagree with the proposal to place a duty on the Welsh Government to prepare and publish an annual BSL report? Please provide reasons for your answer.

Yes.

This proposal is in line with other reporting requirements of the Welsh Government e.g., annual report on compliance with Welsh Language Standards.

Question 15: Are there any other issues that you would like to raise about the Bill and the accompanying Explanatory Memorandum?

We agree with the proposal to place a duty on public bodies to report on their progress in promoting and facilitating BSL through the Well-being of Future Generations (Wales) Act 2015 reporting cycle. Research indicates that ‘the Act provides a transformative framework for addressing the multifaceted needs of the Welsh deaf community’ (Wilks, 2024).

References

Wilks, R. 2024. Unseen and unheard: how the Future Generations Act is not addressing the needs of the Welsh deaf community. Disability & Society. Pp. 1-27 Available at: https://doi.org/10.1080/09687599.2024.2412267