Searchline. Let us do the hunting whatever expert you need. Please call our free SearchLine today on 0161 834 0017

Journal Detail back to listing

Considerations when working with people who are deaf
  • Jun 19, 2020
  • Latest Journal

By Dr Elizabeth Wakeland, Senior Forensic and Clinical Psychologist, Forensic Psychology Practice Ltd and Lauren Teasel, Assistant Psychologist, Forensic Psychologist Practice Ltd

The term ‘deaf’ refers to profound hearing loss, implying little or no functional hearing. There are four categories of hearing loss; mild, moderate, severe and profound, with 900,000 people estimated to be severely or profoundly deaf in the UK. Those who are hard of hearing generally have hearing loss ranging from mild to severe and can benefit from an auditory device, such as a hearing aid or a cochlear implant. The individual’s level of hearing loss, including when they acquired their hearing loss, will impact on their ability to participate in legal proceedings, whether criminal, family or civil. It is important to note that it is not the deafness itself that presents the problem. Being deaf does not inherently mean you cannot participate in proceedings, have a lower intellect or cannot understand English. The focus on the ability to hear, and working in a system catered for hearing individuals, presents barriers for those people who are deaf, and this limits their full participation in some areas if adequate adjustments are not made.

Many deaf people, usually those born deaf, or acquire deafness before they develop language (termed ‘prelingual’ deafness), do not view themselves as disabled, but members of a cultural and linguistic minority. These individuals have usually relied on methods of communication that do not require speech or hearing, and as such, associate with the deaf community. The acquisition of deafness later in life may mean the individual has relied on spoken language, and thus associates with the hearing community. These differences will influence the adaptations required to fully participate in proceedings. For example, it might be assumed that an individual who use BSL as their first, and main, language can understand written language, or engaging them in proceedings is simply about translating information from English to BSL, but this is not necessarily the case.

The assumption may be that all deaf people can or should use some form of hearing aid, however they do not provide benefit to many. Each individual will view the use of hearing aids differently, with some identifying the benefits and usefulness, whilst others will not like to utilise them; viewing them as a tool that enables the hearing person to engage more effectively with a deaf person, rather than being a necessity for the deaf person. Deaf people use a variety of methods of communication, including Sign Supported English (SSE), lip-reading, pen and paper, and light-writers to name a few. In the UK, British Sign Language (BSL) is the most common form of signed communication amongst the deaf community and was formally recognised as a language in 2003. In the 2011 census, it was estimated that 87,000 deaf people use BSL.  

As a language, BSL has its own structure, grammar and syntax. It utilises hand movement, shapes and orientation, along with facial expressions and body movement to express the language. Some English words do not have simple translations, and there are expressions in BSL that may not translate simply into English. It does not follow the rules of English word order. This means it is not simple to place BSL into a written format. It is a visual language, and written English would benefit from being translated into a BSL video translation. This would include documentation and orders that are completed as part of the proceedings.

As deaf people can choose from a number of communication methods, identifying their preferred method is key to ensuring the initial barriers are broken down. Their choice of communication will have been determined by many factors to do with their experiences and the degree of their deafness. Lip-reading should not be relied upon, as even the best lip-readers only catch less than half of what is being said to them. For reasons explained above, paper and pen should also not be relied upon, especially for conversations which require rich detail. If the individual uses signed communication, it is important to identify whether this is BSL or another form (as BSL is not international or a universal signed language). They may use Signed Supported English (SSE) or other variations of signed communication. The introduction of a Sign Language Interpreter (SLI) will be required for signed communication, and finding a SLI that specialises in criminal justice, or mental health related matters (if relevant) will be of further benefit for the particular complex nature of the content being interpreted. There may be a need for a Relay Interpreter to work alongside a SLI. A deaf relay interpreter is used for deaf clients with specific or complex language needs. They are language intermediaries for deaf people who may not be fluent in BSL but use signed communication, and act in a similar capacity to SLI’s in that their role is to facilitate communication, but do not intervene if they feel the client does not fully understand; for that, a deaf intermediary is required.

In any proceedings, one of the first actions of the deaf person may be to attend a solicitor’s office to provide instruction. The question becomes who pays for the interpreter in this instance. Normally solicitors cannot apply for legal aid until they have been instructed, yet the first interview to receive instruction requires an interpreter, and many may not offer one. The Equality Act 2010 protects people from discrimination because of certain ‘protected characteristics’; disability (including sensory impairment) being one of these. There are different types of discrimination, but it includes things that are not done when they should be. For example, the failure to make reasonable adjustments for people who are disabled when required. The Equality Act 2010 covers key areas of life such as employment and training; education; goods, facilities and services; premises and transport. Those who are deaf are recognised under the Act and therefore, solicitors / barristers are responsible for the booking and payment of SLIs.  
It has historically been assumed that deaf people lack capacity or are unfit to plead due to their English language abilities. A deaf person’s understanding goes beyond their communication method, and is rooted in their developmental and educational experiences. Language development is a critical part of a child’s development. Access to any form of language, whether spoken or signed, is important in brain development, however there can be a presumption in certain fields that verbal communication is superior to signed. In the first twelve months, babies develop many of the foundations that underpin language development; whether the baby is deaf or hearing. The key is that parents and child have a shared language. Unfortunately, approximately 96% of deaf children are born to hearing families, but only 1 in 10 of those parents will learn sign language to be able to communicate fully with their child. This lack of communication, and access to a language, can have a significant impact on the overall development of the deaf person. For some, they do not acquire a structured language until they attend school.

The Second International Congress on the Education of the Deaf in 1880, that has come to be known as the ‘Milan Conference of 1880’ banned the use of signed language in schools, and favoured the oralism teaching method, which further oppressed deaf people and laboured the use of speech to communicate. It was not until the late 1960’s that sign language began to be introduced into schools once again, although in the current time, some residential and mainstream educational settings continue to teach using the oralism method, with the children only being allowed to use sign language in their own time (e.g. break times).

This means that many of the older generation did not have access to sufficient language in the developmental years. An assessment of their abilities is required to understand what the best support would be for each individual. It is likely that additional support is required, throughout the legal process, including in court. Language within legal proceedings is extremely sophisticated, if the deaf person has difficulties with abstract language this makes many of the most common aspects of court functioning prove impossible to navigate. A multi-disciplinary approach to working with deaf individuals, which would include specialist SLIs, alongside relay interpreters, deaf professionals (or at the least, those with expert knowledge in the field) and deaf advocates is best practice in order to identify the individuals’ additional needs.

For those children who are not able to access stimulating and challenging language environments, with others who can demonstrate, and thus model, such features as abstract thought, negotiation and emotional awareness, are at greater risk of a number of otherwise preventable cognitive deficits (e.g. Theory of Mind, Executive Functioning). These experiences are hypothesised to have an impact on a deaf person’s moral reasoning and consequential thinking, increasing their likelihood of engaging in criminal behaviour.

When considering criminal proceedings, in addition to the above, it is also important to consider the multiple barriers that deaf people face when they are involved in the CJS. This includes a multitude of complex factors that are interwoven which includes communication issues (e.g. lack of interpreters, inappropriate use of relatives/ perpetrators), lack of appropriate resources, the professionals’ perceptions and knowledge of deafness, and the type/ severity of offence. Often a deaf person’s behaviour can be mistaken for aggression, due to the expressive nature of the language. It is important not to make false assumptions and judgements regarding their communicative ability or misunderstand their needs.

Additional considerations relate to sentencing of deaf people who have been convicted of a crime. Research indicates that prison presents a ‘double punishment’ for deaf people as prisons do not offer any specialist support, resulting in social isolation and an increased vulnerability. They are often unable to access the rehabilitative aspects of a prison environment thus making limited change or learning. The fairest outcome for all involved, including the victim, would be for prisons to provide an accessible service, not dissimilar to the mental health sector.

In the context of family proceedings, there are a number of considerations to address when dealing with a family who have a deaf or hard of hearing family member, and these considerations may change with the family dynamic. For example, a family whose composition is of a deaf child and hearing parents will have differing support needs to a family who are made up of a hearing child and a deaf parent(s).

In the case of a deaf child, it is the duty of the local authority to ensure that their policies and procedures allow them to effectively investigate and manage child protection, which requires effective communication with the child. Without effective provisions in place, a deaf or hard of hearing child may encounter difficulties with reporting concerns or worries, voicing their wishes, and accessing independent facilitators such as advocacy services. It is important to remember that deaf children are considered to be more vulnerable to abuse victimisation than their hearing counterparts. Therefore, it is crucial to ensure that staff within all areas of family proceedings, including social workers and law enforcement personnel have an awareness of deafness and how it impacts upon a child’s development and family functioning, and are adequate in communicating with experienced interpreters to allow a deaf child to communicate as fully as possible within the context of family proceedings.

The required support of deaf parent and a hearing child within family proceedings will differ somewhat to the needs of a deaf child with a hearing parent. When a hearing child is born from a deaf parent, it is likely that the two have a shared sign language, and therefore the barrier to communication between the two is less. However, it is still necessary for the deaf parent to communicate with authorities, social services, Court officials and such like. The tendency may be to use the hearing child to facilitate communication, however this would be ill advised. Their hearing status, and thus ability to act as communicator, should be placed second to their position as a child.

Deafness can have a profound impact upon the mental health of deaf persons, as well as upon their hearing caregivers. With only 10% of hearing parents learning sign language to communicate with a deaf child, children who experience deafness will more often than not encounter barriers to successful and meaningful communication. This lack of communication can lead to feelings of isolation and loneliness, thus adversely affecting the mental wellbeing of the individual. Previous studies have shown that 45-49% of deaf children and adolescents have mental health problems, with social isolation being a significant contributing factor. Also found to be associated with a higher degree of emotional and behavioural problems are poor self-esteem and peer rejection, whilst peer acceptance is associated with a lack of the same problems. Important to note is that these mental health related difficulties are more comparable to the hearing population when the deaf child comes from a familial environment containing deaf parents. This supports the view that the difficulties are not inherent to deafness, but rather the barriers that arise out of being deaf.  

The prevalence of mental health difficulties in large populations of deaf adults is a relatively understudied area; however, epidemiological research has consistently found deaf people to be at a higher risk of mental health difficulties than the general population. It is estimated that 50% of individuals in the UK who have prelingual deafness will develop a mental illness at some stage in their lifetime, ranging from mild depression to psychosis. It is therefore essential to consider what support and interventions are available for those individuals who do experience mental health difficulties.

For individuals with severe to profound hearing loss, cochlear implants have been found to ameliorate the negative effects of communication barriers, particularly when implanted before the age of three years. Evidence shows positive changes in quality of life for individuals with a cochlear implant, with improvements being made in areas such as communication, self-esteem, self-care, psychological wellbeing and cognition. However, a proportion of the deaf population do not consider implants or hearing aids necessary for communication, rather they are considered an aid for the benefit of the hearing population, to communicate with those who are hard of hearing. It needs to be considered how the hearing population can break down barriers to communication and begin to understand the deaf population, rather than focusing on the contrary.

Ensuring equal access to psychological therapies to those who are deaf or hard of hearing must be a fundamental aim of psychology professionals. Working effectively with interpreters should be a skill which every psychological service provider possesses, to ensure that the deaf community are not denied access to any psychological services which they may require.

The effects of deafness upon mental health does not only extend to the deaf individuals themselves. The experience of parenting a child with hearing loss may be a stressful and unexpected experience for parents, and discovering a child’s hearing loss can produce stress, anxiety, and social exclusion in hearing parents. Stigmatisation of hearing parents of deaf children leaves this group of people more vulnerable to developing psychological health issues than hearing parents of hearing children, or deaf parents of deaf children. Research consistently shows that families of children with hearing loss with strong social support systems are able to cope more effectively, and have better wellbeing, than families with lesser social support.

When it comes to best practice for working with deaf people, more than just an interpreter is required. Communication is one area for consideration; albeit a large factor. There are additional difficulties to consider, with an overview being outlined above.

A number of guidelines have been created, and there are various organisations that are best placed to offer advice. For example, the National Deaf Children’ Society (NDCS) have produced a guide for Social Care professionals during child protection cases involving a deaf child. The British Deaf Association (BDA) have produced a range of guidelines on various topics, including helpful tips for people working with interpreters, and health advice. A study was conducted by BDA in Northern Ireland, and a report subsequently produced which advised on access to justice for deaf people. In the UK, the development of ‘toolkits’ has been undertaken to protect vulnerable people in court, including a toolkit on questioning someone with deafness. The toolkit draws on a range of professionals and represents best practice guidelines when communicating with a deaf person in court. It is recommended that the deaf client is asked as to the most appropriate resources they require so as to assist their involvement in proceedings, or specialist advice is sought. This may include hearing loops, assistive devices, or a communication service.

When looking for an expert opinion within any proceedings involving a deaf client, it is important to select the right expert with specialist experience and awareness of deafness. Ideally, these experts should be proficient in the use of sign language, and/ or have experience of working with SLIs, and have specialist knowledge as to the developmental and educational experiences of deaf individuals and thus their potential additional needs (e.g. mental health, physical health or communication needs).

References
Action on Hearing Loss, (2020, March 20). Facts and Figures Retrieved from https://www.actiononhearingloss.org.uk/about-us/our-research-and-evidence/facts-and-figures/

British Deaf Association (2020, March 19). Fast Facts about the Deaf Community Retrieved from https://bda.org.uk/fast-facts-about-the-deaf-community/

Centers for Disease Control and Prevention, (2018). Types of hearing loss. Retrieved from https://www.cdc.gov/ncbddd/hearingloss/types.html

Crocker, S., & Edwards, L. (2004). Deafness and Additional Difficulties. In S. Austen & S. Crocker (Eds.), Deafness in Mind: Working Psychologically with Deaf People across the Lifespan (pp. 252-269). London: Whurr Publishers.

Crowson, M. G., Semenov, Y. R., Tucci, D. L., & Niparko, J. K. (2017). Quality of life and cost-effectiveness of cochlear implants: a narrative review. Audiology and Neurotology, 22(4-5), 236-258.

Denmark, J. (1994). Deafness and Mental Health, London: Jessica Kingsley Publishers.
Ebrahimi, H., Mohammadi, E., Mohammadi, M. A., Pirzadeh, A., Mahmoudi, H., & Ansari, I. (2015). Stigma in mothers of deaf children. Iranian journal of otorhinolaryngology, 27(79), 109.

Fellinger, J., Holzinger, D., & Pollard, R. (2012). Mental health of deaf people. The Lancet, 379(9820), 1037-1044.

Hearing Link (2020, March 19). Facts about Deafness and Hearing Loss Retrieved from https://www.hearinglink.org/your-hearing/about-hearing/facts-about-deafness-hearing-loss/

Hintermair, M. (2006). Parental resources, parental stress, and socioemotional development of deaf and hard of hearing children. The Journal of Deaf Studies and Deaf Education, 11(4), 493-513.

Humphries, T., Kushalnagar, P., Mathur, G., Napoli, D. J., Padden, C., Rathmann, C., & Smith, S. (2016). Avoiding linguistic neglect of deaf children. Social Service Review, 90(4), 589-619.

Izycky, A., Cornes, A., & O’ Rourke, S. (2013). Deaf Clients: In the Courtroom, The Law Society Gazette Retrieved from https://www.lawgazette.co.uk/law/deaf-clients-in-the-courtroom/70514.article

Kelly, L. (2018). Sounding Out d/Deafness: The Experiences of d/Deaf Prisoners. Journal of Criminal Psychology, 8(1), 20­32.

Knutson, J., & Lansing, C. (1990). The Relationship between Communication Problems and Psychological Difficulties in Persons with Profound Acquired Hearing Loss, Journal of Speech and Hearing Disorders, 55, 656-664.

Knutson, J., Johnson, C., & Sullivan, P. (2004). Disciplinary Choices of Mothers of Deaf Children and Mothers of Normally Hearing Children, Child Abuse & Neglect, 28, 925-937.

Kvam, M. H., Loeb, M., & Tambs, K. (2007). Mental health in deaf adults: symptoms of anxiety and depression among hearing and deaf individuals. The Journal of deaf studies and deaf education, 12(1), 1-7.

Lederberg, A. R., & Golbach, T. (2002). Parenting stress and social support in hearing mothers of deaf and hearing children: A longitudinal study. Journal of deaf studies and deaf education, 7(4), 330-345.

Li, G., Zhao, F., Tao, Y., Zhang, L., Yao, X., & Zheng, Y. (2020). Trajectory of auditory and language development in the early stages of pre-lingual children post cochlear implantation: A longitudinal follow up study. International journal of pediatric otorhinolaryngology, 128, 109720.

Mcculloch, D. (2012). Not Hearing Us: An Exploration of the Experience of Deaf Prisoners in English and Welsh Prisoners, The Howard League of Penal Reform, London: UK.

Mitchell, R., & Karchmer, M. (2004). Chasing the Mythical Ten Percent: Parental Hearing Status of Deaf and Hard of Hearing Students in the United States, Sign Language Studies, 4, 138-163.

Mitchell, T., & Braham, L. (2011). The Psychological Treatment Needs of Deaf Mental Health Patients in High-Secure Settings: A Review of the Literature. International Journal of Forensic Mental Health, 10, 92-106.

National Deaf Children's Society. (2011). Social care for deaf children and young people: A guide to assessment and child protection investigations for social care practitioners. London: National Deaf Children's Society. Retrieved from https://www.ndcs.org.uk/media/1802/social_care_for_deaf_children_and_young_peopleprof.pdf

O’Rourke, Austen & Wakeland, (in press). Deaf People within the Justice System: A United Kingdom Perspective.

Quittner, A. L., Barker, D. H., Cruz, I., Snell, C., Grimley, M. E., Botteri, M., & CDaCI Investigative Team. (2010). Parenting stress among parents of deaf and hearing children: associations with language delays and behavior problems. Parenting: Science and Practice, 10(2), 136-155.

Responding to Communication Needs in the Justice System. (2016). Tool Kits. The Advocates Gateway https://www.theadvocatesgateway.org/toolkits

Van Eldik, T. (2005). Mental health problems of Dutch youth with hearing loss as shown on the Youth Self Report. American annals of the deaf, 150(1), 11-16.

Vernon, M., Raifman, L., Greenberg, S., & Monteiro, B. (2001). Forensic Pre-trial Police Interviews of Deaf Suspects Avoiding Legal Pitfalls. Journal of Law and Psychiatry, 24, 43-59.

World Health Organisation, (2019). Deafness and Hearing Loss Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/deafness-and-hearing-loss

Wakeland, E., Austen, S., & Rose, J. (2018) What is The Prevalence of Abuse in the Deaf/Hard of Hearing Population? The Journal of Forensic Psychiatry & Psychology, 29(3), 434-454.

Wakeland, E., Rose, J., and Austen, S. (2019). Professionals’ Experience of Deaf Offenders with Mental Health Difficulties. American Annals of the Deaf, 164(1), 137–157.

Weisel, A., & Kamara, A. (2005). Attachment and Individuation of Deaf/Hard-of-Hearing and Hearing Young Adults, Journal of Deaf Studies and Deaf Education, 10(1), 51-62.

Young, A., Howarth, P., Ridgeway, S., & Monteiro, B. (2001). Forensic Referrals to the three Specialist Psychiatric Units for Deaf People in the UK. The Journal of Forensic Psychiatry, 1, 19-35.

Zhao, F., Bai, Z., & Stephens, D. (2008). The relationship between changes in self‐rated quality of life after cochlear implantation and changes in individual complaints. Clinical otolaryngology, 33(5), 427-434.