Drug Misuse and People with Hearing Impairment
Stage 1
The Home Office would like to ensure that disabled people have the same
access to information and services relating to drug misuse as non-disabled
people. It has commissioned COI Communications to look at this issue in
specific relation to people with hearing impairments and to make
recommendations on how best to achieve this aim for these people.
This report looks at:

the scope and objectives of this project;

the demographics of Deaf, deaf and hard of hearing people;

what we know already about people with a hearing impairment;

who the stakeholders are;

a summary of existing research;

recommendations on how to take the project forward in Stage 2
It also contains 4 Appendices on:

Definitions of deafness

Statistics

Literature consulted

People and organisations consulted
“Arguably, now is as good a time as any to begin a
process of serious reflection and debate on these
issues.”
(Dr Helen Miller, 2004)
DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
Contents
SCOPE OF THE PROJECT.................................................................................. 6
1.1
Definitions of hearing impairment ........................................................... 6
1.2
Numbers ................................................................................................. 6
1.3
Existing Research ................................................................................... 6
1.4
Scope ..................................................................................................... 7
1.5
Reinventing wheels................................................................................. 8
1.6
Joined-upness ........................................................................................ 8
2
OVERALL OBJECTIVES FOR THE PROJECT ........................................... 10
3
OBJECTIVES FOR STAGE 1 ...................................................................... 11
4
DEMOGRAPHICS ....................................................................................... 12
5
4.1
Regional distribution ............................................................................. 12
4.2
Numbers ............................................................................................... 12
4.3
Influencing factors ................................................................................ 13
4.3.1
Gender .......................................................................................... 14
4.3.2
Education ...................................................................................... 14
4.3.3
Parental Influence.......................................................................... 14
4.3.4
Levels of Economic Activity ........................................................... 14
4.3.5
Household tenure .......................................................................... 15
4.3.6
Learning disabilities ....................................................................... 15
WHAT WE KNOW ALREADY...................................................................... 16
5.1
Received wisdom about drugs and alcohol .......................................... 16
5.2
Vulnerability .......................................................................................... 16
5.2.1
Social pressures ............................................................................ 16
5.2.2
Mental health ................................................................................. 17
5.2.3
Learning disability .......................................................................... 17
5.3
Lack of information ............................................................................... 17
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
6
7
5.4
Deafblind people ................................................................................... 17
5.5
Access to health and advice services ................................................... 18
5.5.1
General services............................................................................ 18
5.5.2
Services for BSL-users .................................................................. 18
5.5.3
Services for deaf and hard of hearing people ................................ 19
5.5.4
Existing specialist health services ................................................. 19
5.5.5
Issues around specialist health services and Deaf people ............ 19
5.5.6
Drug and alcohol advice services for Deaf people......................... 20
5.5.7
Brief Interventions.......................................................................... 20
5.5.8
Potential services .......................................................................... 20
SENSITIVITIES ........................................................................................... 22
6.1
Cultural issues ...................................................................................... 22
6.2
Literacy ................................................................................................. 23
COMMUNICATION ...................................................................................... 24
7.1
Varying needs ....................................................................................... 24
7.1.1
Additional disability ........................................................................ 24
7.1.2
People from minority ethnic communities ...................................... 24
7.2
Communications problems ................................................................... 25
7.3
Older people ......................................................................................... 26
8
STAKEHOLDERS........................................................................................ 27
9
A SUMMARY OF EXISTING RESEARCH................................................... 28
9.1
Factors which might reduce access to drugs ........................................ 28
9.2
Reasons for drug misuse ...................................................................... 28
9.2.1
Social exclusion ............................................................................. 28
9.2.2
Emotional pressures ...................................................................... 29
9.2.3
Income & employment ................................................................... 29
9.2.4
Mental health ................................................................................. 30
9.2.5
Child mistreatment......................................................................... 30
9.3
Drug misuse ......................................................................................... 31
9.3.1
Greater Glasgow survey ................................................................ 31
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
9.3.2
British Deaf Association survey ..................................................... 31
9.3.3
Summary of two surveys ............................................................... 32
9.3.4
US research .................................................................................. 32
9.4
Alcohol and tobacco consumption ........................................................ 33
9.4.1
Alcohol consumption ..................................................................... 33
9.4.2
Tobacco consumption ................................................................... 34
9.5
A Sign of the Times .............................................................................. 35
9.6
Deafness in Mind .................................................................................. 35
10
SHORT-TERM RECOMMENDATIONS ................................................... 37
10.1
Further research ................................................................................... 37
10.2
Liaising with other government departments ........................................ 37
10.2.1
Co-ordination ................................................................................. 37
10.2.2
Dept of Health – A Sign of the Times ............................................ 37
10.2.3
Dept of Health – Healthy Living Centres........................................ 38
10.2.4
DWP & RNID project ..................................................................... 38
10.3
Involving the Deaf Community .............................................................. 38
10.3.1
Deaf and hard of hearing organisations......................................... 38
10.3.2
Deaf clubs and pubs ...................................................................... 38
10.4
Guidance for service providers ............................................................. 39
10.4.1
General guidance .......................................................................... 39
10.4.2
Tailored guidance .......................................................................... 39
10.4.3
Assistive technology ...................................................................... 39
10.4.4
Auditing the front-line workforce .................................................... 39
10.5
Information for drug misusers ............................................................... 40
10.5.1
Research ....................................................................................... 40
10.5.2
Frank ............................................................................................. 40
10.5.3
Printed information ........................................................................ 40
10.5.4
BSL video ...................................................................................... 40
10.5.5
Poster publicity .............................................................................. 40
10.5.6
Open i publicity .............................................................................. 41
10.5.7
Mainstream sources of information................................................ 41
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
10.6
Information for parents and guardians .................................................. 41
10.7
Prisons.................................................................................................. 41
11
RECOMMENDATIONS FOR STAGE 2 RESEARCH............................... 42
11.1
Service providers .................................................................................. 42
11.2
Young Deaf drug misusers ................................................................... 42
11.3
Parents and guardians.......................................................................... 42
11.4
Frank website ....................................................................................... 43
11.5
Easy Read drugs pack.......................................................................... 43
11.6
Issues to take into account ................................................................... 43
12
Appendices .............................................................................................. 44
Appendix 1 – DEFINITIONS OF DEAFNESS ..................................................... 44
Appendix 2 – STATISTICS ................................................................................. 45
Appendix 3 – LITERATURE CONSULTED ......................................................... 48
Appendix 4 – PEOPLE AND ORGANISATIONS CONSULTED ......................... 50
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
SCOPE OF THE PROJECT
“It is generally accepted among organisations and
people involved with sensory impairment that deafness
affects a person’s life even more significantly than
blindness.”
(The Informability Manual, 1996)
1.1 Definitions of hearing impairment
Throughout this report, ‘Deaf’ is used to denote BSL users, while ‘deaf’ indicates
someone whose hearing is seriously impaired but whose first (and preferred)
language is English (or another spoken mother tongue). We use ‘hearing
impaired’, or ‘hearing impairment’ to refer to anyone with a hearing impairment of
whatever severity.
Much of the report focuses on the very particular needs of Deaf BSL-users.
However, we also refer to deaf and hard of hearing people where their needs are
clearly not met by existing mainstream services.
1.2 Numbers
According to the Royal National Institute of Deaf People (RNID), there are
approximately 9 million Deaf, deaf and hard of hearing people in the UK and it is
thought that this will rise as the population ages. Of these 9 million, the RNID
estimates around 50,000 are Deaf British Sign Language (BSL) users, while the
British Deaf Association (BDA) estimates the figure to be around 70,000. Either
way, the figures are not large.
Given that drug misuse is predominantly a young person’s activity we also need
to bear in mind that around 6.5 million of the 9 million with a hearing impairment
are over 60 years old.
There are more than 30,000 (25,000) deaf children and young people. And only
about 2% of young adults are deaf or hard of hearing.
1.3 Existing Research
It is widely recognised among health professionals that there is an issue relating
to Deaf people (ie BSL-users), drug misuse and access to drugs-related services,
but there is only a very small amount of published research on this specific
subject.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
Indeed, there is little published research of any sort that has included Deaf
people as part of its sample or as its subject matter. This may be partly due to the
difficulties of identifying Deaf people prepared to participate in research projects,
and partly due to the difficulties involved in interviewing Deaf BSL-users. It may
also be due to the relatively small numbers of people in the target group.
1.4 Scope
There is scope for this project to be extremely wide-ranging as there are many
aspects that could be considered and investigated, including the behaviour and
needs of:

Deaf BSL-users

deaf people

hard of hearing people

Deafblind people

hearing impaired drug misusers

hearing impaired people concerned about drug misuse by others
And misuse of:

alcohol

tobacco

illegal drugs

legal substances such as solvents

prescribed drugs

help and advice services available

information available
And within these categories there is scope for looking at different age groups and
a range of other demographics which may influence susceptibility to drug misuse.
We therefore need to be very clear about:

the precise objectives of the project,

which target audiences should be included, and
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT

the nature of the information needed.
1.5 Reinventing wheels
There is a small body of research available on drug, alcohol and tobacco use
among Deaf, deaf and hard of hearing people. Despite most of the surveys being
based on small samples, many of the research findings are relatively consistent
with current expert opinion. In order to make the best use of limited resources,
we should avoid duplicating existing findings.
Some of the existing research has focused on access to health services for
people with a hearing impairment and, more specifically, on Deaf people with
mental health problems.
There are many useful lessons to be drawn from this existing research.
There is also a considerable amount of knowledge among:

Specialists in Deaf health issues (especially mental health)

Deaf and hard of hearing organisations

Academic departments in a small number of universities

Other government departments (eg Dept of Health and Dept of Work
and Pensions)

COI’s Informability Team (disability expertise)

COI’s Strategic Consultancy (knowledge of drug issues)
This font of expertise will be invaluable in informing further research and avoiding
any unnecessary duplication of effort.
1.6 Joined-upness
It is important to be aware of activity in other areas of government that could be
complementary to this project.
For instance, the Dept of Health’s report on the A Sign of the Times1 consultation
(expected to be published around the end of October 2004) looks at issues
A Sign of the Times – modernising mental health services for people who are Deaf
consultation document set out proposals aimed at making a significant difference to the
lives of Deaf people with mental health problems. It is about the development of a
national strategy for mental health services in England for people of all ages who are
Deaf or Deafblind. The consultation document can be found at
www.dh.gov.uk/Consultations/ClosedConsultations
1
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
surrounding Deaf people and mental health services and makes proposals for
developing services to meet the mental health needs of Deaf people. Many of the
recommendations in this report will also be relevant to the needs of Deaf people
who misuse drugs.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
2 OVERALL OBJECTIVES FOR THE PROJECT
“Assessing the prevalence of drug misuse in Britain is
more like piecing together a jigsaw – with most of
the pieces missing and the rest filling poorly, if not
at all – than an exercise in statistics.”
(Baker, 1999)
The following is COI’s interpretation of the objectives:

To ensure that people with hearing impairments have comparable
access to information and services relating to drug misuse as the rest
of the population.

To ensure service providers have the expertise available to meet the
specific advice and information needs of people with hearing
impairments.

To ensure service providers have the tools available to meet the
specific advice and information needs of people with hearing
impairments.

To ensure service providers meet the demands of the Disability
Discrimination Act.

To advise Home Office on how best to meet these objectives.
The project will be carried out in three stages:

Stage 1 – COI scoping and initial recommendations (including this
report).

Stage 2 – Further research among people with hearing impairment and
stakeholders identified in Stage 1 to inform further recommendations in
the Stage 3 report.

Stage 3 – Production of a final report outlining recommendations on
how to achieve the overall objectives.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
3
OBJECTIVES FOR STAGE 1
“Effective communication does not just rely on
technical ability but on an understanding of Deaf
culture and language.”
(The Informability Manual, 1996)
Stage 1 of the project was designed to:

Conduct desk research to identify existing research/knowledge.

Identify the main stakeholders.

Quantify and qualify audiences as far as possible from existing
statistics.

Look at the various needs of Deaf, deaf and hard of hearing people as
to the relative importance of the different audiences’ needs for special
services and advice about drugs.

Identify the best means of engaging with different stakeholders.

Identify gaps in existing knowledge.

Make recommendations on further research/activity.

Provide briefing materials for future research.

Produce a report to Home Office outlining our findings and initial
recommendations.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
4 DEMOGRAPHICS
“Whether located in a deaf centre or elsewhere it
was felt by many that more deaf people would use a
service if it was dedicated to deaf people because
they would feel more comfortable and confident using
the service.”
(Glasgow study, 2002)
4.1 Regional distribution
The number of Deaf people registered in each Government region does not
reveal any significant concentrations in any particular region2. However, there are
small concentrations of Deaf people in Wandsworth, Lambeth, Bristol and
Salford. This could suggest that Deaf people and their families migrate to areas
that have specialised services available. The services in these cases are
specialist mental health services for Deaf people (ie the Springfield Hospital in
London, the Mayflower Hospital in Birmingham and the National Centre for
Mental Health and Deafness in Salford).
4.2 Numbers
The following figures give an overview of the numbers of different types of deaf
and hard of hearing people. More detailed figures, and an explanation of the
different types of deafness can be found in the Appendices. (Figures in brackets
are approximate extrapolated figures for England only).
There are 9 million3 (7.5m) deaf and hard of hearing people in the UK. This
number is rising as the number of people over 60 increases. Of these 9 million:

6.5 million (5.5 million), ie the vast majority, are over 60.

Estimates vary as to how many profoundly deaf people use British Sign
Language, but it is probably between 50,000 and 70,0004 (42,000–
58,000).

Only about 2% of young adults are deaf or hard of hearing.
People Registered as Deaf of Hard of Hearing Year ending 31 March 2001, England,
Department of Health.
2
All the statistics in Demographics are from the RNID website www.rnid.org.uk, unless
otherwise stated.
3
4
British Deaf Association website www.bda.org.uk estimates the higher figure.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT

There are more than 30,000 (25,000) deaf children and young people,
including about 20,000 (17,000) aged 0-15 years who are moderately
to profoundly deaf5.

Of these, about 12,000 (10,000) were born deaf and are likely to use
sign language.

Only 5% to 10% of Deaf children are born to Deaf parents.

Only about 20%6 of hearing parents of Deaf children learn sign
language. This is significant as children brought up by signing parents
are often said to be more successful academically and have more selfesteem.

Assuming that most drug misuse relates to younger people, we are
looking at very small numbers of potential/actual drugs misusers with
hearing impairments.

According to the 2002/03 British Crime Survey (BSC)7, people aged
between 16 and 24 were more likely than older people to have used
drugs in the last year and in the last month. And 28% of people aged
between 16 and 24 had used at least one illicit drug in the last year.
The survey also showed that drug use was higher among 20- to 24year-olds than among 16- to 19-year-olds.
4.3 Influencing factors
There are a number of factors which may increase the likelihood of Deaf people
misusing drugs. These include:

social exclusion

emotional pressure

mental health problems

maltreatment in childhood
These factors are covered in more detail in Section 9 – A Summary of Existing
Research.
5
National Deaf Children’s Society
6
Bob McDonald, Dept of Health, author of A Sign of the Times
BCS is a large national survey of adults who live in a representative cross-section of
private households in England and Wales.
7
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
Other factors which may also influence someone’s propensity to take drugs
include:
4.3.1 Gender
From the age of 40, more men than women become hard of hearing. This is
probably linked to exposure to higher levels of industrial noise. After the age of
80 more women than men are hard of hearing but this is simply due to the fact
that women live longer8.
There is no marked difference in the numbers of male and female Deaf people.
4.3.2 Education
Opinion is divided on whether it is better for Deaf children to be educated in
mainstream schools, with support, or whether they get more benefit from
attending a Deaf school.
Regardless of this debate, schools of both types are – or should be – important
sources of information on drugs and alcohol for children with a hearing
impairment.
4.3.3 Parental Influence
It is often said that Deaf children brought up by signing parents tend to be more
successful academically and have more self-esteem. It is suggested that this is
because they are able to communicate more effectively with their parents and
hence develop better social skills and more self-confidence.
4.3.4 Levels of Economic Activity
It is recognised that drug misuse and unemployment among the population in
general are sometimes linked.
Of the 3.5 million people in the UK (2.9 million) of working age (i.e. aged between
16-65) an estimated 160,000 (133,000) are severely or profoundly deaf9.
The unemployment rate among severely and profoundly deaf respondents to an
RNID survey in 200210 was 20%, or four times the national unemployment rate.
8
RNID
9
See Appendix 1 for definitions of types of deafness.
The employment situation and experiences of deaf and hard of hearing people, W
Bradshaw, RNID (2002)
10
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
And, according to another study the same year11, the employment rate for people
with hearing impairments is 68%, as opposed to 81% for non-disabled people.
The RNID survey found that unemployment was higher for hearing impaired
people with additional disabilities (32%) and for those aged under 25 (34%).
4.3.5 Household tenure
According to research carried out between 1997 and 2001 among 240 Deaf
people nationwide12, there are no major differences in accommodation type
between the Deaf community and the general population.
However, Deaf households were found to be more likely to contain three or more
adults (28% versus 9% of hearing households). The research concludes that this
seems to reflect larger numbers of Deaf adults still living with their parents.
4.3.6 Learning disabilities
Deaf people with learning disabilities are especially vulnerable. They may be
more likely to be influenced by siblings of other influencers in their lives and may
use drugs or alcohol without understanding the full health implications.
Labour market experiences of people with disabilities, A Smith & B Twomey, Labour
Market Trends, 2002
11
Deaf People in the Community, Health and Disability, by Matthew Dye, Jim Kyle et al,
1997-2000
12
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
5 WHAT WE KNOW ALREADY
“Current provision relies heavily on a small community
of dedicated, expert staff and many service
developments have occurred as a consequence of
enormous individual and organisational effort.”
(A Sign of the Times, 2004)
A lot of what we know is received wisdom from people who work with Deaf and
hard of hearing people rather than based on formal research.
5.1 Received wisdom about drugs and alcohol
We know that there is an active Deaf club/pub culture among young Deaf people.
We know, anecdotally, that a lot of Deaf people do use drugs – especially
tobacco, alcohol and Ecstasy13. Indeed, according to the VeeTV website, Deaf
people are also more at risk from drink spiking because they don’t nurse their
drinks (because they use their hands to communicate).
It has also been suggested that drug use is on the increase among the Deaf
Community possibly due to the fact that text messaging may have made buying
and selling drugs easier for Deaf people. (Having said that, text messaging may
also help information providers to target Deaf audiences as well.)
Deaf people are often unaware of a lot of information – the safe levels for alcohol
consumption for example, or the dangers of sharing needles – because they
don’t receive much information from mainstream sources. Information provided
through print, TV and radio or by phone may all present access problems for
Deaf and, to a lesser degree, deaf and hard of hearing people.
Levels of knowledge of drugs and alcohol can also be influenced by what sort of
education a person has had, and by whether their parents are Deaf or not.
5.2 Vulnerability
5.2.1 Social pressures
Young people with hearing impairments may use drugs or alcohol to identify with
and be accepted by their hearing contempories.
This statement is based mainly on anecdotal information, but Stephen Dering, of
deafPLUS, confirmed this view at a meeting at the Home Office on 7 April 2004
13
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
Negative stereotypes of deafness continue to be common among hearing
people14 and this can affect Deaf/deaf people’s self esteem and therefore
increase their susceptibility to substance abuse disorders (SUDs).
Deaf people may also use drugs to deal with anger or frustration experienced as
a result of communication difficulties with the hearing world.
Some Deaf people experience feelings of low self-esteem and of helplessness,
and have difficulty adapting to their Deafness. Substance misuse may be a way
of numbing these feelings.
5.2.2 Mental health
Deaf people have a higher susceptibility to mental health problems; and there are
recognised links between mental heath problems and drug and alcohol misuse.
5.2.3 Learning disability
Deaf people with learning disabilities are especially impressionable and therefore
vulnerable, and may also use drugs or alcohol without understanding the dangers
or health implications.
5.3 Lack of information
Deafness creates barriers to audible sources of information such as TV and
radio, and lower literacy levels among BSL-users mean that access to
information in print may be restricted.
Although research is lacking in this area, it is generally agreed that there is a lack
of information for BSL-users on drugs and alcohol. For instance, although Deaf
people might be aware of the effects of alcohol, they might not be aware of the
number of standard units that different measures of alcohol might contain, or
appreciate the dangers of sharing needles.
However, once Deaf people start to become aware of services and/or sources of
accessible information, because of the closeness of the Deaf Community, word
should travel fast and members of the Community are likely to help increase
awareness among themselves.
5.4 Deafblind people
Whatever the problems are for Deaf or hard of hearing people, they are much
greater for Deafblind people who as well as complex communication needs, also
Can you hear us? – Deaf people’s experience of social exclusion, isolation and
prejudice, Breaking the Sound Barrier Report, RNID, 1999
14
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
have added problems relating to their ability to travel or get around in general.
This has huge implications both for their ability to access information and for their
ability to access services themselves.
5.5 Access to health and advice services
“Effective treatment requires skilled personnel,
resources activity and co-operation of the highest
order, between disciplines and across agencies. This
has already occurred with respect to Deaf mental
health services and there is no logical reason why it
should not occur in relation to substance use.”
(Dr Helen Miller, 2004)
5.5.1 General services
GPs have a statutory responsibility (and are paid) to provide advice on diet,
exercise, smoking, alcohol and drug use. The Disability Discrimination Act means
that many strategic health authorities and primary care trusts are beginning to
address this problem as a matter of policy.
However, this service is still not benefiting as many people with hearing
impairments as it should due to the reluctance of many to visit their doctors15
because of the communications problems they encounter. It may also not be
influenced by the lack of time available for GP consultations, and the fact that
people with hearing impairments need more time than hearing people to get the
same advice.
A Glasgow study in 2002 found that 67% of Deaf respondents didn’t know of any
specific services for people with alcohol or drug problems.
5.5.2 Services for BSL-users
Opinion among Deaf people is split as to whether specialist services should be
provided for Deaf people, or whether mainstream services should be able to
accommodate their needs.
Some people feel that equity of access (ie local services that can cope across the
board) is the ideal solution. Indeed, specialist Deaf organisations couldn’t hope to
meet all the health/advice/information needs of Deaf people, so many of these
have to be met through mainstream services.
Can You Hear Us? – Deaf people’s experience of social exclusion, isolation and
prejudice, RNID, 1999
15
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
However, access to mainstream medical or advice services is notoriously difficult
for Deaf people. Also, they nearly always need to travel to access specialist
services as these are very few and far between. Sometimes Deaf people can
access initial or crisis services, but longer-term treatment and facilities tend to be
inaccessible.
A Sign of the Times examines mental health services for Deaf people and makes
many recommendations about services which will be relevant to this project.
5.5.3 Services for deaf and hard of hearing people
It is generally accepted that mainstream services should be able to cope with
most people with a hearing impairment, but that they often fall short of providing
an accessible and user-friendly service.
Increased deaf awareness and introduction of assistive technology could help
service providers to deal much more effectively with the vast majority of people
with hearing impairments.
5.5.4 Existing specialist health services
There are currently three specialist mental health services for Deaf people (in
London, Birmingham and Salford). There is also Rampton Special Hospital which
is high-security and has developed services to meet a perceived need. There is
also a privately-run unit in Bury.
These services have developed because it is essential to have direct
communication with mental health patients in order to accurately assess and
treat them. They exist due to individual dedicated clinicians identifying and
addressing a problem rather than due to any overall strategy.
None of these centres currently has services for people with substance misuse
problems. This is not to say, however, that these couldn’t be developed in due
course.
5.5.5 Issues around specialist health services and Deaf people
When looking to provide services for Deaf people in particular, there are a
number of issues that need consideration. For instance:

How far can specialist services be expected to become Jack-of-alltrades, coping with the full range conditions, including drug or alcohol
misuse alongside mental health, learning disability, autism etc?

How desirable is it for doctors/advisors in regional specialist centres to
be responsible for clients living many miles away. And it how far would
people be prepared to travel to receive treatment or advice?
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT

Given the small number of Deaf BSL-users, is it feasible to expect
some staff in every service centre to have BSL skills?

Given the small number of Deaf BSL-users, is it reasonable to try to
recruit drug misuse specialists with BSL skills?

How can service providers deal with the problem of the very limited
availability of qualified BSL interpreters?
5.5.6 Drug and alcohol advice services for Deaf people
The British Deaf Association provides some counselling for Deaf people about
alcohol and drug misuse, but resources are very limited.
COI has been unable to identify any other specialist services for Deaf people
relating to drug or alcohol misuse.
5.5.7 Brief Interventions
Brief Interventions is a system of information giving and counselling designed to
be used usually in primary care environments with a minimum of time and
resource implications. According to Dr Helen Miller of National Deaf Services at
St George’s Hospital in SW London, Brief Interventions has proved effective with
Deaf psychiatric patients. This is noteworthy because it suggests that the
mainstream treatment approach may be adaptable for Deaf people. It is also
interesting in that interventions to reduce substance-related harm are usually less
effective for people with psychiatric disorders – this suggests that using Brief
Interventions with Deaf people who don’t have psychiatric disorders could be
useful in a higher proportion of cases.
5.5.8 Potential services
Services for Deaf people will always cost more whether they’re adapted within
the mainstream or special services for Deaf people only.
A Sign of the Times says that services should achieve the same standards for
everyone – including (mainly older) people whose hearing impairment has
developed later in life and whose main method of communication is still speech.
Dr Miller believes that integrated care ensures continuity of care and appears to
deliver better outcomes than either serial care (where treatment is delivered by
specialists in sequence), or parallel care (where different treatments are carried
out by different specialists over the same period).
The Department of Health has plans to develop a number of Healthy Living
Centres. These will combine a range of health and information services in a
signing environment. Centres are being considered in:

London – well-advanced in the planning stage
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT

Birmingham – likely to happen

Manchester – probable

Bristol – a possibility
Bob McDonald16 at DoH holds the budget for developing plans for these centres.
The NHS will pay for implementation, buildings and services.
There are obvious implications for this project and potential for joint development.
16
Bob McDonald is author of A Sign of the Times
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
6 SENSITIVITIES
“If the service was for deaf people only, then all
deaf people would know my business – it’s a really
small community.”
(Deaf female, 25-44, Glasgow study, 2002)
There is a dichotomy of opinion among ‘Deaf’ and ‘deaf’ people as to the
desirability of encouraging the use of BSL and information provision in BSL
versus encouraging integration with the mainstream community which implies
communicating using spoken and written English, lip reading etc.
6.1 Cultural issues
One of the problems researchers encounter when looking at Deaf issues is that
there is a political aspect to the use of BSL which can complicate (or even cloud)
the issues.
To summarise this complex and (sometimes) emotive subject:
Most members of the Deaf Community see deafness as a cultural issue – they
are distinguished from the hearing community and deaf and hard of hearing
people by their language (BSL). Like some Welsh speakers, they want
information and communications to be supplied in their own, and in many cases
first, language. They do not consider themselves disabled by their deafness, but
by society’s inability to recognise and meet their communication needs. Some
Deaf people do not wish to be ‘cured’ of their deafness, nor do they wish to ‘cure’
their children of deafness (despite medical advances17 which have made this a
viable option for many people with a hearing impairment). This can be a difficult
concept for many hearing and hard of hearing people to understand but is crucial
to understanding Deaf people’s attitudes to service and information provision.
Because English is the second language of many BSL users, levels of literacy
are lower among the Deaf Community than among the population as a whole.
This is one of the arguments for providing communications in BSL rather than in
spoken or written English.
On the other hand, most deaf and hard of hearing people view themselves as
part of the mainstream community. They read English (or their native language)
and receive most of their information through the mainstream sources (that don’t
rely on hearing).
17
Specifically cochlear implants
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
For these reasons, Deaf and deaf people constitute two very distinct audiences
with very different needs.
6.2 Literacy
As already mentioned, there are some sensitive issues relating to BSL.
Organisations and lobbyists representing Deaf people stress that Deaf BSL-users
need information supplied in BSL because this is their first language and levels of
literacy are low among this group.
There do not appear to be any generally accepted statistics available on how
many BSL-users have such low levels of literacy that they are precluded from
using written English. But a research study carried out in Glasgow in 2002 found
that only around 20% of BSL users in their sample were fluent in English
grammar.
The Informability Team, which has regular contact with many Deaf people in the
course of our work, has found that many Deaf BSL-users do indeed have lower
levels of literacy than their hearing counterparts. However, our experience also
suggests that severe literacy problems are less prevalent than some of the
lobbying organisations might like to suggest.
It is difficult therefore to estimate with any accuracy how many Deaf people have
such low levels of literacy that they can’t receive information in a written or
printed form.
It is likely, however, that the majority will be able to access information provided
in plain language supported by helpful illustrations/photographs/diagrams etc.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
7 COMMUNICATION
“I don’t think a lot of Deaf people use counselling
services because it’s a different form of
communication. Hearing people go to a counsellor and
just talk, talk, and the counsellor listens without
saying a lot. When you’re signing, you expect a twoway communication.”
(Deaf female, Glasgow study, 2002)
7.1 Varying needs
Deaf, deaf and hard of hearing people miss out on a lot of information the rest of
the population takes for granted because much mainstream information is
communicated through the spoken word – face-to-face, by telephone and
through TV and radio.
The vast majority of hearing impaired people can access information in print,
provided they don’t also have a visual impairment.
However, Deaf BSL-users prefer and need information in BSL.
Translation into BSL can be complicated by the fact that many expressions and
words relating to substance misuse don’t have direct equivalents in BSL.
Since the communication needs of Deaf BSL users are very different to those of
deaf, hard of hearing or Deafblind people the most effective means of targeting
the different groups also need to be very different.
7.1.1 Additional disability
There is a higher prevalence of additional disabilities in the Deaf population18
which may further affect their communication needs. For instance, among those
under 60, 45% of severely or profoundly deaf people have other disabilities.
7.1.2 People from minority ethnic communities
According to the RNID, “Some minority ethnic groups may experience higher
levels of deafness. This is especially true of recent immigrants who have come
from regions with greater levels of poverty, poor health care and low levels of
immunisation against diseases such as rubella.
18
RNID website
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
7.2 Communications problems
Problems for people with a hearing impairment relating to communication
include:

Deaf people’s lack of awareness of available services

Lack of communication aids – both human and technological

Lack of awareness of Deaf cultural and etiquette

Failure to adapt mainstream services and information materials to
accommodate the needs of Deaf, deaf and hard of hearing people

Small numbers and a disparate population which make it difficult to
resource specialist services effectively and economically.
Particular problems relating to access to health services include:

Difficulty making an appointment

Missing being called from the waiting room into a surgery/consultation

Difficulty of communicating effectively with advisers and doctors

Booking interpreters (there’s not enough to go round)

Cost of interpreters

Lack of extra time allowed by GPs and other service providers to meet
the communication needs of people with hearing impairments

Lack of resources and planning for a geographically dispersed minority
group

Previous bad experiences
All these problems are worse for Deafblind people, who also have mobility
difficulties.
NB It’s worth noting that RNID is working closely with DWP to increase the
number of available fully-qualified BSL/English interpreters19. This should be an
issue of interest across the public service.
19
A Simple Cure, RNID, 2004
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
7.3 Older people
Older Deaf people may find themselves particularly socially isolated (due to
bereavement perhaps) especially if they become frail and less mobile. As their
contemporaries develop hearing impairment with age, there’s a greater risk that
their unique communication needs may not be recognised by social care and
health services.
This is probably not an issue regarding illegal drug misuse, but has implications
for misuse of prescribed drugs – whether inadvertent or deliberate.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
8 STAKEHOLDERS
“The key challenge for creating a national strategy is
to develop local and specialised services in a way that
strengthens both components, rather than one being
at the expense of the other.”
(A Sign of the Times, 2004)
COI has identified the stakeholders for this project as including:

Home Office

Department of Health

Professionals in specialised health services for Deaf people

Professionals in mainstream services, including:
o DATs
o Local authority sensory teams
o Health professionals

Voluntary organisations representing Deaf people

Professionals working in:
o mainstream schools
o specialist Deaf schools

Deaf BSL-using drug misusers (including alcohol and tobacco users)

People who are deaf and hard of hearing drug misusers (including
alcohol and tobacco users)

Deaf, deaf and hard of hearing young people in general (potential drug
misusers)

Deaf parents/carers/guardians

Hearing parents/carers/guardians of Deaf children
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
9 A SUMMARY OF EXISTING RESEARCH
“It’s an unfortunate fact – in the 21st century – that
a paucity of evidence means that discussion of Deaf
peoples’ substance use largely remains an exercise in
supposition, inference and ‘guestimation.”
(Dr Helen Miller, 2004?)
9.1 Factors which might reduce access to drugs
Prior to discussing the research in detail, it should be noted that there are various
influencing factors that might have the effect of lowering the incidence of alcohol
and drugs use within the Deaf community.
For example, it is possible that there is limited or less access to drugs and
alcohol for Deaf children who attend special Deaf schools. Also, it is likely that
some Deaf people live in an environment where they are over-protected by family
members and hence would have restricted access to drugs.
Finally, communication between drug dealers and Deaf people might be a further
barrier assuming the former would need BSL in order to communicate, although
advances in mobile telephony and high use of text messaging services by the
Deaf community, particularly younger Deaf people, might run counter to this.
9.2 Reasons for drug misuse
As already mentioned, there is little existing research or published articles on the
issue of Deaf people and the use of drugs, nor on deaf and hard of hearing
people. However, there are a few sources of information on this topic, which we
discuss below.
Although none of the published research we have examined conclusively points
to a higher incidence of drugs use or alcohol use in the Deaf community, it is
generally accepted by experts in the field such as Sally Davidson and Peter
Hindley that the incidence of use is likely to be the same, or higher, than in the
general population.
9.2.1 Social exclusion
LG Stewart suggests in an article20that Deaf people in general suffer unique
pressures, over and above those faced by the wider population. These may be
pressures surrounding feelings of social isolation, loneliness, difficulties in
20
"Hearing Impaired Substance Abusers", ALMACAN Newsletter, April 1983
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
personal relations, lack of education and inability to hold down jobs. In another
article21 ME Rendon suggests that this sense of isolation and lack of information
could lead to an increased tendency to misuse substances among Deaf people.
This view of Deaf people feeling excluded and living in isolation is confirmed by
RNID research22 among deaf and hard of hearing people which states that:

71% feel isolated because of their hearing loss

39% avoid meeting new people

59% believe hearing people think they are stupid

20% have been the victim of abusive language or gestures
9.2.2 Emotional pressures
As well as feelings of isolation and exclusion, Deaf people may be subjected to
higher levels of stress than the wider community as a result of having to
communicate with hearing people that do not use BSL, or having to lip-read in
social situations. It may be that the additional stress involved in "breaking the ice"
in social situations with hearing colleagues could lead to higher use of alcohol
and/or drugs. Rendon23 compares the loneliness of alcoholism with the loneliness
of deafness.
Deaf people may also use alcohol and/or drugs as a means of reducing negative
feelings such as anxiety, depression or physical pain in the same way that some
hearing people do. Although there is no evidence to suggest that a higher
proportion of people in the Deaf community experience these symptoms than the
hearing population, it may be that they are less likely to access services aimed at
treating such conditions and are more likely to resort to drugs and alcohol as a
means of 'self-medication'.
9.2.3 Income & employment
Poverty may be another risk factor as Deaf people are more likely to be in lower
socio-economic groupings than the rest of the population. They also experience,
as mentioned above, significantly higher rates of unemployment. Poverty and
social exclusion have been linked by the Home Office to increased risk of
problematic drug use in the general population.
Deaf Culture and Alcohol and Substance Abuse", Journal of Substance Abuse
Treatment, 1992
21
Can you hear us? – Deaf people’s experience of social exclusion, isolation and
prejudice, Breaking the Sound Barrier Report, RNID, 1999
22
“Deaf Culture and Alcohol and Substance Abuse", Journal of Substance Abuse
Treatment, 1992
23
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
A survey24 conducted by RNID in 1999 showed that the rate of unemployment for
deaf and hard of hearing people was four times that of the mainstream population
at 19% of all respondents.
9.2.4 Mental health
The consultation paper A Sign of the Times says that mental health problems
occur more frequently in Deaf children than in hearing children and that Deaf
adults appear to suffer the same rates of psychoses as the population in general,
but have higher rates of common mental health problems and complex problems.
According to Sign, the National Society for Mental Health and Deafness 25, BSL
users are twice as likely to experience mental health problems than the general
population with25% of people in the UK said to experience mental health
problems versus 50% of BSL-users.
Research has also shown that traumatic causes of deafness (eg. accidents,
infections, anoxia, rubella) appear to contribute to mental health problems26 and
attention deficit disorders.
In addition, research suggests that there is a higher incidence of hearing
impairment among people with learning difficulties or other mental disabilities,
which may contribute to mental health problems. These factors – mental health
problems and the higher prevalence of learning disorders in childhood – are
associated with increased risk of developing problematic substance misuse in
adults.
9.2.5 Child mistreatment
Finally, research suggests that there may be a higher incidence of maltreatment
of children in the deaf and hard of hearing community. This is also an issue
among people with other disabilities.
According to research by Sullivan and Knutson (1998)27, Deaf and hard of
hearing children and young people are at increased risk of becoming victims of
maltreatment whether that be from neglect, physical abuse and/or sexual abuse.
Parents and other family members perpetrate about half of these incidences.
The employment situation and experiences of deaf and hard of hearing people, W
Bradshaw, RNID, 1999
24
25
www.signcharity.org.uk/aboutus/
Mental Health in Children who are Deaf and Have Multiple Disabilities, David E Bond
in Mental Health and Deafness, edited by Peter Hindley and Nick Kitson (2000)
26
The Association between Child Maltreatment and Disabilities in a Hospital Based
Epidemiological Study. Child Abuse and Neglect 22(4) : 271-188 (quoted in Mental
Health and Deafness, edited by Peter Hindley and Nick Kitson (2000))
27
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
Outside of immediate family, people in close contact with Deaf children also
commit a significant proportion of these acts. (eg. Care attendants, babysitters,
van drivers, peers, older students, friends of siblings, etc.)
The use of residential schools for Deaf and hard of hearing children also puts
them at a higher risk of abuse.
Such traumatic experiences in childhood are also associated with increased risk
from problematic drugs use.
9.3 Drug misuse
COI identified only two research studies conducted in the UK which addressed
the issue of Deaf people and drugs.
9.3.1 Greater Glasgow survey
One survey was conducted in Greater Glasgow28 by FMR Research on behalf of
the Greater Glasgow NHS board. COI has certain reservations about the sample
and methodology used in this particular study.
The sample was skewed towards older age groups – the over 40s – which is not
the most relevant age group amongst which to research drug misuse, and
respondents were given self-completion questionnaires to complete, which, given
the lower literacy of people within the Deaf community, is not the most
appropriate research instrument.
However, the survey did involve two focus groups as well as an on-line focus
group which led to interesting qualitative findings. Some of the survey’s findings
are summarised in Appendix 2 – Statistics.
9.3.2 British Deaf Association survey
The other survey29 was commissioned by the BDA and carried out by Cox &
Jackson Consultancy. The sample comprised 214 Deaf people aged 11 -24 and,
once again, COI has concerns about the sample. The study recruited BDA
members who were attending a weekend rally, which suggests that the resultant
sample may not be typical of young Deaf people in general.
Final Report November 2002 : Drug and Alcohol Issues Affecting Those With A
Sensory Impairment in Greater Glagow, FMR Research for Jac Ross, Addictions
Manager, North Greater Glasgow NHS Board
28
Drugs in the Deaf Community – summary of key findings of a survey carried out by
Cox & Jackson Consultancy for the British Deaf Association (1998??)
29
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
9.3.3 Summary of two surveys
Despite our reservations about the samples and methodologies used in these
two surveys, some interesting themes emerged.
The survey found that awareness of the names of drugs ranged from 7% of the
sample having heard of DFs and 39% saying that they had heard of crack to
around 70% saying they had heard of cannabis.
For the general population, awareness of the names of the thirteen drugs listed
by the British Crime Survey, reached 90% across all age groups, which suggests
that awareness of drugs is significantly lower within the Deaf community.
A large majority of the BDA sample claimed to have tried drugs, with just under
half saying they had tried them in the three months before the survey.
Cannabis was the most commonly used drug followed by ecstasy.
These statistics would appear to show that use of drugs was higher in the sample
surveyed than in the general population. In the 2002/03 British Crime Survey,
28% of 16-24-year-olds said they had taken any drugs in the past year.
Understanding of the risks associated with drug use was very imprecise and
most respondents were unaware of harm reduction methods, or perceived any
risk to health associated with drug use other than that it could cause death. Most
respondents perceived that the main non-health risk resulting from drugs use
was that it would lead to “trouble with the law”.
However, of those who had used drugs, just under half claimed they would stop
because of concerns about their health.
In terms of exposure to drugs, the BDA survey found that Deaf children who
attended special schools were less likely to have access or exposure to drugs
than those who were attending a mainstream school.
The majority of respondents to the Glasgow survey cited TV programmes and
schools as their main source of knowledge about drugs.
9.3.4 US research
Other studies on drugs and Deaf people have shown that patterns of drugs use in
the Deaf community are similar to that in the general population. A study quoted
in “Deafness in Mind – Working Psychologically with Deaf People Across the
Lifespan”30, conducted among New York City’s Deaf population found that Deaf
Chapter 12, Substance Use Disorders and Developing Substance Use Services for
Deaf People, Davidson, Miller and Kenneth
30
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
people experienced similar drinking and drug use patterns to the general
population. (Lipton and Goldstein, 1997).
9.4 Alcohol and tobacco consumption
“Alcohol misuse is the most common form of
substance misuse, probably because it is readily
available, and where drug misuse occurs it often coexists with alcohol misuse.”
(Dept of Health, 2002)
“Deaf People in the Community, Health and Disability”, written by Matthew Dye,
Jim Kyle et al (1997-2000) looked at consumption of tobacco and alcohol among
240 Deaf people nationwide with the sample constructed in accordance with the
Census (1991) and General Household Survey (1996) so that it reflected gender,
regional and ethnic composition. The main difference was that this sample
contained a smaller proportion of 60-75 year olds (19% compared with 36% in
the Census) and a higher proportion of 18-29 year olds (28% versus 15%).
9.4.1 Alcohol consumption
The questionnaire was based on that used in the General Household Survey.
Respondents were asked about frequency of drinking during the year and
quantity consumed on a normal day of the following alcoholic drinks:

shandy

lager and beer

spirits

sherry & port

wine
The findings of this survey suggested that Deaf people drank and smoked less
than the population as a whole. However, three groups were identified as being
at particular risk from alcohol:

Deaf women of all ages tended to drink more than the average
consumption of alcohol for hearing women and for Deaf men.

Deaf women in employment and those living in households with
relatively large gross weekly incomes were identified as being at
particular risk due to dangerous levels of alcohol consumption.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT

Deaf women were less likely than Deaf men to drink for celebrations or
because they were thirsty but more likely to drink to forget frustrations,
drown sorrows, or because of stress and worries.

Although the proportion of Deaf men drinking above the recommended
daily limits was below that of hearing men, within the 16-24 year old
age group, Deaf men tended to consume higher levels of alcohol than
in the general population.
9.4.2 Tobacco consumption
The research also covered smoking habits among the Deaf community.
In terms of tobacco use, the study found the following:

Deaf men aged between 20 and 24 were identified as having a
significantly high prevalence of smoking. Two thirds (67%) of this group
reported that they were current smokers. This is significantly higher
than for hearing men from this age group. According to the 2002
General Household Survey, 37% of men in the 20- to 24-year-old age
group smoked.

In comparison, a much lower proportion of 25- to 34-year-old Deaf men
(29%) were smokers. This suggests that some young Deaf men cease
smoking in their late 20s and early 30s.

However, the research concluded that the large difference between the
two age groups suggests that a higher proportion of 20- to 24-year-old
men are smokers now than was the case ten years ago.

For the rest of the Deaf sample a higher proportion had never smoked
compared with the UK population as a whole.

There was also a tendency for the Deaf smokers to smoke less than
smokers in the general population.
Similar findings were found in the two previously mentioned studies. The
Glasgow study suggested that awareness of alcohol and its effects is low among
the Deaf community with many claiming to be unaware of the number of ‘units’ of
alcohol in a bottle of wine or a pint of beer. Interestingly, findings from the group
discussions revealed that many Deaf people had not heard of the term ‘units’ of
alcohol and were unaware of the drink-drive limit of units of alcohol. The survey
also showed little evidence of heavy drinking among the Deaf respondents with
most saying they drank between 1 and 4 drinks, mainly with friends, family and
colleagues.
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9.5 A Sign of the Times
The recent consultation document from the Dept of Health, A Sign of the Times,
outlines a number of proposals for increasing accessibility for Deaf people to
mental health care services in particular and to health care in general.
The paper recommends that Primary Care Trusts and social care services work
within their Local Implementation Teams to develop plans that increase
accessibility for Deaf people to mental health services. This would include
provision and availability of appropriate communication support and general
training in deaf awareness for front-line staff in primary care and prisons as well
as other initiatives to tackle awareness of communications problems when
interacting with Deaf patients with mental health problems.
In addition, the paper recommends highly specialised regional expertise centres
with intermediaries that work between the primary care level and the regional
level.
It then opens up for consultation two options for this intermediate level :

Local mental health provider trusts develop services to meet the needs
of the Deaf community within the context of their LIT and local CAMHS
development strategies;

The three existing specialised Deaf services developing
comprehensive multi-agency and multi-professional community
services all over the country as well as care co-ordination provision for
all patients in their care.
9.6 Deafness in Mind
Following on from this, an approach recommended by Davidson, Miller and
Kenneth in Deafness in Mind – Working Psychologically with Deaf People Across
the Lifespan31 for substance misuse among Deaf people is that primary care
services become accessible to the Deaf community (in accordance with statutory
requirements) in order that low to moderate cases of drugs use disorders can be
treated at this point while more serious or complex cases are referred to and
treated by specialist regional teams.
Specialist regional teams would be useful in making links between relevant
statutory and voluntary organisations while local teams would not have to
dedicate large amounts of resources to a small minority of people. At the same
time, the needs of a geographically disparate minority could be met by regional
Chapter 12, Substance Use Disorders and Developing Substance Use Services for
Deaf People, Davidson, Miller and Kenneth
31
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
teams, which could become providers/enablers of substance use screening,
prevention and treatment services for Deaf people.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
10 SHORT-TERM RECOMMENDATIONS
Deaf adults may benefit from health education,
effectively communicated, regarding such matters as
post-natal depression, alcohol and drug misuse and
coping with stress and bereavement.”
(Sign of the Times, 2004)
The following are recommendations for Stage 2 of the project based on our
finding in Stage 1. Some of the recommendations we anticipate will also be
carried over into the final recommendations following Stage 3.
10.1 Further research
We recommend Home Office commissions some research as part of Stage 2 of
this project to examine and clarify a range of issues identified in Stage 1. The
issues are outlined in this section and summarised in Section 11.
10.2 Liaising with other government departments
10.2.1 Co-ordination
Co-ordination of effort is vital if government in general and Home Office in
particular hope to achieve a joined-up solution for meeting the needs of people
with hearing impairment. Also, as there are already projects underway under the
auspices of the Department of Health and the Department of Work and Pensions
(and possibly others), it will be important to combine efforts to ensure the best
use of public money and most efficient capitalisation of resources.
10.2.2 Dept of Health – A Sign of the Times
Although it focuses on mental health issues, A Sign of the Times contains many
proposals, suggestions and ideas which are relevant to this project. We therefore
recommend that Home Office collaborates with the Department of Health (Bob
McDonald in particular) to develop joint services which serve the needs of Deaf
people across a range of health/advice issues.
For instance, A Sign of the Times outlines a number of proposals for the
development of primary care services for Deaf people and improving access to
health care throughout the system. It also suggests undertaking studies to
establish the numbers of Deaf people and their mental health needs and
mentions services in prisons and young offender institutions.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
We think that Home Office (and DoH) would benefit from combining forces on
this project and broadening the research to include substance misuse as well as
mental health issues.
10.2.3 Dept of Health – Healthy Living Centres
DoH is currently working towards setting up the first Healthy Living Centre for
Deaf people in London. We recommend that Home Office liaises with DoH on the
development of these centres.
10.2.4 DWP & RNID project
DWP is working closely with RNID to increase the number of fully-qualified
BSL/English interpreters available. We suggest that Home Office (through COI?)
liaises with DWP to keep-up-to-date with progress on this project.
10.3 Involving the Deaf Community
Involving the Deaf Community in developing services will be essential.
10.3.1 Deaf and hard of hearing organisations
We recommend that Home Office and COI involve major Deaf and hard of
hearing organisations in this project. The organisations may be able to offer:

advice

useful contacts/volunteers for interviews and/or focus groups

promotion of the Frank site, and other messages, to their client groups

distribution of Frank or other materials
RNID and Turning Point are currently working together to try to improve drug
services for Deaf people. We recommend that Home Office (through COI?)
keeps in touch with this project – especially with RNID – and shares findings.
10.3.2 Deaf clubs and pubs
Visits to Deaf clubs (20 in London alone) and pubs may prove a useful source of
information and anecdotal evidence. Future research should take this into
account.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
10.4 Guidance for service providers
10.4.1 General guidance
Any future new or revised information materials and advice for service providers
should include advice on meeting the needs of disabled people in general.
10.4.2 Tailored guidance
We recommend that Home Office produce guidance for service providers on
meeting the needs of all disabled people, including those with hearing
impairment. The proposed Lifeline project will go some way towards this but we
think a ‘Manual of good practice’ should also be developed. We suggest that
research in Stage 2 tests this proposal on service providers.
We think that the guidance should cover a range of disabilities, and that the
hearing impairment section should:

Explain the problems people with hearing impairments encounter.

Give specific advice on communicating with people with a range of
hearing impairments.

Make suggestions on equipping premises to make them more
accessible (eg hearing loops, textphones, faxes, visual alarm systems
etc).

Give advice on booking and using BSL interpreters.

Offer sources for further advice.
10.4.3 Assistive technology
There are a number of technologies such as textphones, hearing loops, faxes etc
which help people with hearing impairments and also people with speech
impairment. We recommend that Stage 2 research looks at how best to
encourage service providers to make such adjustments to their working
practices.
10.4.4 Auditing the front-line workforce
We have discussed the possibility with the Home Office of auditing front-line
service providers to find out what skills and experience of working with people
with hearing impairments already exists and how it could be shared effectively
with other service providers. However, it is felt that this would be unlikely to
identify much useful information and would also be very time-consuming. We
therefore suggest that Stage 2 research could discuss this issue with a small
number of service providers. Kirklees should be included in the sample as they
have a good track record on disability.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
10.5 Information for drug misusers
10.5.1 Research
It is clear that information materials for Deaf people should be specially tailored to
meet their specific information needs and that they should be made available in
places where they are likely to be seen – such as Deaf clubs and pubs, audiology
clinics, and health centres.
We know that printed information in plain language with helpful illustrations will
be accessible to a large number of Deaf people, and that information on video
with BSL and subtitles will be useful to BSL-users. We do not see any need to
research this further. However, we think that the research in Stage 2 should look
at the accessibility of the Frank website, and at whether the Easy Read pack of
information for people with learning disabilities would be useful (see below).
10.5.2 Frank
Frank is a major source of information on drugs for mainstream audiences but we
do not know how accessible or well-known it is for Deaf people. We therefore
recommend that knowledge of, and usability of the site are tested among young
Deaf people and among Deaf parents/guardians as part of the Stage 2 research.
10.5.3 Printed information
We recommend producing a plain language information pack about drug misuse
for young people. In the first instance, we suggest testing the pack produced for
people with learning disabilities on Deaf young people with a view to either using
the pack as it stands, or adapting it for Deaf audiences.
10.5.4 BSL video
We also suggest that Home Office produce a BSL video (with subtitling and plain
language voice over) on drug and alcohol misuse in general. This should be
distributed to the Open i distribution list (around 4500 addresses) and to DATs
and other front-line services.
Since Open i is broadcast on a number of digital and freeview channels, we also
suggest promoting the availability of the drugs video to these outlets with a view
to getting them broadcast for free – or at least promote its availability.
10.5.5 Poster publicity
Once specially tailored information materials have been produced, we
recommend promoting them through plain language posters (for use by local
services with space for contact details to be added locally). These could promote
information materials, including the Frank site, and advertise local drug advice
services
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
We recommend distributing the posters to local services with recommendations
on where to display them.
The posters could also be sent out with the BSL video to the Open i distribution
list.
10.5.6 Open i publicity
Once specially tailored information materials have been produced, we
recommend promoting them through Open I, ideally once a year.
10.5.7 Mainstream sources of information
Mainstream sources of information for hearing impaired young people could
provide a useful conduit for information. We recommend the Stage 2 research
looks at whether there are any magazines or TV programmes which are
especially popular with Deaf, deaf or hard of hearing young people.
10.6 Information for parents and guardians
Information materials for hearing impaired parents/guardians should also be
produced. We suggest that the Stage 2 research looks at how appropriate
existing Frank and other materials aimed at hearing audiences are for their
hearing impaired peers, and that any that prove appropriate are actively
promoted to Deaf audiences, or adapted in line with the research findings and
then promoted appropriately.
10.7 Prisons
There is obviously a link between drugs and prisons. This may need to form part
of a separate project, but there is clearly a need to look at the needs of Deaf
prisoners at some point.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
11 RECOMMENDATIONS FOR STAGE 2 RESEARCH
“Information technologies are bringing about rapid
change and a proposal to use these new technologies
within service delivery would be welcomed.”
(UKCoD response to Sign of the Times)
As already said, we believe there is a need for some further qualitative research.
To summarise, we recommend that the Stage 2 research does the following:
11.1 Service providers

Talks to service providers about any experiences they have had
dealing with people with hearing impairment, and what, if any
experiences and advice they could share with others.

Consults service providers on what tools they need, or would like, to
improve how they deal with disabled people in general and people with
hearing impairments in particular.

Looks at how best to encourage service providers to make adjustments
to their working practices and equipment to make them more
accessible to people with hearing impairments.
11.2 Young Deaf drug misusers

Conducts interviews in Deaf clubs and pubs to find out what Deaf
young people think about drugs, drug services and information.

Looks at whether there are any mainstream magazines or TV
programmes which are especially popular with Deaf, deaf or hard of
hearing young people.

Establish whether text messaging is a well-used form of
communication among young Deaf, deaf and hard of hearing people.
11.3 Parents and guardians

Looks at how appropriate existing Frank and other materials aimed at
hearing people are for their Deaf peers.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
11.4 Frank website

Looks at how well-known the Frank campaign, especially the website,
is among young people with hearing impairments and their
parents/guardians.

Looks at how accessible the Frank website is for Deaf people and at
what might make it more accessible.
11.5 Easy Read drugs pack

Tests the Easy Read drugs pack (produced for people with learning
disabilities) on Deaf young people.
11.6 Issues to take into account
Researching substance misuse is difficult enough within the general population,
but is even more difficult with Deaf people given:

the communication issues around BSL

the innate mistrust among Deaf people of hearing researchers, and

their fear of stigmatisation within the Deaf Community given that it is
such a small community.
Confidentiality will be especially important given these sensitivities.
It may be difficult to identify and recruit appropriate respondents to participate in
the research, therefore COI recommends enlisting the help of Deaf organisations.
Although it is likely that groups of BSL-using Deaf people would be more
comfortable in a ‘signing environment’ containing only signing people, it would be
difficult to arrange this effectively, so the Informability Team’s view is that
discussion groups should be separated into Deaf BSL users, and deaf and hard
of hearing people, but that the Deaf groups should be led by a qualified hearing
researcher assisted by interpreters.
The research should bear in mind that printed text is of less use when
interviewing Deaf people, who tend to have low levels of literacy in English.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
12 Appendices
Appendix 1 – DEFINITIONS OF DEAFNESS
Hearing loss is usually measured by finding the quietest sounds someone can
hear using tones with different frequencies. The threshold is measured in dBHL –
decibel (dB) hearing level (HL). Anyone with a threshold between 0 and 20 dBHL
across all the frequencies tested is considered to have ‘normal hearing’ – so the
higher the dBHL, the worse the hearing loss. Definitions relate to the quietest
sounds people can hear in their better ear.
Mild hearing loss: some difficulty following speech, mainly in noisy situations.
dBHL 25–39.
Moderate hearing loss: difficulty following speech without a hearing aid. dBHL
40-69.
Severe deafness: rely a lot on lipreading, even with a hearing aid. BSL may be
their first or preferred language. dBHL 70–94.
Profound deafness: communicate by lipreading. BSL may be their first or
preferred language. 'Profound deafness' means that a person has no useful
hearing. dBHL 95 or more.
Prelingual deafness: were born deaf or lost their hearing before they learnt to
speak. BSL is likely to be their first language.
Deafened: describes people who were not prelingually deaf, but have become
profoundly deaf in adult life. This often happens suddenly as a result of trauma,
infection or drugs that can cause hearing loss. They often rely heavily on
lipreading and written communication. They may require communication support,
such as speech-to-text reporters, lipspeakers or notetakers, in meetings and
other situations where lipreading is difficult. However, they are less likely to be
BSL users as their first language is a spoken one.
Deafblind: Some deafblind people are totally deaf and totally blind – others have
some useful hearing and/or vision.
Hard of hearing: by far the largest number of people with a hearing impairment
are hard of hearing. They have some useful hearing and may benefit from using
a hearing aid and induction loops. Many people become hard of hearing with
age.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
Appendix 2 – STATISTICS

Around 9 million32 (7.5 million)33 people in the UK have a hearing
impairment.

Of these, 698,000 (580,000) are severely or profoundly deaf and

Of these, 450,000 (375,000) are unable to use a voice telephone even
using assistive technology.

There are an estimated 123,000 (102,000) deafened people in the UK.

There are an estimated 50,000 to 70,000 (41,500 to 58,000) British
Sign Language (BSL) users in the UK.

Only around 20% of BSL users are fluent in English grammar
according to the findings of research study carried out in Glasgow in
2002. (This would extrapolate to around 8,300 to 11,600 people in
England, but since the Glasgow sample was very small, this may not
be an accurate estimate.)

There are estimated to be 3.5 million people in the UK (2.9 million) of
working age (i.e. aged between 16-65). Of these, 160,000 (133,000)
are estimated to be severely or profoundly deaf34.

Deafness occurring before the age of 3 years has an estimated rate of
one per 1000 (Schein, 1987). More recent studies estimate the
prevalence of profound deafness in children to be one in 2,700 per
birth cohort (Davis et al, 1995).

About one in every 1,000 children are deaf at three years old. This
rises to two in every 1,000 children aged nine to 16.

There are more than 30,000 (25,000) deaf children and young people.

A high proportion of severely or profoundly deaf people have other
disabilities as well. Among those under 60, 45% have additional
disabilities – these are most likely to be physical disabilities.

The Glasgow study35 looked at resources needed to facilitate the use of
services by Deaf and hard of hearing people. They found:
32
All statistics are from RNID unless otherwise stated.
33
Figures in brackets are extrapolated to indicate estimated numbers for England only
34
See Appendix 1 for definitions of types of deafness.
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
Resource
Deaf
Hard of hearing
Induction loop systems
10%
56%
Textphones
51%
33%
Good lighting to facilitate BSL and lipreading
35%
56%
Staff with BSL skills
71%
33%
BSL interpreters provided
53%
11%
Finger speller, note-taker, palantypist
1 person
Lipspeaker
1 person

The Glasgow study also found:
o 67% of Deaf respondents didn’t know of any specific services
aimed at people with alcohol or drug problems
o 6% said they would seek information on the Internet (this was 2
years ago, so there may be more now);
o 35% said family and friends would be a major source of info.

An RNID study of 866 people found 35% of deaf and hard of hearing
people had experienced difficulty communicating with their GP or nurse
and 35% had been unclear about their condition when they left the
surgery. 77% of BSL-users who had visited a hospital said they could
not easily communicate with NHS staff36.

Although it is a recognised fact that Deaf people have problems
communicating with health professionals, an RNID survey in 1999
found that 87% of GPs reported that they could communicate
effectively with Deaf and hard of hearing people37.

One of the groups expressing greatest need for info is people of an
age most likely to have parental responsibility for teenagers38.
Final Report November 2002 : Drug and Alcohol Issues Affecting Those With A
Sensory Impairment in Greater Glagow, FMR Research for Jac Ross, Addictions
Manager, North Greater Glasgow NHS Board
35
36
A Simple Cure, RNID, 2004.
Can You Hear Us? Deaf people’s experience of social exclusion, isolation and
prejudice, RNID, 1999
37
38
Health Education, 1998
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT

An RNID survey of 1507 deaf people found that 86% had suffered
prejudice and ill-treatment from people they had just met.

An RNID survey found that 57% of respondents with a hearing
impairment who were unemployed and seeking work had been out of
work for more than a year, 52% had been out of work for two years or
more and 20% had been unemployed for more than five years. 70% of
respondents to the survey also felt that their deafness prevented them
from gaining employment.

The unemployment rate among severely and profoundly deaf
respondents to an RNID survey in 200239 was 20%, or four times the
national unemployment rate. And, according to another study the same
year40, the employment rate for people with hearing impairments is
68%, as opposed to 81% for non-disabled people.

The RNID survey found that unemployment was higher for hearing
impaired people with additional disabilities (32%) and for those aged
under 25 (34%).

The British Crime Survey has discontinued questions regarding
awareness of drugs as it found that awareness among the population
in general of all drugs was very high and so not worth asking about.
Nearly 90% of all 15- to 59-year-olds having heard of all 13 drugs on
the list. The three that received lowest awareness figures were
methadone (87%), amyl nitrate (70%) and magic mushrooms (89%).
Questions on awareness were last asked in 2000.

Around 23,00041 (19,000) Deafblind people have very little sight or
hearing.

BSL is one of the most popular evening classes but has a very high
drop-out rate.
The employment situation and experiences of deaf and hard of hearing people, W
Bradshaw, RNID, 2002
39
Labour market experiences of people with disabilities, A Smith & B Twomey, Labour
Market Trends, 2002
40
41
Sense website www.sense.org.uk
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
Appendix 3 – LITERATURE CONSULTED

A Sign of the Times – a Dept of Health consultation on modernising
mental health services for people who are Deaf, 2003 [check
description and date]

A Simple Cure, RNID, March 2004

Drug and alcohol issues affecting those with a sensory impairment in
Greater Glasgow, FMR Research, November 2002

Drugs in the Deaf Community – summary of key findings of a survey
carried out by Cox & Jackson Consultancy for the British Deaf
Association (1998??)

Free Your Mind – report on a research project into the needs of Deaf
people experiencing mental distress in Leeds, Yvonne Prendergast,
Echo Training and Consultancy, 2003

Are You Listening? A Report on Deaf Issues in Health Services,
Greater Glasgow Health Board, November 2000

People Registered as Deaf of Hard of Hearing Year ending 31 March
2001, England, Department of Health

The employment situation and experiences of deaf and hard of hearing
people, W Bradshaw, RNID, 2002

Labour market experiences of people with disabilities, A Smith & B
Twomey, Labour Market Trends, 2002

Deaf People in the Community, Health and Disability, by Matthew Dye,
Jim Kyle et al, 1997-2000

Can you hear us? – Deaf people’s experience of social exclusion,
isolation and prejudice, Breaking the Sound Barrier Report, RNID,
1999

Chapter 12, Substance Use Disorders and Developing Substance Use
Services for Deaf People, Davidson, Miller and Kenneth

Mental Health in Children who are Deaf and Have Multiple Disabilities,
David E Bond in Mental Health and Deafness, edited by Peter Hindley
and Nick Kitson (2000)

The Association between Child Maltreatment and Disabilities in a
Hospital Based Epidemiological Study. Child Abuse and Neglect 22(4):
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
271-188 (quoted in Mental Health and Deafness, edited by Peter
Hindley and NickKitson (2000))

"Hearing Impaired Substance Abusers", ALMACAN Newsletter, April
1983

“Deaf Culture and Alcohol and Substance Abuse", Journal of
Substance Abuse Treatment, 1992
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT
Appendix 4 – PEOPLE AND ORGANISATIONS
CONSULTED

Bob McDonald, Policy Adviser, Mental Health Services, Department of
Health

Government Office for London drugs team

Royal National Institute for Deaf people (RNID
o Chris Leek, Head of Mental Health Services
o Anna Syplywczak, Head of Learning Disabilities Services
o Emma Emmerson
o Clarinda Cuppage, Head of Media, RNID

Tommy Torley, British Deaf Association

Turning Point
o James Huitson
o Richard Kramer

Adult Team National Deaf Services, SW London & St George’s Mental
Health Services
o Dr Helen Miller, Consultant
o Bruce Davidson, Consultant
o Peter Hindley, Consultant

Matthew James, Sign

Tom Fenton, Royal Association for Deaf people (RAD)

Jim Kyle, Director, Centre for Deaf Studies, University of Bristol

Charlie Clough, Deaf Youth Project Manager, Deafax North

Sally Austen, Consultant Clinical Psychologist, National Deaf Services,
Queen Elizabeth Psychiatric Hospital, Birmingham

Jac Ross, Great Glasgow NHS Board
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DRUG MISUSE & PEOPLE WITH HEARING IMPAIRMENT

Quentin Summerfield, Institute for Hearing Research, Medical
Research Council

Sue O'Rourke, Consultant Clinical Psychologist, Mayflower Hospital,
Bury
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