Improving Access to Psychological Therapies for British Sign Language (BSL) users

BSL Healthy Minds

BSL Healthy Minds is a new service delivered by SignHealth (national charity for mental health and deafness) and NHS North West - a partnership for Positive Healthy Minds for Deaf People. The service accepts GP and self-referral and the BSL Healthy Minds Website and patient information leaflet (below) include information on how to access the service. You can also SMS or email the service.


The aim of BSL Healthy Minds is to provide a BSL IAPT service enabling Deaf sign language users to have access to psychological interventions at Primary Care.

Deaf with a capital ‘D’ refers to the cultural and linguistic minority group whose first and/or preferred language is British Sign Language (BSL) and to which this Service aims to serve. People who are deafened or hard of hearing are usually identified by a small ‘d’ and are generally able to access mainstream services with technical support and deaf awareness training for staff and practitioners.

You can download various resources below:

BSL Healthy Minds information for professionals
BSL Healthy Minds patient information leaflet
BSL Healthy Minds promotional poster
or visit the BSL Healthy Minds website


Many people who are born Deaf and communicate through BSL will consider themselves part of a distinct community with a common language and cultural heritage. The Deaf community share characteristics that derive from common experiences, beliefs, values and norms. The Government recognises that BSL is a language in its own right and used by the Deaf population (101,107 Deaf adults in England, 12,800 Deaf adults in the North West).

BSL users have been identified under the Equality Act 2010 as a group with ‘protected Characteristics’ under the category of disability. BSL users are also now classed under Black Minority and Ethnic groups (BME).

The Deaf community have poor access to mainstream mental health services often being referred inappropriately to specialist tertiary services without an assessment being completed at Primary Care as part of a stepped care approach.

The prevalence of common mental health problems amongst the Deaf population is 40% compared to 20% within the general population. Historically, teaching Deaf children has focused on teaching intelligible speech rather than education resulting in a large number leaving school with very little understanding of the world in which they live. For many, being Deaf is associated with social exclusion and reduced educational and employment opportunities, all key drivers behind the IAPT philosophy. Unemployment within the Deaf community is 13% compared to 4% of the general population.

Traditionally, there have been a number of challenges in delivering mental health services to the Deaf population, such as:

  • Cultural aspects of working with a Deaf client
  • Assessment tools and self help materials in written English and therefore inaccessible
  • Lack of BSL fluent and culturally aware clinicians
  • Small size of Deaf population in a PCT resulting in separate funding arrangements leading to uncertain and potential unlimited spend to provide a psychological therapy service

If Deaf people did not receive appropriate psychological assessment and, if appropriate, ongoing Primary Care led treatment, this will inevitably develop into long-term, acute mental health problems. This could lead to an in-patient referral at one of the specialist Deaf units.

As highlighted, the main challenge is the inability of service providers to deliver linguistically and culturally appropriate services for Deaf people which results in a distinct lack of local service provision at all tiers. Also the BSL user’s stigma of mental health and their ability to trust and confide in the relevant professionals is an on-going problem that needs to be addressed. We aim to breakdown those barriers and ensure that BSL users get the right services at the right time.

BSL Healthy Minds?

‘IAPT workers, rather than interpreters that communicate in BSL, meet the language needs and the requirements of the Equality Act 2010 - that public organisations make reasonable adjustments to how information is delivered to ensure that it is accessible to everyone’

This is an innovative time for the Deaf Sector as there has been little evidence or understanding of the support required for an individual who uses BSL to have equal access to mental health services on any level of the stepped care model.

BSL Healthy Minds has been developed by SignHealth in partnership with NHS North West and consists of a BSL fluent psychological therapy workforce at both Step 2 and Step 3. The Service covers the whole of the North West and enables a sign language user to access IAPT within their GP surgery and work with a Psychological Wellbeing Practitioner (PWP) or Step 3 Practitioner (Clinical Psychologist) in BSL.

The IAPT accepted assessment tools, PHQ9 and GAD7 and W-SAS are being translated into BSL and validated by the University of Manchester. The Northumberland Guided Self Help materials are also being translated into BSL and will be available for any practitioner to access in order to support their Deaf client. It has been highlighted as an issue for practitioners who have provided psychological therapies for Deaf clients previously, that the written English format of the assessment tools and self help materials have not allowed an accurate assessment to take place or beneficial ongoing treatment. It is crucial when undertaking a mental health assessment of a BSL client to incorporate cultural and linguistic knowledge as this will have a bearing onthe outcome and treatment plan.

This IAPT service, BSL Healthy Minds with a specialist workforce fluent in BSL and embedded in existing mental health care pathways will enable local Deaf communities to have equal access to psychological therapies alongside the general population.

For further details please contact:

Hazel Flynn
Clinical Management Lead
BSL Healthy Minds

Tel: 01494 687 600

or visit the BSL Health Minds Website at

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