Abstract
Aims and Method This paper compares the case mix and clinical activity in a specialist mental health service for deaf people within a general psychiatric population, using ICD–10 diagnostic criteria. Results Out-patient and in-patient caseloads differ between the two services: 27% of the deaf out-patient caseload have schizophrenia, schizotypal and delusional disorders (compared with 19% of hearing patients) and 19% have neurotic, stress-related and somatoform disorders (compared with 8% of hearing patients). The general psychiatric service out-patient case-load had rates of 8% and 43% for bipolar affective disorder and unipolar depression, respectively, compared with 3% and 17% in the deaf group. Deaf patients have a mean length of stay of 59 days, compared with 30 days for the hearing group. In-patient treatment accounts for 89% of the annual treatment cost for the deaf patient population. Clinical Implications Expansion of community services for deaf people as recommended by a recent Health Advisory Service report could reduce admission rates for deaf patients, delivering treatment benefits and cost savings.
Highlights
Patients who are not found to be experiencing mental health difficulties, or who have improved to the point where they could be maintained without specialist input, are discharged but can be re-referred as necessary
For patients who had admissions that began or ended outside the cut-off dates for this study, the length of stay is reduced to include only those in-patient days that have occurred within the relevant time period
The comparison group consists of all patients under the care of a general adult psychiatrist based at the same hospital
Summary
Out-patient and in-patient caseloads differ between the two services: 27% of the deaf out-patient caseload have schizophrenia, schizotypal and delusional disorders (compared with 19% of hearing patients) and 19% have neurotic, stress-related and somatoform disorders (compared with 8% of hearing patients). Expansion of community services for deaf people as recommended by a recent Health Advisory Service report could reduce admission rates for deaf patients, delivering treatment benefits and cost savings. Denmark House is one of three specialist units offering mental health services to deaf people in England and Wales. The clinical team consists of deaf and hearing people. There is a consultant psychiatrist, a specialist registrar, a Senior House Officer (SHO), four community psychiatric nurses, two psychology staff, two social workers and two occupational therapists. The core patient group consists of prelingually profoundly deaf people, whose preferred communication strategies include British Sign Language, sign-supported English, speech and lip-reading, Makaton and various methods of deaf-blind communication. Many are referred by social workers and other professionals providing input to deaf people. Patients who are not found to be experiencing mental health difficulties, or who have improved to the point where they could be maintained without specialist input, are discharged but can be re-referred as necessary
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