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Bevan Exemplar Cohort 5 Projects

Building the Foundations of Deaf Mental Healthcare Services with British Sign Language

Anne Silman (BCUHB) with Andrew Mayers (Institute of British Sign Language) and Richard Speight (UNISON)

Betsi Cadwaladr University Health Board with Institute of British Sign Language and UNISON


Access to British Sign Language (BSL), the understanding of mental health development and mental health needs is a barrier to Deaf and hard of hearing people in Wales, despite continued action taken by local Assembly Members to bring equality to this vulnerable group.

A report by the National Assembly for Wales Petition Committee highlights this:

Video: To improve access to Education and services in British Sign Language, Summary Report


This project unites staff within BCUHB who have empathy and willingness to learn BSL and the aspects of deafness in order to provide a Deaf Mental Health Service (DMHS), which will provide an equal healthcare experience, improve service provision and offer future career prospects for D/deaf individuals and families within North Wales.

Project Aims:

The aims of the project are to build the foundations for a Deaf Mental Health Service (DMHS) in BCUHB. Currently there is no DMHS in Wales. The specialist subject of Deaf mental health is not included in learning outcomes set by The Royal College of Psychiatrists therefore the expertise in this field is extremely limited.

First Steps:

  • To collate numbers of BCUHB staff who have interest in learning BSL and working within a Deaf mental healthcare setting.
  • Include in the workforce Deaf professionals who are experts in their field and are role models for our Deaf society.
  • Include the British Deaf Association BSL Charter recommendations BSL Charter in service design to ensure the needs of the Deaf community.
  • Liaise with English Deaf Mental Health Services to arrange staff training opportunities and future service provision.
  • Embrace the concepts of all 4 Bevan Commission Principles by inclusion, training, improvement and collaboration with current DMHS.
  • The timeliness of this project helps prepare for the future plans in the BCUHB Deaf mental health agenda.


  • This project has taken years to receive recognition, the opportunity to present the project at a Bevan Showcase event was greatly encouraging and beneficial to the outcome of the project.
  • Funding opportunities from the UNISON WULF Project enabled BSL classes to commence, but not all staff who wished to register to learn BSL were able to obtain study leave from their posts.
  • The original learning schedule was to hold 2 face to face classes. Due to COVID-19 regulations class numbers had to be reduced therefore a new schedule was made to provide an additional Zoom class.
  • In December 2020 due to the new COVID variant, health and safety resulted in the loss of our venue and the suspension of face to face classes. Classes will recommence in April 2021.
  • COVID-19 lockdown added pressures on staff, work environment and home life, affecting the time, health and moral of iBSL learners, which resulted in class numbers reducing. It was necessary to delay the start of the classes a number of times, and change venues. Currently 8 of the 20 lessons have been taught and unfortunately some learners have left the course.

Key Outcomes:

This project was presented at the BCUHB Bevan Exemplar showcase event in early 2020.

Short questionnaires asking of DMH experience, BSL interest and learning opportunities, plus adverts in Newsletters were sent within BCUHB resulting in 65 staff members from various disciplines corresponding their interest.

Correspondence via Zoom to the Institute of British Sign Language provided the opportunity to contact a freelance Deaf tutor of BSL.

  • Funding requests via the UNISON WULF Project provided a budget for up to 30 staff members to learn BSL level 1.
  • We were able to enrol 26 staff members on the iBSL level 1 course.
  • The MHLD Directorate and Patient User Experience Team are currently working together on a Deaf mental health agenda.
  • Dr Margaret du Feu, Consultant Psychiatrist, author and founder of the Birmingham DMH Service has offered to be mentor for MHLD staff for the DMH Service
  • Discussions have commenced with English Deaf Mental Health Services to bring Deaf adult MH and CAMHS services to North Wales
  • Discussions due to take place in early March with the Deaf Nursing Forum for the training and DMH service work experience of BCUHB staff. This will utilise skills and resources, and help care for our vulnerable D/deaf community at a faster pace.


“….Over the course of the rest of the year, Anne and Andrew worked tirelessly to reorganise and redesign the course in response to the changing lockdown restrictions, first as an online course and then a blended course with elements of face-to-face delivery whenever it was safe. Together, despite the pressures on front-line NHS services and the difficulties staff have faced in connecting and completing their courses online, they have not given up and new plans are being drawn up for the remaining learners to continue their learning journey and finally complete the qualification….”

Andrew Speight, WULF Project Co-Ordinator

We asked the learners ‘what are your thoughts so far on BSL in the workplace and Deaf mental health?’

“Currently BSL in the mental health area that I work within is very thin on the ground, This certainly makes me question, how we as Mental Health teams are delivering positive, holistic and purposeful care and treatment required for our patients who are Deaf, when a patient comes into hospital, it can be scary, it may be unknown, so many faces to remember, doctors, nurses, fellow peers, admission is always the hardest, members of staff throw questions at you, doctors want to do physical examinations, for someone who is hearing it’s hard enough to understand the situation, for someone who is deaf it must be horrendous. Translators aren’t available straight away, they offer a service within daytime hours, a few hours per day, so in the evening, night time’s the patient is again left to muddle through with the nursing team. This does equate to being a service that is providing holistic care and treatment for all.


“I think it has been great that there is an opportunity for staff members from all different areas of BCUHB to access courses like this to help improve the service that is available for people who are deaf and hard of hearing. It would be great if this course could be offered to more staff in the future.


Bevan Exemplar Experience:

The Bevan Commission gave an opportunity to bring a business plan to fruition that has been in progress for a number of years.



Anne Silman:, @SilmanAnnie

Further Reading: