Drug misuse & people with hearing impairment

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)

Contents

SCOPE OF THE PROJECT

1.1Definitions of hearing impairment

1.2Numbers

1.3Existing Research

1.4Scope

1.5Reinventing wheels

1.6Joined-upness

2OVERALL OBJECTIVES FOR THE PROJECT

3OBJECTIVES FOR STAGE 1

4DEMOGRAPHICS

4.1Regional distribution

4.2Numbers

4.3Influencing factors

4.3.1Gender

4.3.2Education

4.3.3Parental Influence

4.3.4Levels of Economic Activity

4.3.5Household tenure

4.3.6Learning disabilities

5WHAT WE KNOW ALREADY

5.1Received wisdom about drugs and alcohol

5.2Vulnerability

5.2.1Social pressures

5.2.2Mental health

5.2.3Learning disability

5.3Lack of information

5.4Deafblind people

5.5Access to health and advice services

5.5.1General services

5.5.2Services for BSL-users

5.5.3Services for deaf and hard of hearing people

5.5.4Existing specialist health services

5.5.5Issues around specialist health services and Deaf people

5.5.6Drug and alcohol advice services for Deaf people

5.5.7Brief Interventions

5.5.8Potential services

6SENSITIVITIES

6.1Cultural issues

6.2Literacy

7COMMUNICATION

7.1Varying needs

7.1.1Additional disability

7.1.2People from minority ethnic communities

7.2Communications problems

7.3Older people

8STAKEHOLDERS

9A SUMMARY OF EXISTING RESEARCH

9.1Factors which might reduce access to drugs

9.2Reasons for drug misuse

9.2.1Social exclusion

9.2.2Emotional pressures

9.2.3Income & employment

9.2.4Mental health

9.2.5Child mistreatment

9.3Drug misuse

9.3.1Greater Glasgow survey

9.3.2British Deaf Association survey

9.3.3Summary of two surveys

9.3.4US research

9.4Alcohol and tobacco consumption

9.4.1Alcohol consumption

9.4.2Tobacco consumption

9.5A Sign of the Times

9.6Deafness in Mind

10SHORT-TERM RECOMMENDATIONS

10.1Further research

10.2Liaising with other government departments

10.2.1Co-ordination

10.2.2Dept of Health – A Sign of the Times

10.2.3Dept of Health – Healthy Living Centres

10.2.4DWP & RNID project

10.3Involving the Deaf Community

10.3.1Deaf and hard of hearing organisations

10.3.2Deaf clubs and pubs

10.4Guidance for service providers

10.4.1General guidance

10.4.2Tailored guidance

10.4.3Assistive technology

10.4.4Auditing the front-line workforce

10.5Information for drug misusers

10.5.1Research

10.5.2Frank

10.5.3Printed information

10.5.4BSL video

10.5.5Poster publicity

10.5.6Open i publicity

10.5.7Mainstream sources of information

10.6Information for parents and guardians

10.7Prisons

11RECOMMENDATIONS FOR STAGE 2 RESEARCH

11.1Service providers

11.2Young Deaf drug misusers

11.3Parents and guardians

11.4Frank website

11.5Easy Read drugs pack

11.6Issues to take into account

12Appendices

Appendix 1 – DEFINITIONS OF DEAFNESS

Appendix 2 – STATISTICS

Appendix 3 – LITERATURE CONSULTED

Appendix 4 – PEOPLE AND ORGANISATIONS CONSULTED

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)

1.1Definitions 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.

1.2Numbers

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.

1.3Existing 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.

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.

1.4Scope

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

the nature of the information needed.

1.5Reinventing 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.

1.6Joined-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 Times[1] consultation (expected to be published around the end of October 2004) looks at issues 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.

2OVERALL 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.

3OBJECTIVES 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.

4DEMOGRAPHICS

“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)

4.1Regional distribution

The number of Deaf people registered in each Government region does not reveal any significant concentrations in any particular region[2]. 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 SpringfieldHospital in London, the MayflowerHospital in Birmingham and the National Centre for Mental Health and Deafness in Salford).

4.2Numbers

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 million[3] (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 70,000[4] (42,000–58,000).

Only about 2% of young adults are deaf or hard of hearing.

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 deaf[5].

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 self-esteem.

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 24-year-olds than among 16- to 19-year-olds.

4.3Influencing 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.

Other factors which may also influence someone’s propensity to take drugs include:

4.3.1Gender

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 longer[8].

There is no marked difference in the numbers of male and female Deaf people.

4.3.2Education

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.

4.3.3Parental 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.

4.3.4Levels 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 deaf[9].

The unemployment rate among severely and profoundly deaf respondents to an RNID survey in 2002[10] was 20%, or four times the national unemployment rate. And, according to another study the same year[11], 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%).

4.3.5Household tenure

According to research carried out between 1997 and 2001 among 240 Deaf people nationwide[12], 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.

4.3.6Learning 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.

5WHAT 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.

5.1Received 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 Ecstasy[13]. 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.

5.2Vulnerability

5.2.1Social pressures

Young people with hearing impairments may use drugs or alcohol to identify with and be accepted by their hearing contempories.

Negative stereotypes of deafness continue to be common among hearing people[14] 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.

5.2.2Mental 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.

5.2.3Learning 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.

5.3Lack 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.