Deaf people who communicate through the use of British Sign Language (BSL) as their only or preferred means of communication are recognised as a cultural and linguistic minority group. They have a shared language, experiences, norms and cultural values as individuals and as part of a wider group; The Deaf Community.

The Department of Health guidance 'Towards Equity and Access' (2005) acknowledges the fact that Deaf people with mental health problems have not received accessible and appropriate assessment and treatment at all levels of service delivery and are over represented in secure mental health settings.

The TEA report recognises the role of Deaf staff in supporting service developments and recommends services "actively strive to increase the numbers of Deaf employees at all levels".

Since the development of the National Service Framework for Mental Health in 1999 the government has called for responsive services which see service users in the full context of their lives, as people in society with a greater emphasis upon their social needs. Involving service users and carers in treatment and service development is no longer an optional extra.

One of the basic requirements of service users within any care setting is the right to have their needs met according to a common standard taking full account of their ethnic or cultural needs.

Within specialist mental health services for Deaf people this has not previously been possible. Existing services have developed following a non-deaf model; few Deaf staff and non-deaf staff with low levels of competence in BSL, failing to match the cultural needs of the service users.

Although developments now provide medium secure care for Deaf forensic patients, there still exists a gap in service provision as regards people moving out into open and community settings.

"A culturally competent mental health service will be prepared to adapt the conventional ways of working to meet the needs of culturally diverse groups of people" (NIMHE 2004)

For a substantial group of Deaf service users change may not be possible, due to Cognitive Impairment. These individuals, and their carers and commissioners need to make a conceptual shift away from expecting change and towards services and staff attitudes changing to accommodate and compensate for difficulties in order that the person can experience success. This often necessitates a creative and non-traditional model of service provision. We propose that a social rehabilitative model, using a Cognitive Rehabilitation model to compensate for impairment, acknowledging individual's strengths, limitations and needs, is more appropriate for delivering a service which makes sense to the person themselves.