TALKWORKS continues to break down barriers to accessing psychological therapies

Posted by Devon Partnership Trust in News on 3rd May, 2023

Deaf Awareness Week graphic with tipsOur NHS Talking Therapy service TALKWORKS has always been proactive in its outreach into local communities with its offer of evidence-based psychological therapies for, primarily but not exclusively, anxiety and depression. Although TALKWORKS has national targets to meet, harder to reach groups have not been ignored and specific marketing campaigns have focussed on, for example, men, students, or on expectant mothers and new parents.

TALKWORKS is now forging links with a marginalised community which is not always served well by mainstream public services, namely the Deaf community. Statistics show that the Deaf community is even more in need of mental health support than the general population – 40% of Deaf or hard of hearing people are affected by mental health issues, compared to 25% of the hearing population. Read more here

TALKWORKS has taken a huge stride forward in employing, for the first time, a trainee Psychological Wellbeing Practitioner (PWP) whose first language is British Sign Language (BSL). Kosar commenced her training in Spring 2022 and began to see her first clients last summer. Kosar will be fully qualified later this year. The Psychological Wellbeing Practitioner training provided by the University of Exeter takes a full year to complete.

Although Kosar is based in the Exeter TALKWORKS team, she sees Deaf clients from right across the TALKWORKS area – all of Devon except Plymouth. Kosar is supported in her training by Hayley, one of the PWP Practice Leads for TALKWORKS, and by Exeter TALKWORKS Clinical Lead Georgina.

We met with Kosar, Georgina and Hayley a few weeks ago and posed some questions to them about the benefits of having a BSL user in the team and the personal challenges Kosar has faced:

Why is it so important to have a BSL user in TALKWORKS?

Kosar: The Deaf community faces so many barriers on a daily basis whether it be access to education, to health services or to other support services. I am really excited to be involved in breaking down the barriers for Deaf people to access support for their mental health. Through my previous role with the National Deaf CAMHS service and in care homes for children and young adults, I have supported many young people through crises and mental health issues and have first-hand knowledge of the difficulties that Deaf people face.

Hayley: The therapeutic relationship with a client is really vital in providing good care. Kosar being able to speak directly to a Deaf person using BSL is so valuable in establishing a good therapeutic relationship. When using an interpreter it may, in some cases, take longer for a good therapeutic relationship to be established and more so if there is a different interpreter each time. Kosar also has that first-hand knowledge of some of the barriers a Deaf client is likely to have faced and she can tailor the interventions to them in a way that a hearing PWP may not necessarily do. I know from my own practice as well that it takes time to learn to work with an interpreter, for example, learning to look at the client rather than the interpreter.

Georgina: Not only, as both Kosar and Hayley have suggested, does this opportunity break down the barriers for the Deaf community who wish to access mental health provision via TALKWORKS and enhance the therapeutic alliance between Kosar and her patients, Kosar joining the team has offered clinicians and administration staff alike a greater awareness of how to effectively communicate with the Deaf community and what barriers they may face. The team now routinely have the opportunity to work with interpreters and consider how we can adapt our practice to be more inclusive.

What does good practice look like when using an interpreter?

Kosar: You should look at the client rather than the interpreter; don’t cover your mouth or look away when you are speaking as this makes it difficult for anyone who can lip-read; use gestures to help get your meaning across; make sure you’re in a well-lit area; and check you have the client’s attention before speaking. Also, bear in mind that the interpreter won’t necessarily know any of the jargon you might use in your service or some medical terms and may ask you to explain. Depending on the length of the meeting and the number of attendees, there may need to be two interpreters so they can cover each other and take a break.

It’s good practice when you are working with interpreters that you let the client know beforehand the name of the interpreter and vice versa in case there is any conflict of interest ie if they know each other socially or through a mutual contact, or if they have worked together in the past and there has been an issue. Unfortunately, this isn’t always possible when interpreters are sourced through agencies. Many interpreters also work freelance rather than for agencies so although it would be useful for a Deaf person to request an interpreter they are familiar with, this isn’t always possible.

The Deaf community in Devon is relatively small which means that many of us are known to one another, or we have mutual friends. On one occasion I was due to meet a new client whose name was familiar to me. I asked our admin team to flag it up with the client and ensure that they were happy to see me or to have the alternative of seeing a hearing PWP with an interpreter. It’s important to give clients a choice – it’s their personal life that they are having to share with strangers essentially. As an example, a Deaf friend of mine preferred to use an interpreter from outside Devon for her ante and postnatal health appointments but for other appointments she had an interpreter in Devon.

What are some the challenges that TALKWORKS has faced?

Hayley: This is the first time TALKWORKS has supported a Deaf PWP trainee – it’s not an easy qualification to attain at the best of times, let alone if you are faced with extra challenges around that. It’s been a steep learning curve but Kosar is working very hard and we are doing all we can to support her and enable her to have a big enough population of patients to complete the required number of clinical hours for her training. The Deaf charity SignHealth has been referring some of their clients to Kosar – they provide mental health support to Deaf people and work in partnership with the NHS to promote easier access to healthcare and information for Deaf people. 

Georgina: In addition to her training, Kosar has been invaluable in advising TALKWORKS of the best routes into the Deaf community to increase awareness of the TALKWORKS service. She has supported TALKWORKS with producing resources and events targeted at the Deaf community and has contributed to a short film using BSL for promotional purposes.

What have your personal challenges been, Kosar?

Kosar: This is the first time I have ever worked in a mainstream organisation that is a non-signing environment. I have always worked in places where people could sign and communicate directly with me. Mask wearing was a huge issue for me in the early days of the Covid pandemic when we were required to wear them in the office, as it meant I couldn’t lip-read or see people’s facial expressions. TALKWORKS sourced alternative masks which were see-through which made this easier.

My team also made some simple changes to our shared office to ensure that I was positioned where I was able to see people coming and going – if I had to sit with my back to the door I wouldn’t be able to see or hear anyone approaching. There was some limited Deaf awareness training provided to the whole team and I was involved in planning what would be helpful for the team.

I have a budget through Access to Work which means there is no cost to the Trust for the online interpreting service that I use to communicate with colleagues – it provides face to face interpreters when necessary too. 

Georgina: Our team were really keen to have Kosar come on board and she’s been really helpful in providing feedback about how we could improve communication. 

What’s next for Kosar and for TALKWORKS?

Georgina: We want to continue to spread the word that TALKWORKS is a Deaf-friendly service. Kosar’s feedback and expertise has helped us to increase our awareness of Deaf issues. In addition to having Kosar as a BSL practitioner, we have access to skilled BSL interpreters provided by Prestige and Sign Solutions. The service is easy to use through our laptops or Trust mobile devices and none of this incurs any cost to our patients.

Kosar: First for me is finishing my training and obtaining my qualification. I hope to be able to help more with promoting TALKWORKS to the Deaf community and also to increase awareness among all Trust staff about Deaf issues. For example, I’d like to host some drop-in sessions for Trust staff to have the opportunity to ask questions about how best to support a Deaf patient or how to make their ward or team more accessible for Deaf people. If there is any interest, I’d like to teach some basic sign language to staff who want to learn. It makes a massive difference to Deaf people when hearing people know some basic signs like ‘hello’, ‘please’ and ‘thank you’ etc.

Thanks to Kosar, Georgina and Hayley for sharing their journey so far with us. We wish Kosar all the very best in gaining her qualifications and look forward to hearing more from Kosar and the Deaf people who use our services about how we can continue to improve our communication and support. Let us know in the comments below if you would be interested in attending a drop-in deaf-awareness session.


TALKWORKS is Devon Partnership NHS Trust’s free, confidential service for people aged 18+ in Devon (excluding Plymouth) giving them access to psychological therapies for, primarily but not exclusively, anxiety and depression.

Previously known as IAPT – Improving Access to Psychological Therapies – the nationwide service has recently changed its name to NHS Talking Therapies. Although the main aim since its inception has been, and continues to be, to improve access for everyone to psychological therapies, it was felt that the new name would be better understood by the general public.

Since the IAPT service was established in Devon in 2009 (when it was initially known as the Depression and Anxiety Service), TALKWORKS has helped over 130,000 people, not only with anxiety and depression but a whole range of other issues which evidence has shown are best treated with psychological therapies. This includes stress, anxiety, insomnia, phobias, menopause, and long-term health conditions.

The range of therapies available from TALKWORKS includes Cognitive Behavioural Therapy (CBT), Counselling for Depression, EMDR (Eye Movement Desensitisation and Reprocessing), and Mindfulness Based Stress Reduction. TALKWORKS also provides Employment Support. Treatment is provided via 1:1 sessions (in person, by phone or online), group therapy sessions, wellbeing workshops, live text-based therapy and online self-help.

What's the difference between 'deaf' and 'Deaf'?

The word 'deaf' is used to describe or identify anyone who has a severe hearing problem. Sometimes it is used to refer to people who are severely hard of hearing too. We use Deaf with a capital D to refer to people who have been deaf all their lives, or since before they started to learn to talk. They are pre-lingually deaf. It is an important distinction, because Deaf people tend to communicate in sign language as their first language. For most Deaf people English is a second language, and understanding complicated messages in English can be a problem. SignHealth