Commentary

Although this is a case about the assessment of capacity, it is of general relevance. A psychiatrist whose evidence had often been admitted in capacity cases was assisted in this case of a hearing-impaired person by an interpreter who had British Sign Language (BSL) Level 1 training. Her assessment was subsequently criticised as she conducted the assessment without ‘suitable specialist learning support’. BSL Level 1 training is the lowest of the six levels of training. Clearly, reliable communication is essential in assessment, as in this case, of capacity to make various decisions, a matter usually one for psychiatrists and psychologists. However, there are other circumstances in which healthcare experts are particularly reliant on an interpreter’s skills, for example in exploring, in retrospect, a hearing-impaired person’s capacity to consent to an operative procedure or operation.

For psychiatrists and psychologists, the case illustrates the importance, in the case of some hearing-impaired subjects, of being assisted, or of the assessment being carried out, by a psychologist or psychiatrist who has experience of the assessment and treatment of hearing-disabled people.

Learning points:

General

• There is an obligation on those proposing an expert instruction, and on the expert themselves, to make sure that expert has the requisite expertise to prepare the expert report being sought.     

•  If you are assisted by a British Sign Language interpreter ascertain to what level they are qualified. There are six levels. Record the level in your report.

Capacity

• If you are a non-deaf specialist, you need suitable specialist interpreting support.

• A diagnosis in someone with extreme language deprivation of a 'borderline learning disability' is likely to be inaccurate if it has arisen due to use of assessments which are not valid for deaf people.

• An individual with 'language deprivation syndrome' functions very much as if they have a learning disability, although the origin of it is deprivations, rather than organic impairment of the brain from birth'.

• The use of a non-specialist expert is not an appropriate substitute for the specialist assessment.

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