This is the first study to systematically explore voice-hallucinations in deaf people and to advance a model of subvocal articulation to account for such counterintuitive phenomena.

Background: Deaf sign language users encounter many barriers to accessing local services and receiving appropriate help and treatment. As a result Deaf 1 people with serious mental illness can fall through the net of service provision. Aims: To identify and explore the issues involved in providing care for Deaf people with serious mental health problems from the perspective of community mental health teams (CMHT). Method: Eight focus groups were used to explore perceptions and experiences of providing care for this population. Discussions were recorded and transcribed verbatim and analysed using thematic analysis. Data analysis was supported by ATLAS-ti, (Scientific Software Development, 1997) a software package for coding and organising qualitative data. Results: Five key themes were identified: (1) CMHT lack of skills/knowledge/resources, (2) Communication difficulties, (3) Distance of specialist Deaf services, (4) Joint working between CMHT and specialist Deaf services, and (5) Issues specific to Deaf patients. Findings are discussed in the context of implications for improving the access and provision of care for Deaf people with severe mental illness. Conclusions: CMHTs frequently feel ill equipped to provide care for Deaf patients with severe mental illness. Implications require ongoing attention to ensure a more collaborative and efficient continuity of care.

The psychiatric literature has described profoundly prelingually deaf people with psychosis who report hearing voices. The present study proposes that such reports in fact reflect the beliefs of professionals in mental health and deafness and not the hallucinatory experience of psychotic deaf people. The study demonstrates that it is functionally meaningless to assert that a prelingually profoundly deaf psychotic patient "hears voices," and provides a theoretical structure from which to consider more appropriately the internal experiences of deaf people with psychosis, and to encourage the clinically relevant articulation of these experiences. The authors also suggest that the "true" phenomenological experience is of secondary clinical interest to the meaning imposed upon it by the client and the distress caused by it.

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