N.B. This article is of most relevance to court users with mild to moderate hearing loss, rather than d/Deaf court users who may have severe or profound hearing loss and who may require a BSL (British Sign Language) interpreter or lip-speaker. The Advocate’s Gateway Toolkit 11: “Planning to question someone who is deaf”, is a valuable source of information for those working with a d/Deaf defendant or respondent in legal proceedings.

The Royal National Institute for Deaf People (RNID) estimates that “in the UK, more than 40% of people over 50 years old have hearing loss, rising to more than 70% of people over the age of 70.”.

With hearing loss affecting such a large percentage of the population, it’s a pressing issue when it comes to communication at court. Hearing loss poses a particular barrier to accessing the contents of trials and hearings. When an individual has a mild or moderate hearing loss, they may not hear all of the verbal information presented during a case and may be required to exert additional attention in order to access the contents of proceedings.

When an individual has both hearing loss and a communication difficulty, ensuring effective access to proceedings can become even more challenging. Such individuals may have greater difficulty advocating for themselves to ensure their hearing loss is effectively accommodated, their attention may be further adversely impacted, or they may be unable to utilise alternative strategies to mitigate their hearing loss (for example, reading written notes).

In some cases, a defendant or respondent may be given access to a hearing loop or Infrared hearing system. Both function in a similar way, offering two main options for accessing amplification of the environment:

• A device worn around the neck connecting hearing aids to the system when the aid is set to “T”.
• A headphone set for users who do not have hearing aids.

A judge’s experience of court hearing loops

The former judge, HH Gordon Risius, lost most of his hearing following a head injury. This interesting article explores his experience of using courtroom hearing loops, and the implementation of a more advanced system in his courtroom to ensure his effective access to proceedings. He explained, “the typical loop system uses a single small microphone, designed to pick up sounds from the court-room generally, not just the voice of whoever happens to be speaking at the time. In consequence it can radiate such a multiplicity of sounds that an accurate note of the evidence or submissions is impossible”.

In this judge’s experience, the standard court hearing loop system did not allow him to hear evidence accurately. This view reflects the experience of many defendants and respondents I have assisted during court proceedings. HH Risius noted, “The loop system undoubtedly helps those with mild hearing loss, but does little for those whose hearing is more seriously affected. There is a practical solution, encouraged by the Disability Discrimination Act 1995, but it is expensive for the public purse…”.

Out of the loop: Issues with courtroom systems

HH Risius’s view is echoed by many defendants and respondents I have worked with. For example, I recently assessed a service user who required hearing aids to make use of his limited residual hearing. Speaking about his experience in the courtroom, he reported, “They have the… the… [gesture, pause] loop, hearing loop, but sometimes the loop doesn’t work. They were speaking very fast, I couldn’t understand anything”.

In an intermediary role, I have often seen hearing loops treated as a silver bullet, which magically ensures access to proceedings for those with a hearing loss. When they work well, loops can be helpful. However, at their worst, I have observed hearing loops to be painful, distracting and emotionally dysregulating. In some cases, they actively negatively impact the service user’s ability to follow the thrust of evidence, engage with proceedings, engage with their intermediary and understand the contents of hearings.

Case Study

I assisted a service user during a Crown Court hearing. He had a hearing impairment but did not use hearing aids. In conversation, in a quiet conference room, he required communication partners to speak very loudly, one at a time, ensuring they were facing him to allow him to support his hearing with facial expression and body language. The service user was also diagnosed with a mild learning disability, a large number of physical health conditions and several mental health conditions. He reported that he often heard voices, an experience which worsened when he became emotionally dysregulated.

At the hearing, the service user was provided with a hearing loop. The device was connected to headphones he could wear, which amplified the sounds in the courtroom. The device was tested before the judge entered and was set to a comfortable volume. When the hearing began, however, the prosecution barrister began to speak remotely via a CVP link. This caused the hearing loop to generate considerable feedback, resulting in a very loud squealing sound which caused the, already highly anxious, service user considerable discomfort and alarm.

The difficulty was raised with the judge. As no immediately available solution could be found, the judge decided that the hearing would have to proceed regardless. The feedback persisted, causing further discomfort and distress. Eventually, the service user elected to stop using the hearing loop.

To assist the service user, the judge permitted me to recap key points from conversations very briefly and loudly while facing him, during pauses in proceedings. As the service user had low literacy, it was not possible to implement other strategies to assist him, such as typing the contents of the hearing in a large font on a laptop screen or taking simple notes in his view. The limited strategies available meant that the service user became increasingly anxious and emotionally dysregulated, as he could not hear what the legal professionals were saying. He was instead wholly reliant upon my very brief, simplified summaries. While the legal professionals spoke, he repeatedly asked me, “Am I going to prison?”. Following the hearing, he reported that the hearing loop feedback had made the “voices worse”.

I have attended many hearings where hearing loops have proven ineffective, particularly where feedback has impacted their use. But feedback isn’t the only issue which impacts the usefulness of hearing loops. Typically connected to just one microphone in the courtroom, the hearing loop picks up every sound, from the feverish typing of notes to the busy shuffling of papers. These background noises all impact the audibility of speech sounds when listening via hearing loop and can be a particular issue for service users with attention difficulties or sensory sensitivities.

In other cases, the type of hearing equipment available impacts individuals’ access to proceedings. This anonymous account, published on deaf blog The Limping Chicken, reports that, upon attending a family court hearing, a respondent with severe hearing loss was provided with unsuitable equipment (an infrared receiver with earbuds) which would require them to remove the hearing aids they were dependant upon to hear. This individual explained, “There was no ‘plan B’. I was just told I could ask for things to ‘be repeated’”.

A recent written question submitted to UK Parliament in June 2022 requested “a list Crown Courts in England and Wales (a) with (b) without an operational hearing loop”:

• 69 Crown Courts were “confirmed to have operational hearing loops”.
• 19 Crown Courts were “not confirmed to have operational hearing loops”.
• The response added, “The Crown Court locations which were not reported to have hearing loops on site may still have facilities available or be able to make reasonable adjustments to help users who need hearing equipment. Some of the hearing loop equipment used by HMCTS is portable and can be moved between Crown Court sites…”.

Practical measures

It is important not to throw the baby out with the bathwater. When they work well, hearing loops undoubtedly assist some court users with mild and moderate hearing loss. They are an essential tool to help improve access to legal proceedings.

However, issues with provision of a range of equipment and technical problems with the available equipment appear to result in poor outcomes for those with hearing loss. In some cases, a hearing loop can even be detrimental to an individual’s ability to follow proceedings, by causing distraction, distress, or by providing a smokescreen which masks the individual’s difficulties (many court professionals may assume that a court user can hear and understand everyone once a hearing loop is implemented).

It’s also important to bear in mind that a person with a hearing loss who is assisted by an intermediary is likely to have difficulty hearing the intermediary while using a hearing loop. They may need to take off the hearing loop in order to hear the intermediary, while intervention from the intermediary may prevent them from hearing the signal from the loop as clearly. As such, intermediaries may need to focus more on assistance outside the courtroom, in conferences, to support the service user’s understanding.

When working with a court user who requires a hearing loop, the following measures may assist:

• Learn more about the individual’s hearing
  Do they use a hearing aid? Do they know how to connect to a hearing loop? Have they used one at court before? What was their experience? How much can they hear with a hearing loop? All of this information can help the court to prepare in advance to accommodate a court user’s needs (for example, by ensuring wireless infrared access to the hearing loop system is available).
  
  
• Avoid hybrid hearings
  Remote attendance by some parties can result in feedback for hearing loop users.
  
  
• Trial the equipment in advance
  Ideally with the service user present. This will help ensure the volume is set to a comfortable level. It may assist for a ‘helper’ to speak from key locations in the courtroom (e.g. the judge’s seat, the prosecution bench), to ascertain what volume will be required and to acclimatise the service user to how the loop will sound.
  
  
• Provide a mechanism for the individual to signal if in difficulty
  This should be agreed with the judge and explained to the individual in advance. The defendant or respondent could hold up a card or use a signal to indicate they are unable to hear. Be aware that they may find raising the issue intimidating, especially if required to speak during proceedings.
  
  
• Minimise background noise
  All efforts should be made to reduce background noise, which may be picked up by the hearing system. Measures could include, turning of the microphones of parties attending remotely or encouraging advocates to use digital rather than paper bundles (which cause considerable rustling).
  
  
• Consider seating position
  Being able to see the face of each speaker provides additional visual information (e.g. facial expression and mouth shape), which can support individuals with hearing loss to understand speech more clearly.
  
  
• Use a ‘hearing rating’ system
  An intermediary can monitor a service user’s ability to hear by encouraging them to use a visual self-rating scale. The intermediary can then raise any issues with the court, and/or take a particularly careful note of verbal information raised while the individual is struggling to hear, to be recapped in conference.
  
  
• Allow longer conferences and breaks
  For the individual’s legal team to carefully check their understanding of key points to ensure nothing has been missed or misheard. If the individual has an intermediary, they may not be able to access simplification and explanation during the hearing itself. As such, additional time may be required for this during breaks and conferences. Bear in mind that listening to court proceedings with hearing loss via a hearing loop is very likely to place additional demands on any individual’s attention, which may have a cumulative effect over the course of a day, resulting in fatigue and inattention.
  
  
• Provide a clear written note
  For court users with appropriate literacy skills, a clear written note of the day’s key points will help ensure important information is accessible and important information has not been misheard.
  • Learn more about creating easy read documents for people with communication needs.
    

If problems with a hearing loop arise…

• Provide a live typed or written note of proceedings in sight of the service user (dependant upon their literacy level).
  
  
• Use visual aids to support the service user’s understanding, e.g. drawing out a sequence of events.
  
  
• Permit an intermediary to provide frequent loud summaries of what is being discussed, facing the service user.  
  
  
• Permit the service user and intermediary to attend remotely from a different room. This will allow the intermediary to provide loud, real-time simplification of proceedings in a quieter, one-to-one listening environment.

Learn more about court communication from experienced court intermediaries on The Access Brief. A growing library of free resources developed for legal professionals working with clients who have communication needs.

Featured Image by Dylann Hendricks | 딜란 on Unsplash

As intermediaries, our working lives are very varied. One day we can be administering assessments, the next we are whispering explanations in court and advising barristers about changes to question style prior to cross-examination. One part of our job that is a little less well-known is assisting during conferences.

As any time-poor solicitor will know, there is a mountain of preparation to undertake before a case actually gets to court. Information gathering sessions must take place to help solicitors build the case, defendants and respondents have to tell the court what they think of certain evidence, advocates will need to provide legal advice and take instructions. Conferences also need to take place during court hearings themselves, for example, to allow counsel to take instructions on a new issue which has arisen, or to explain a judges’ ruling.

• For quick tips to help you support a client with communication difficulties in conference, download our two-page guide from The Access Brief, a library of free resources for legal professionals, developed by experienced intermediaries.

Communication difficulties in conferences

These conferences can be every bit as challenging for individuals with communication needs as formal court hearings. Conferences often place considerable demands upon someone’s ability to understand verbal information, express themselves clearly, manage their emotions and maintain attention. There may be complex legal concepts to explain, emotive information to discuss, lengthy documents to review and large volumes of evidence to explore.

In many cases, an individual’s ability to understand and communicate clearly in conferences preceding the start of a trial is even more critical than their understanding in a court hearing. When accounts, information and instructions are provided clearly, the risk of miscommunication is minimised, and clients are more likely to understand the process and have realistic expectations of the proceedings. Legal representatives, meanwhile, are more likely to be able to advocate clearly for their client. This often improves the smooth-running of proceedings, reducing adjournments, issues in working relationships and last-minute changes in instructions.

Intermediaries in conferences

Defendants and respondents with communication difficulties often benefit from having an intermediary present in conferences. This case study from my own practice is an illustration of this:

Case study 1: I assisted a father involved in care proceedings who had attended a number of conferences with his solicitor in advance of a fact find hearing without an intermediary present. The solicitor believed they had an excellent rapport and a good understanding of each other. When the case got to court however, it was clear that the respondent’s position statement and his response to threshold were inaccurate. He actively and adamantly denied a number of things he had previously agreed.

For this reason, the judge adjourned the case and ruled a conference with an intermediary must take place before the next hearing. He was an approachable judge, but even he was displeased that considerable time had been lost and that serious misunderstandings had arisen.  

On the day of the conference, it became clear where the communication breakdown had occurred. The solicitor had read the threshold to his client as it was written, page by page. The respondent had difficulty understanding more complicated vocabulary (e.g. “compliance” and “disengaged”) and remembering large chunks of information. As such, he had simply agreed to everything the solicitor read out. I went through the threshold step-by-step with him, simplifying each point as I went. With this support, he was able to give precise instructions, including telling us when dates were just a couple of days’ off. As a result, his legal team gained a much clearer and more coherent response from him.

The solicitor was a little disheartened after the respondent left, telling me she had thought they got along really well. I explained that it was clear that they did have a good rapport, but often communication difficulties cannot be overcome with positive rapport alone. In fact, it can be particularly hard to recognise communication needs in everyday conversation (especially if an individual has good social communication skills).

An intermediary’s perspective

Many intermediaries I have spoken to have said they enjoy assisting at conferences. The setting is more informal than court and we don’t feel quite so disruptive when intervention is required. The service user is often more relaxed and, when they have someone there to help them understand, they are more likely to seek that help in the informal environment of a conference than under the weight of a court hearing.

In conferences, we often have the opportunity to try a wider range of strategies to assist a service user’s understanding; from visual aids to interactive tasks. This allows intermediaries to develop the most effective possible working relationship with a service user before a hearing takes place.

Case study 2: One service user I worked with was adamant that she wanted to take her case in a certain direction. The solicitor was worried that the client hadn’t understood the options clearly, and I could understand why. The service user would listen to the solicitor’s advice and then immediately restate her previous view. This difficulty appeared to relate to the hypothetical nature of the discussion (e.g., if we do this, then this might happen, so we can ask for this). This required her to hold lots of abstract verbal information in mind and was hard to follow. To assist, I drew a flow chart detailing all the options and possible outcomes. The service user began to ask questions about each route. A visual representation helped her to understand and retain the different options, then weigh the potential benefits and downsides of each. In response, the service user changed her approach slightly and agreed that the new approach was more child-focussed.

Booking an intermediary for a conference

Even when solicitors have a positive rapport with their clients, an intermediary can support effective communication in conferences, and this often has a knock-on positive effect in court too. But how do you go about booking an intermediary for a conference?

Funding
Firstly, you will need funding:

• In family court, HMCTS can fund a conference. In some cases, a court may be unwilling to provide funding, and Legal Aid or the Local Authority may need to be approached to fund intermediary provision.
  
  
• In criminal proceedings, Legal Aid typically fund conferences.

Assessment
If your client has not yet had an intermediary assessment, this will need to be arranged before a conference with an intermediary can be booked. If the ensuing intermediary report recommend an intermediary, arrangements can be made for an intermediary to attend conferences with your client.  

Booking
Once the assessment is complete and the report has been sent to the solicitors, a booking for the relevant dates can be made through Communicourt’s online portal. You will then receive a booking form that needs to be filled out and signed by court personnel (family court) or the solicitor (criminal court). This then needs to be returned to Communicourt and an intermediary will be allocated.

The legal process in its entirety is confusing and hard to understand for any non-legal professional. Many people with communication difficulties need help at every stage, including in legal conferences, in order to make informed decisions and to participate as fully as possible.

For more information about intermediary assistance in legal conferences, or for advice on funding and booking an intermediary for a conference, please contact the Communicourt bookings team.

Learn more about court communication from experienced court intermediaries on The Access Brief. A growing library of free resources developed for legal professionals working with clients who have communication needs.

Image credit: Gabrielle Henderson on Unsplash

I recently attended a conference with a defendant in prison. During the usual lengthy wait to gain entry, I bumped into his barrister who was able to brief me on the purpose of the conference. She shared a document which she wished to take the defendant through, setting out all of the key information he needed to understand, alongside important legal advice.

Time and effort had evidently been invested in making this information as straightforward as possible. The sentences were generally short and key topics were highlighted by helpful subheadings. However, the document ran to eight pages in dense size 11 font, including challenging vocabulary, such as “consecutive” and “recuse”, alongside many complex and abstract concepts.

After reviewing the document, I mentioned to the barrister that, if she provided me with a copy, I could produce an easy read version to be sent to the defendant. She responded, “Well, I’d like to think that it is easy read!”.

The intermediary assessment (conducted previously) found that the defendant had considerable literacy difficulties. Although able to read some simple words with effort, he was unable to read longer or ‘less everyday’ words. His diagnosis of schizophrenia also made it very challenging for him to maintain focus while attempting to read longer text, resulting in further difficulty extracting key points from even simple documents. The document provided by the barrister, although undoubtedly very helpful for a layperson with average literacy skills, would not have meaningfully improved this particular defendant’s access to written information regarding his case.

Why does accessible written information matter?

Ensuring that written information is made as accessible as possible for individuals with communication needs is extremely important:

• The Human Rights Act (1998) stipulates that public services, like the courts and care providers, have to ensure individuals’ rights are protected and respected. Within a court setting, Article 6 (Right to a Fair Trial) states that, “Everyone charged with a criminal offence has the following minimum rights: (a)to be informed promptly, in a language which he understands and in detail, of the nature and cause of the accusation against him…” (emphasis author’s own).
  
  
• Article 21 of The Human Rights Act states that Governments must adopt measures to make sure disabled people can “express their views freely and access information on an equal basis to everyone else”. There are a number of measures which should be implemented to achieve this, which include producing information in accessible formats in a timely way, at no extra cost to the individual.
  
  
• The Equality Act (2010) describes a range of protected characteristics, including disability, and measures which must be taken to ensure individuals with these characteristics are treated equally to others who do not. Section 149, for example, concerns the duties of public sector bodies (such as HMCTS), which include “advance[ing] equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it”. Public sector institutions must:
  • “…Remove or minimise disadvantages suffered by persons who share a relevant protected characteristic that are connected to that characteristic”.
  • “Take steps [e.g. make reasonable adjustments] to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it”.
    
    
• Accessible Information Standard (2016). Although this standard only applies to organisations supplying NHS care or publicly funded adult social care, it contains valuable information regarding providing people who have a disability or sensory loss with accessible documents.

Why is this important at court?

You only need glance at a court bundle (or bundles) to appreciate the extent to which court cases are built on written information. Contact notes from family cases, psychological reports from expert witnesses, care plans produced by written local authorities, non-molestation orders, written agreements – the list of documents crucial to cases of all kinds goes on and on. With so much written information to digest, an individual with difficulty accessing documents may:

• Not fully understand the case against them.
• Not understand legal advice.
• Not have access to detailed information about their case.
• Not understand what steps they must take (e.g. attending appointments).
• Not understand what the possible outcomes of their case may be.
• Not understand the terms of agreements and orders.
• Break agreements and orders due to lack of understanding (resulting in further legal issues).

Who needs easy read?

Difficulties accessing written information can take many forms. Dyslexia, low literacy stemming from limited access to education in childhood, learning disability, Attention Deficit Hyperactivity Disorder (ADHD), autism, visual impairment – there are many reasons why an individual may have difficulty accessing information in written form. An individual may have:

• Difficulty following written information (letters may jumble, it may be hard to keep your place from line-to-line).
• Difficulties reading words (decoding letters and phonemes).
• Difficulty understanding words (reduced receptive vocabulary).
• Difficulty focusing on written information.
• Difficulty ‘reading between the lines’ (drawing inference) from a text.
• Difficulty picking out ‘key points’ from a text.

Case Study

I worked with a service user who had diagnoses of mild learning disability, dyslexia and a number of physical and mental health conditions, including a condition which impacted their eyesight. At their intermediary assessment, I found that they were able to read very short words and sentences, with considerable effort, but only when text was large and bold, presented on blue paper.

Before the sentencing hearing, defence counsel emailed me a copy of a Sexual Harm Prevention Order which the court would be making, asking for my assistance in simplifying this for the service user. The order was complex and lengthy, written in small font on white paper. It included very long, low-frequency words (e.g. “encryption”). Complex syntax and long sentences were used, including the phrase: “installing any encryption or wiping software on any device other than that which is intrinsic to the operation of the device”.

To simplify the document, I presented text on a blue background in a large, bold font (following the recommendations set out in the intermediary report). I included images to serve as visual prompts, to assist the service user to most easily ‘pick out’ parts of the order they wished to review. The visual prompts were also designed to support the service user’s understanding of each ‘rule’ in the order.

I simplified the text, as far as possible. In some cases, specialist vocabulary (e.g. “encryption software”) was used and simplification wasn’t possible. In these instances, I added a short, simple definition. I used red and green text to make clear what was and was not allowed. I broke the text up with bullet points as far as possible.

It was challenging to simplify the document without adding considerably to its length. As such, some longer words such as “supervising” remained in the text. Having worked with them previously, I was aware that the service user had a supportive friend who attended hearings and assisted them to read documents and process complex information. This friend had strong literacy skills and understood the service user’s needs well. I was confident that they could assist where necessary. 

At the hearing, the defence barrister and prosecution barrister reviewed the document with me, providing further suggestions and advice, to ensure all key legal points were included. The defence barrister helpfully provided blue paper, to ensure the document could be printed in the most accessible format. The barristers presented the simplified document to the judge. The judge explained that the text should not be considered an alternative to the original version of the order. Instead, it should be used to supplement the service user’s understanding, however the text contained in the original order would form the basis for the order itself.

The service user had presented as highly anxious about the rules which would affect their life, expressing great concern about accidentally breaking the rules. After reading the order in conference (with assistance from counsel and myself), they were able to demonstrate understanding of each rule. They were provided with a copy to take home and review as necessary, if they required reminders of ‘the rules’.

Top tips for producing easy read documents

	Use a two-column table format Just like this one. This makes it easy to add pictures and ensure documents are not visually cluttered.
	Use headings and bullet points This makes it easier for readers to pick out key points and process information.
	Add images This makes it easier for readers to pick out information and can support their understanding of adjacent text. Only add images with a clear meaning. If a point doesn’t lend itself to pictorial representation, don’t use a loosely-connected image which may cause confusion.
	Use simple words If low-frequency words can’t be avoided, add a simple definition below. For example: Low-frequency means words which aren’t used very much. They might be more difficult to understand.
	Use short sentences A Communicourt intermediary report will include information about the service user’s key word level. Although this relates to auditory working memory capacity, it can be a good benchmark when simplifying text. For example, if a service user has a four key word level, try to keep your sentences at this length. It is often helpful to imagine writing in bullet points.
	Ask the service user what helps them to read Possible adaptations might include: Using a coloured overlay (if they are dyslexic).Presenting documents in a large, bold font.Using widely spaced text.Reducing documents to no more than one page.
	Ask an intermediary! With sufficient preparation time, the intermediary assigned to a service user can often produce easy read versions of key documents.

Learn more about court communication from experienced court intermediaries on The Access Brief. A growing library of free resources developed for legal professionals working with clients who have communication needs.

Featured Image credit: Mert Güler

In some instances, sources cited in this article refer to women. However, menopause is a condition which impacts people of all genders. The issues explored in this article may also impact transgender people, non-binary people and others, who are an important part of this conversation.

At Communicourt, we are celebrating World Menopause Day and opening up the conversation about menopause in the workplace. As part of The RCI Group, we have taken the Menopause Workplace Pledge and hosted an awareness session for colleagues, by Emma Persand of Working with the Menopause, about the impact of menopause upon our working lives. The RCI Group is also introducing a new group-wide menopause policy to support people at work.

Rarely discussed in our professional lives, menopause is a significant life transition and physical change which will affect 51% of the UK population. The recently published House of Commons Committee Report ‘Menopause and the workplace’ has collated a wealth of information which illustrates the importance of more open discussion about the topic:

• 3 in 5 women experiencing menopause were negatively affected at work (CIPD, 2019).
• 900,000 women in the UK had left their jobs because of symptoms relating to menopause (BUPA, 2021).
• Less than a third of people experiencing menopause told anyone at work, citing privacy and the reactions of others as key reasons for this (Women and Equalities Committee, 2022).
• Over 25% of people who did not request adjustments for menopausal symptoms did not do so because they were “worried about the reaction” (Women and Equalities Committee, 2022).
• 14 million working days per year in the UK are lost due to menopause and related symptoms (Health and Her, 2021).

These statistics paint a clear picture of the impact which lack of understanding and adaptations around menopause has on individuals, workplaces and the economy as a whole. Evidently this is a health issue which can have a marked impact on people’s ability to work without adaptations, yet which few people feel comfortable raising in a workplace setting. As such, workplaces are losing valuable, experienced staff members. These are often people who offer years of expertise and perform vital functions such as mentor and role model to more junior employees.

Destigmatising hormonal change

Bringing conversations and understanding about the menopause into the workplace is clearly an important task. When workplace cultures understand the potential impacts of menopause (and become aware of the adjustments which are likely to support menopausal employees), organisations can start to retain more senior staff.

Open dialogue about menopause at work also encourages important conversations about the effects of other hormonal changes which may affect employees, including pregnancy and the use of hormones for processes like IVF or gender confirmation. Other health conditions which impact women, transmen and non-binary people, such as endometriosis, can also become part of this wider conversation about better support and inclusion.

Menopause in the workplace: The facts

When does menopause happen?

• Menopause typically occurs between 45 and 55 years of age.
• In 1% of cases, premature menopause takes place before the age of 40.
• Perimenopause takes place before periods stop (menopause). During this time, menopausal symptoms can occur, lasting for months or (in some cases) years.
• After menopause (the total cessation of periods) menopausal symptoms last for around four years after periods stop. In some cases, the symptoms last longer.

What are the most common symptoms of menopause?

• Hot flushes and night sweats.
• Disturbed sleep and sleep difficulties.
• Vaginal discomfort.
• Mood changes, including increased anxiety and low mood.
• Memory and concentration difficulties.
• Headaches.
• Heart palpitations.
• Joint stiffness, aches and pains.
• Reduced muscle mass.
• Recurrent urinary tract infections (UTIs).
• Reduced libido.
• Bone strength (increased risk of osteoporosis).
• Increased vulnerability to heart disease and stroke.

How can menopausal symptoms impact people at work?

• 65% of survey respondents reported problems with concentration.
• 58% said they felt more stressed.
• 52% reported feeling less patient when working with clients and colleagues.
• 30% reported taking sick leave due to menopausal symptoms.
• Of this 30%, only 25% were able to tell their manager their absence was due to menopausal symptoms (Women and Equalities Committee, 2022).

5 ways workplaces can support menopausal employees

1. Normalise conversations about menopause and hormonal changes in the workplace by participating in events like Menopause Awareness Day, setting up a regular employee support group and sharing information.
2. Allow flexibility around the working day. Some menopausal people may have sleep difficulties which may impact their work in the morning. Others may feel more physically comfortable working from home.
3. Provide desk fans or adapt office seating plans to make individuals experiencing hot flushes more comfortable.
4. Allow more frequent comfort breaks.
5. Allow alterations to workplace uniforms to increase comfort.

References

BUPA (2021), Written evidence from Bupa [MEW0046], accessed October 2022

CIPD, “Majority of working women experiencing the menopause say it has a negative impact on them at work | CIPD”, accessed October 2022

Health & Her Ltd (2021) A fact-based focus on Perimenopause and Menopause issues faced by women [MEW0054], accessed October 2022

Women and Equalities Committee (2022) Fourth Special Report of Session 2021–22, Menopause and the workplace survey results, HC 1157.

Does my client need an intermediary? How can intermediary help at a parole hearing? What are ‘questions in advance’? If you have a question about communication difficulties and court proceedings, you will find the answer in The Access Brief, a new resource created by Communicourt.

The Access Brief is a library of free, downloadable factsheets for legal professionals working with someone who has a communication need. Created by experienced intermediaries, The Access Brief provides essential information about all aspects of communication difficulty in the courts.

The purpose of this new resource is to share up-to-date information about the courts and communication needs with solicitors, barristers, parole officers and other court professionals.

The Access Brief can be used as a ‘go to’ reference for quick questions about intermediaries, or an in-depth resource to improve understanding of the impact of communication difficulties at court. Whether you are concerned about the communication skills of a new client, or have booked an intermediary for a client’s hearing and want to advise them about what to expect, The Access Brief offers valuable advice and information in short, easy-to-digest guides.

The ‘court process’ collection

This week, the first collection of 19 guides was launched. These guides provide ‘at a glance’ information about the fundamentals of working with an individual who has a communication difficulty in the court system. This collection includes information about:

• Identifying communication difficulties.
• Ground Rules Hearings.
• The roles of advocates and intermediaries.
• Interpreter and intermediary co-working.
• Assisting clients who have Official Solicitors.
• The intermediary role during evidence.
• The purpose of Questions in Advance.
• The use of intermediaries at probation interviews.

These guides explain how intermediaries can assist at different stages of court proceedings. They also include practical information about requesting intermediaries and assisting clients with communication needs, from initial conference to final hearing.

Coming soon: The ‘diagnoses’ collection

Over the coming month, a further set of guides will be published, sharing information about the common court communication needs of people with a learning disability, autism, Attention Deficit Hyperactivity Disorder (ADHD), dementia, Developmental Language Disorder (DLD), Traumatic Brain Injury (TBI), personality disorder, stroke, depression, anxiety, Post-Traumatic Stress Disorder (PTSD) and schizophrenia. These guides contain a wealth of information, including:

• Background information about each diagnosis.
• Common communication difficulties for legal professionals to be aware of.
• Strategies to assist clients at different stages of proceedings.
• Tips for legal professionals working with each client group.

How to use The Access Brief

This new resource is free to all. Simply visit The Access Brief and register for free using your email address to browse the information online. Do you have a question which isn’t explored on The Access Brief, or a topic you’d like to know more about? Contact us for further information or submit your question via The Access Brief suggestion box.

One of our intermediaries Holly talks about how to avoid the ‘do you understand?’ trap.

If I could wave my magical intermediary fidget aid and make one small change to legal proceedings, I would banish the question, “Do you understand?” from existence. Almost impossible to avoid, “Do you understand?” (and its close cousin, “Does that make sense?”) are very widely used in legal proceedings (particularly conferences). Even legal professionals who are notably adept in working with individuals who have communication difficulties frequently fall into the “Do you understand?” trap.

The problem with questions of this nature is two-fold:

1. The service user may just say “yes”. Many of us would struggle to respond “no”, if asked this question by a Crown Court judge during our oral evidence, while feeling flustered and overloaded in front of a full courtroom. This issue can be compounded when a person has a communication difficulty. People with communication difficulties are often skilled at masking their needs. Many will have done so throughout their educations and adult lives. There are many reasons why an individual would erroneously respond “yes”, when asked whether they understand. They may:
   
   • Feel embarrassed about not understanding.
   • Feel overwhelmed and simply want a situation to end.
   • Feel uncomfortable seeking support from unfamiliar professionals.
   • Have an expressive difficulty which makes it challenging to provide a more nuanced response.
     
2. The service user may think they understand. An individual may also state that they understand because they erroneously believe that they do. Misunderstandings frequently arise between individuals who do not have a communication need, resulting in two people having very different understandings of one piece of information. When an individual does have a communication difficulty (for example, difficulty maintaining attention, processing verbal information or understanding figurative language) the opportunities for misunderstanding can increase. A person with a communication difficulty may have entirely misunderstood information or partially misunderstood, yet still respond “yes” when asked whether they understand.

As an intermediary, I have endless examples of situations in which a service user has said they understand but, when their understanding was directly checked, revealed that they had not.

Case study: I assisted a service user with a mild learning disability. They presented with strong expressive communication skills, using a wide range of legal terminology correctly while giving instructions. The barrister mentioned to me that they were surprised the service user had been allocated an intermediary, based on their presentation. The barrister spoke rapidly to his client, using very low frequency vocabulary (eg, “Otiose”). It was necessary for me to check the service user’s understanding while the barrister was not present, then provide simplification. The service user explained to me that they did not feel comfortable speaking to the barrister.   In conference after the hearing, the barrister stated, “Well you understood all that, didn’t you? You know what VIG work is”. The service user nodded. I then checked their understanding by asking a direct comprehension question (“What is VIG work?”). They responded, “I don’t actually know”. I therefore provided a simple explanation of the term, which they were able to recap in their own words when understanding was re-checked.

How to check understanding

Direct, specific comprehension questions are one of the most effective methods of checking understanding and retention of information. For example, after an explanation of a Special Guardianship Order, ask: “What is a Special Guardianship Order?”, rather than, “Do you understand the SGO?”. This ensures the individual expresses exactly what they have understood, so that it can be checked and (where necessary) corrected.

Although this process is simple and often highly effective, in some cases it can be challenging to implement if:

The service user doesn’t engage with comprehension checking

Some individuals may feel patronised or put on the spot by this strategy. In these cases, there are lots of measures that can be implemented to assist, including:

• Explaining the rationale for the strategy (e.g., “It’s really important that your legal team gives you all the information you need. This is to check we have explained everything properly”)
• Adopting a more informal, conversational approach after building rapport (e.g., “What was all that about, then?”)
• Asking their opinion to open up the conversation in order to assess understanding (e.g., “What did you think about X?”)
• Feigning ignorance, to allow the service user to ‘fill in the blanks’ (e.g., “What did the judge say about X again? I missed it”)

The service user has expressive difficulties

If an individual has difficulty putting their understanding into words, it can be challenging to explore their true understanding using comprehension checking questions alone. It may assist to:

• Use more specific prompt questions (e.g., “What did the doctor say about X?”, “What does that mean?”, “Why is that important?”)
• Give multiple options, including a distractor item (e.g., “Does consecutive mean: One after the other, at the same time, or no prison time?”)
• This approach can be visually supported if the service user has a reduced auditory working memory capacity (e.g., using pictorial multiple choice questions)
• Use other visual aids to support their expression (e.g., if discussing court roles, use a plan of a courtroom to allow them to point to different areas and professionals)

Never assume understanding

Intermediaries and legal professionals should never assume “yes” means that an individual with a communication need has understood. There are also other presentations which we should not assume demonstrate understanding. These include:

• Nodding during explanations.
• Making sounds of engagement during explanations, (e.g., “Mhmm”).
• Echoing parts of the explanation (e.g., repeating the final clause, “Yeah, like the social worker said”).

Checking understanding more effectively can be a longer process but helps ensure that individuals with communication needs have the information required to fully understand proceedings. This can help them to make better informed decisions, give clearer instructions and feel more confident engaging with proceedings (among many other advantages).

Learn more about court communication from experienced court intermediaries on The Access Brief. A growing library of free resources developed for legal professionals working with clients who have communication needs.

Rhianna explores how trauma can affect communication skills.

“The physical trauma – or more precisely the memory of the trauma – acts like a foreign body which long after its entry must continue to be regarded as an agent that is still at work”. – Freud and Breuer

Trauma is a subjective experience which overwhelms a person’s ability to cope. It may involve an individual feeling as though there is a direct threat to their life, sanity, or safety. In an effort to survive, preserve a coherent sense of self, and process the traumatic experience, the brain seeks out various coping mechanisms.

The brain can make mistakes – and these coping mechanisms may leave enduring consequences on an individual’s ability to integrate their emotional experiences and process information. The shadow left by a traumatic event may affect how an individual presents, behaves, communicates, and relates to others.

Research into the understanding of trauma is developing. Increasingly, professionals and practitioners across many fields are shifting towards a trauma-based perspective when dealing with those who live with Post Traumatic Stress Disorder (PTSD). However, this has not always been the case. PTSD has only existed as a diagnosis since 1980. Prior to this, veterans and victims of abuse who were suffering, with what we now call PTSD, would be routinely misdiagnosed with a plethora of conditions, including alcoholism, substance abuse, depression, mood disorder, schizophrenia, or neuroses.

Whilst people diagnosed with PTSD may experience any of the aforementioned conditions (plus many, many more), trauma lies at the heart of the issue. The roots of trauma run deeply, the consequences and effects branch wide.

Fight, Flight, Freeze, Collapse

Our nervous system is ancient. Like all species, humans have evolved self-protective mechanisms to help us survive imminent danger. This system evolved to mobilise us away from very real threats such as, a predator, a landslide, or a fire. The complexity of modernity means, however, that the dangers we face are not always as concrete as they were historically. We may misinterpret safe situations, seeing danger where none exists. Before our rational brain can process and de-escalate the situation, our central nervous system has already sprinted into action.

Trauma survivors are often hypervigilant to danger. They may be far more likely to misinterpret situations, to feel like danger is imminent and inescapable, when in fact they are perfectly safe. Individuals with PTSD are effectively on hyperalert. Their fight or flight response has been hijacked, meaning that this chain reaction can be quickly triggered.

Once this chain reaction has been set off, the body is running on pure instinct. This is an extremely physical response. The amygdala (the stress centre of the brain) fires stress hormones called cortisol and adrenaline through the body. The pupils dilate, and we experience the phenomenon of tunnel vision. Blood flows to the major muscle groups such as the thighs, and arms, preparing us to run from or fight off an attack. The breath and pulse quicken, our blood pressure increases, and we are elevated to a heightened state of tension. The intensity of this physical response can have serious consequences for our ability to communicate, and we may struggle to articulate our feelings, to decipher meaning and to express ourselves coherently.

Courtroom environments can be extremely overwhelming, in particular for people with PTSD. The atmosphere is heightened and stressful, the pressure on the individual is intense, and the consequences are often life changing. Breaks from the court environment can interrupt the mounting anxiety trauma survivors may be feeling. Intermediaries can monitor the emotional presentation of service users and alert the court if it deteriorates. Taking some time and space away from the court environment can reset an individual’s anxiety levels and allow them to de-escalate their panic response.

The intermediary can assist further with this by implementing grounding exercises. These exercises may include guided deep breathing with a particular focus on the outbreath, as this stimulates an individual’s parasympathetic nervous system and slows their heart rate. The intermediary may also guide the service user through exercises to assist them to reconnect with their senses, for example, by asking them to name 5 things they can see, 4 things they can hear, 3 things they can feel, 2 things they can smell and 1 thing they can taste.

Feeling a sense of presence and connection with the earth can bring us back to the current moment, and the intermediary could invite the service user to feel the full weight of their body against the floor or chair. The path of the vagus nerve carries messages of panic through the throat, chest, and abdomen. Grounding exercises can help to direct an individual’s focus away from this system. Focusing attention on the hands, which lie outside of the path of the vagus nerve, can create physical sensations which can counterbalance the feeling of being out of control. The intermediary could introduce the use of fidget objects or offer the service user some paper so that they can draw, write, or shred. The intermediary may guide the service user through some gentle movement, such as tapping on the pressure points, or simple stretches. These exercises can help create space and movement in the mind, body and voice, which acts as an antidote to the frozen, paralysing fear we experience when living in a traumatic moment.

Speaking out and sitting down

As part of our instinctive panic response, a key area of our brain which is used for communication – known as the Broca’s area – completely shuts down. The Broca’s area is a key speech centre, and if this part of the brain stops functioning, you are effectively unable to articulate your feelings. This poses enormous challenges to individuals who are required to give evidence in court.

With an impaired Broca’s area, individuals in court will struggle to alert professionals when miscommunications occur. They may have difficulty recognising and advocating for breaks when they are needed. They may struggle to decipher meaning when presented with information which uses low frequency vocabulary (for example, the word, ‘instigated’ may be harder to process and understand than the word, ‘started’). They may also struggle to comprehend complex sentence structures, such as tag questions, or questions which contain multiple parts. Of course, all of these issues are only magnified if the individual already experiences barriers to their communication in their daily life. Any pre-existing communication difficulties will be exacerbated, at a time when effective communication could not be of greater importance.

When asked to give evidence in court, individuals who have PTSD may become so overwhelmed that they can barely speak. Their nervous system may be hijacked into a state of panic, rendering them unable to clearly articulate what happened to them. Their evidence may be fragmented, chaotic, confusing, or incoherent. Alternatively, they may try and recount the events of what happened to them in a way that prevents them from becoming triggered. This may result in their responses appearing evasive, minimal, or unreliable.

An integral part of the intermediary role is assessing the communicative ability of the individual service user and intervening to ensure that the questions asked of them in evidence are appropriate for their communication profile. At the assessment stage, the specific difficulties each service user faces will have been identified, and recommendations for effective communication will be set out in the intermediary report. However, the service user’s ability to process and understand language may fluctuate, and this will need to be constantly monitored by the intermediary. If a service user enters fight or flight mode, they may become far less able to process question types which ordinarily may not pose any issues.

The intermediary can alert the court’s attention to complex question types and offer suggestions for simplifications. Ensuring that language is kept extremely simple and that questions are short and easy to understand, will assist the service user to provide their best possible evidence to the court. If the evidence given by the service user lacks sufficient detail, the intermediary can also recommend the use of simple, follow up questions, such as, “Where did you go next?”, or, “What happened after that?”. If the service user is unable to understand or process verbally presented information, the intermediary can intervene and offer visual explanations, using simple visual aids. These strategies are not only effective when a service user is giving evidence, as the intermediary can continue to use visual aids and give verbal simplifications throughout proceedings to support comprehension.

Our nervous system is a powerful thing, and the intensity and regularity of the fight or flight response can have lasting consequences for how trauma survivors understand, process, and retain information. Over a prolonged period of time, constantly elevated stress hormones can have serious impacts on the memory of traumatised individuals and their ability to maintain concentration and attention.

The court environment was not designed with PTSD survivors in mind. In court, there is often large volumes of complex verbally presented information, which contains unfamiliar or court-specific language, such as ‘indictment’, or ‘threshold’. This can be extremely fatiguing for individuals with trauma-related communication difficulties to process. In addition to this, the court environment has an intensity which requires focused attention, and due to time pressures, breaks are not always factored in.

This is where intermediaries can assist individuals with PTSD to access and participate fairly in the justice system. Having a timetable or checklist of what is coming up within the court day can manage expectations and assist the service user to maintain their attention. Another key strategy which intermediaries may implement to support the retention and concentration of individuals with PTSD is enabling regular breaks. The intermediary can closely monitor the presentation of the service user, and if it is clear that the fight or flight response has overwhelmed their ability to participate fairly, then the intermediary can advocate for breaks and alert the court when they will be necessary. In these breaks, salient points from proceedings can be repeated and recapped to assist retention. Time should also be carved out within the break for the service user to have a complete rest from processing, which will then enable them to concentrate more effectively when they return.

Flashbacks

A common experience of trauma survivors is that of visceral flashbacks. These flashbacks are intense physiological experiences and do not operate in the same way that typical memory does. When an individual with PTSD is presented with images, sounds or thoughts which relate to a traumatic event, the amygdala lights up in alarm. Physiologically, their body reacts as though the traumatic event is ongoing, as though the danger is immediate and inescapable, even if their brain is simultaneously aware that there is no tangible risk of harm.

When a flashback occurs, the left hemisphere of the brain deactivates. This can have disastrous consequences for an individual’s ability to communicate coherently. Without the left side of the brain functioning, the individual may find themselves unable to name and compare things and understand how one thing relates to another. They may be unable to organize and sequence events, and whist being consumed with overwhelming emotions, individuals may have extreme word-finding difficulties. This can leave them feeling incapable of communicating their subjective experiences to others.

The court environment is rife with stimuli that could trigger a flashback or adverse reaction. When attending court, individuals may be required to publicly relive traumatic events. Some may be faced with seeing the perpetrator of their trauma. Individuals may undergo cross examination which may feel invasive, personal, or triggering. The subjects that are discussed in proceedings are often highly sensitive, and even if not directly related to their trauma, could nonetheless stir up distressing memories and feelings. In addition to this, the unique formality of the court environment, the stakes and pressure of the situation, as well as the anticipation and anxiety surrounding court attendance, could all act as further catalysts.

As intermediaries, we can implement various strategies to minimise the risk of an individual experiencing a flashback. If the service user is likely to be triggered by seeing a particular individual in a court setting, intermediaries can recommend the use of special measures, such as screens, to shield the service user from being visually confronted with the source of their trauma. If the court building itself could be a trigger, we could implement a familiarisation visit, to allow the service user to acclimatise to the environment in which the proceedings will be taking place. If this does not alleviate the service user’s anxiety, we could recommend that the service user attend remotely from another room in the court, or even a neutral building, such as a solicitor’s office.

Whilst attending court remotely certainly has its own complications, for some service users it can be a far less anxiety inducing experience and enable them to fully participate in their proceedings. Some individuals may find authority figures intimidating and could feel triggered by the hierarchical structure of the court environment. In some cases, a service user’s anxiety can be alleviated if certain court specific formalities and traditions are forgone. For example, it may be helpful to refer to traumatised individuals by their first name, or to allow them the opportunity to meet the advocates and judge prior to the court hearing. Some traumatised individuals may have a comforting object, or a person who provides emotional support who they may wish to accompany them to court. The presence of a reassuring object or individual in such an overwhelming environment may help to create a feeling of familiarity and safety.

Rapport and repair

Trauma is a rupture which can drastically alter how we view ourselves and interact with others. Those who have been traumatised may have great difficulty trusting new people. If their trauma was enabled by an abuse of power, they may find it particularly hard to engage with professionals and authority figures. It is for that reason that building a rapport is so fundamental to the intermediary role when working with trauma survivors. This rapport is the foundation on which all other assistance provided by intermediaries is layered. If the service user feels comfortable and relaxed working with the intermediary, they are more likely to express their lack of understanding or their need for a break. They may engage better with simplifications and explanations provided in court. In addition to this, there may be an increased likelihood of the intermediary being able to effectively assist with managing any emotional dysregulation.

Humans are innately social beings. When we feel under threat, we instinctually turn towards others to seek reassurance or call for help. If our distress is recognised and reassurance is given, this can go a long way to avoiding the stress response escalating to a fight, flight, freeze or collapse response. It may sound simple but acknowledging an individual’s emotions can be an extremely useful tool for de-escalation. Simple mirroring statements, such as, “I see you are very upset”, “I know what Mr X said made you very angry”, or “I understand that you feel very anxious about tomorrow”, carry a reassuring message: that the service user’s subjective experience is heard, understood, seen, and acknowledged. Having an intermediary in court can provide a soothing and steadying presence for those who suffer from PTSD. Whilst an intermediary is impartial, our purpose at court is specifically to assist the service user. For the service user, knowing that there is someone there who will be attentive to their communicative needs, and provide support when necessary, can be hugely beneficial in managing emotional dysregulation over the course of proceedings.

Trauma is complex and subjective. The ripples that it creates are far reaching and unique from individual to individual. With appropriate therapeutic intervention, traumatic experiences can be re-integrated and processed by the ever learning and adaptable brain. Left unresolved, however, trauma can permeate all aspects of how one interacts with the world. Individuals with PTSD who are required to attend court can feel as though they are being left exposed, vulnerable and at risk of re-traumatisation, if their experience is not adapted to meet their unique needs. Intermediary support can enable individuals who carry the complex scars of a traumatic past to participate fairly in a justice system which may often shine a light directly onto their wounds.