cause of their sensory impairment and need early multi-disciplinary intervention. Emotional and practical support is needed for families to make fully informed choices. Those with and without sensory impairment need the same access to mental health services and this is particularly difficult to achieve for deaf and deaf–blind people. Local and specialist teams need to work together to implement the National Service Framework for this vulnerable patient group. Visual and hearing problems are seen as medical problems and as disabilities. However, the main concerns of those affected by the total or partial absence of sight and/or hearing are usually how to live, how to learn and how to communicate. Their difficulties are often as much to do with society’s attitudes towards them as with the direct effect of sensory impairment. Helen Keller (1948) said that blindness cut her off from things and deafness from people. She wrote ‘I have found deafness to be a much greater handicap than blindness. Deafness … cheats many of their birthright to knowledge’ (quoted in Grant, 1987) The effect of sight and/or hearing loss depends on the degree of loss and the age at and speed of onset. ]