This research is rooted in an everyday conversation with a Deaf mental health practitioner who thought it important for a hearing researcher to talk to other hearing people about Deaf Services because: “Some just don’t get it. Why? Is it them or is it something to do with me?” The aim was to investigate current experiences of tertiary and secondary level mental health care for Deaf adults and examine factors influencing service delivery. Participants of the study are Deaf service users; Deaf and hearing mental health practitioners working in tertiary level care; hearing mental health practitioners working in secondary level services; and freelance sign language interpreters working in secondary and tertiary level settings. A thematic analysis identified interrelated themes across the different participant groups. The themes are concerned with communication and equity of access. They are captured by an overarching theme: “It makes such a big difference if the attitude is right”. Personal reflexivity is an important part of the methodology and is discussed alongside the literature review findings and the analysis of participant interviews. The research shows that when Deaf service users are offered good, clinical care in secondary level services, it is experienced as exceptional, rather than a default position Deaf people should expect. Therefore, the findings of this study suggest that “audiocentric privilege” and “audism” need to be brought into the mainstream discourse in the UK. It is argued that audism is analogous to racism and is examined through psychoanalytic and critical realist lenses in the discussion. The research contributes to understanding the challenges in delivering good clinical care to Deaf adults in a system that operates from a hearing frame of reference.