Mental health issues in deaf populations

Deaf & Mental Health

Individuals who are battling depression, anxiety or a similar mental health issue are in great emotional pain and distress and have much less ability to communicate their needs and, especially, to disagree with someone who is coming across as very forceful and intimidating. Yet, the four studies in this short literature review indicate that professional care for the mentally ill, although improved over the years, still has a long way to go to satisfy the well being of the patients. To add to this concern is the fact that these four articles also demonstrated not only the insensitivity but the discrimination that the healthcare workers also have toward individuals with physical disabilities, particularly deafness. One would hope that that people who went into the healthcare field, especially mental health, would be less biased and more open to those who are challenged. These articles proved differently.

The article by Jeffrey Dickert, published in 1988, showed that despite the fact that healthcare professionals in a mental healthcare facility have more positive attitudes toward the deaf than those in the general public, these same employees evaluate deaf people who are mentally ill differently than those who are "just" mentally ill. The deaf patients received more restrictive forms of treatment and greater supervision. Apparently, either the healthcare workers misread the communication problems of the deaf as further proof of mental illness and/or were acting on their innate biases against deaf patients.

Since this previous study by Dickert was conducted in 1988, it was thought that perhaps the situation may have changed over the past two decades. The next article, written in 2002, by Janet DeVinney and Stephen Murphy, was even more disconcerting, since it was a first-hand narrative of a deaf and severely depressed woman with suicidal thoughts who actually was working in a community support program to help individuals such as herself. Because of her training, she had a better than usual perspective regarding mental healthcare. Despite this, however, DeVinney was repeatedly treated with misunderstanding and ignorance bordering on malice. Her efforts to explain that she could not hear her name being called, the questions by the doctor, or the group discussion were ignored. Her request for a TTY to talk with her family was only accepted after her husband came to the hospital on her behalf. Her request for interpreters was also ignored. Regardless whether DeVinney was deaf or not, she should have had more say in her own care and be listened to rather than talked at. As DeVinney notes at the end of her article, the irony is that even when mental healthcare facilities are open to people with disabilities, they still are not understood.

The report, "Challenges of mental health interpreting when working with deaf patients" (2005), shows that it is not only the United States where there are misunderstandings about the mentally ill, deaf individuals. This is an occurrence in other Western nations, as well. The article also demonstrates that better education is needed by professionals who serve the deaf, as well as those whose main responsibility is providing care to the mentally ill. A review of literature by the issues regarding this issue in terms of adolescents, rather than adults, indicates that there are a variety of challenges that interpreters and therapists both face when working with the deaf. For example, the terminology and the nuances of certain words and phrases that the interpreters need to accurately explain to the deaf patients is being said by the clinicians is lacking. Further, although interpreters are expected to abide by a Code of Ethics to govern their role as communication facilitators, it appears that many interpreters, as the authors state, "step outside" of their traditional role in therapeutic contexts for a number of reasons, such as feeling uncomfortable with the content being discussed in the therapeutic sessions, commenting on a deaf patient's linguistic capabilities, and reasons to do with the deaf community as a linguistic and cultural minority group.

The authors conclude that that training could rectify much of this lack of understanding, in addition to conducting more research. They made the following suggestions: Interpreters and therapists should take the time necessary to prepare for and debrief from therapy sessions to ensure that therapeutic goals are clear, linguistic and cultural issues are discussed and emotional and psychological reactions are recognized. Secondly, there is a need for a Code of Ethics to interpret mental health in these settings. Third, therapists require training that consists of knowledge about the cognitive, social, emotional and psychological development of deaf people. Fourth, interpreters also need specialized training for therapeutic contexts. Finally, both therapists and interpreters need to work collaboratively with the deaf community's professional organizations to offer informative and psychoeducational workshops for deaf members and to provide them with further insights on the role that the therapist plays, the purpose of and techniques that are used in therapy and the function of the interpreters and families in the therapeutic process.

Given this found need for better training, education and understanding by healthcare professionals and interpreters, it comes as no surprise, then, that deaf individuals may be reluctant to get mental health care support when they need it or have greater fear, mistrust and frustration than the general public when it comes to having encounters with mental healthcare providers. This is what was found in another study by Steinberg et al. (2005), "Health Care System Accessibility Experiences and Perceptions of Deaf People. The authors collected information regarding healthcare communication and perceptions of clinician attitudes as well as both positive and negative encounters with mental healthcare providers. They found that deaf individuals often felt mistrust toward these individuals. On the other hand, some of them did have positive experiences. This was when there were medically experienced interpreters, professionals who had sign language ability and who did their best to enhance the communication process. A significant number of the people interviewed said they did not know much about their legal rights nor how to advocate for themselves in such situations. Some did feel that those in the healthcare field need to learn more about the sociocultural aspects of deafness.

It was the authors' conclusion, therefore, that deaf people need to become more vocal about any negative experiences they are having with the healthcare services. Physicians also have do to their part in improving this situation. Further, deaf individuals need to look at ways that they can increase their inclination and ability to be self-advocates and recognize their legal rights.