Deaf mental health care

Last updated January 22, 2024

Deaf mental health care is the providing of counseling, therapy, and other psychiatric services to people who are deaf and hard of hearing in ways that are culturally aware and linguistically accessible.^[1] This term also covers research, training, and services in ways that improve mental health for deaf people. These services consider those with a variety of hearing levels and experiences with deafness focusing on their psychological well-being. The National Association of the Deaf has identified that specialized services and knowledge of the Deaf increases successful mental health services to this population.^[2] States such as North Carolina,^[3] South Carolina, and Alabama have specialized Deaf mental health services. The Alabama Department of Mental Health has established an office of Deaf services to serve the more than 39,000 deaf and hard of hearing person who will require mental health services.^[4]

There are multiple models of deafness; Deaf mental health focuses on a cultural model in that people who are deaf view themselves as part of a socio-cultural linguistic community, rather than people with a medical deficit or disability. Accordingly, providing deaf mental-health care to people of the Deaf community requires services from clinicians, doctors, and interpreters who are trained with this perspective and the inclusion of deaf professionals in this system of health care.

Deaf children language development

Early access to language in deaf children is important for normal development of language. The critical period of language development is an important part of the linguistic development of all children - and delaying access to language input can lead to mental health concerns. Deprivation of language can negatively affect mental health and in severe cases can cause language deprivation syndrome.^[5] Child psychiatrist Sanjay Gulati is a strong proponent for the importance of language access in deaf children so that they can establish a fundamental first language. Access to auditory and visual language is important, and availability differs based on each child's abilities. Approximately 40% of deaf children also have additional disabilities.^[6]

Many states have deaf schools and institutions that provide appropriate language models along with mental health services for their students and those in the surrounding Deaf communities. The Lexington School for the Deaf in Queens, New York, provides a variety of educational and social services for the deaf.^[7] The Texas School for the Deaf in Austin, Texas, also provides a focus on mental health for students.^[8]

Deaf children in mainstream schools may be more neglected in the classroom than their hearing peers. It is also more common for deaf children to have a harder time making friends.^[9] Bullying can occur frequently among children who are deaf or hard of hearing, which can lead to negative mental health outcomes.^[10]

Education and access

For a deaf person, obtaining access to proper medical treatment is challenging and they face a variety of obstacles in communication and access. This can include the way in which medical professionals initiate patient's various health exams without prior modification suitable for deaf individuals.^[11] Communication challenges and lack of doctor awareness of the culture and language of the deaf can lead deaf patients to avoid making medical appointments.^[12] An increase in the number of professionals who are trained in American Sign Language and have experience with Deaf culture increase positive mental health outcomes for deaf people.^[13]^[14]

Aging and deafness

Age-related hearing loss gradually occurs in many people as they get older, typically affecting those over the age of 65.^[15] This type of hearing loss can lead to feelings of embarrassment and isolation due to the fact that those affected may no longer be able to hear family, friends, or simple everyday sounds. Those with hearing loss are less likely to want to engage in social activities due to frustration over not being able to hear. A study conducted by the National Council on Aging showed that a large portion of elders with hearing loss who were studied reported symptoms of lasting depression.^[16] Higher rates of exclusion from social and employment opportunities due to higher rates of miscommunication, making deaf adults more susceptible to mental illnesses.^[10]

Studies have found that when a person becomes deaf at an older age, it has a less extreme impact on their mental health than it does when hearing loss begins at an earlier age.^[17] However, those who were either born deaf or lost their hearing at a younger age and then age as a deaf person face some particularly difficult challenges. When a non-deaf person ages, isolationist tendencies are generally increased. This increase is even more drastic for deaf people. Furthermore, many technological advancements that are heavily dependent on auditory communication also present challenges to deaf people.^[18]

Knowledge of professionals

The type and onset of deafness may cause different types of language disfluencies, diagnoses, and treatments of clients who are deaf.^[19] Cultural knowledge, language skills (e.g., fluency in American Sign Language or access to trained interpreters), and other social-cultural factors are part of the deaf mental health access model. Lack of knowledge about Deaf culture and sign language among mental health professionals can make it difficult for deaf people to access appropriate services.^[20]

American Sign Language interpreting and training for mental health

The National Association of the Deaf has eight recommendations for qualifications of interpreters working in mental health settings:^[21]

Fluency in American Sign Language
Fluency in English and register choices
Culturally competent
Attending a comprehensive training curriculum for mental health interpreting
Mentoring with experienced mental health interpreters (at least 50 hours)
Individual or group supervision and peer consultation
High standards of ethical practice
Knowledge of relevant ethical literature or decision-making models in interpreting

Specific knowledge and training in mental health contexts is necessary for adequate sign language interpreting for mental health clients. Accordingly, the State of Alabama requires "Certification of mental health interpreters for persons who are deaf" for interpreters to work in mental health contexts, and this certification must be renewed yearly by either: a) working 40 hours in clinical settings; b) attending 40 hours of training; or c) a combination of work in clinical settings and training equaling 40 hours.^[22] To provide the opportunity for education and training, the Alabama Department of Mental Health's Office of Deaf Services directed by Steve Hamerdinger established the Alabama's Mental Health Interpreter Training Project.

Attitudes about the use of interpretation in psychotherapy

According to psychologist Camilla Williams, "Deaf people enter therapy with the same problems as hearing people."^[23] As members of a linguistic minority, the ability to receive psychotherapy in their preferred language, independent of a translator can be difficult. Within the Deaf community, sign language fluency is considered very important when choosing a therapist.^[24] While it is preferred to have a therapist familiar with Deaf culture and fluent in American Sign Language the reality is that there are very few therapists having the specific skills necessary. This impacts the ability of both the client and the therapist to communicate effectively allowing for a therapeutic alliance to be formed. The addition of a translator shifts the dynamic between client and therapist. Research shows that while a well-qualified translator is appreciated, translation often creates additional challenges.^[25] It can be frustrating when the therapist believes that the translator is only for the client's comfort and not benefiting both parties.^[24]

Related Research Articles

Hearing loss is a partial or total inability to hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to acquire spoken language, and in adults it can create difficulties with social interaction and at work. Hearing loss can be temporary or permanent. Hearing loss related to age usually affects both ears and is due to cochlear hair cell loss. In some people, particularly older people, hearing loss can result in loneliness.

The three models of deafness are rooted in either social or biological sciences. These are the cultural model, the social model, and themedicalmodel. The model through which the deaf person is viewed can impact how they are treated as well as their own self perception. In the cultural model, the Deaf belong to a culture in which they are neither infirm nor disabled, but rather have their own fully grammatical and natural language. In the medical model, deafness is viewed undesirable, and it is to the advantage of the individual as well as society as a whole to "cure" this condition. The social model seeks to explain difficulties experienced by deaf individuals that are due to their environment.

Deaf culture is the set of social beliefs, behaviors, art, literary traditions, history, values, and shared institutions of communities that are influenced by deafness and which use sign languages as the main means of communication. When used as a cultural label especially within the culture, the word deaf is often written with a capital D and referred to as "big D Deaf" in speech and sign. When used as a label for the audiological condition, it is written with a lower case d. Carl G. Croneberg coined the term "Deaf Culture" and he was the first to discuss analogies between Deaf and hearing cultures in his appendices C/D of the 1965 Dictionary of American Sign Language.

Audism as described by deaf activists is a form of discrimination directed against deaf people, which may include those diagnosed as deaf from birth, or otherwise. Tom L. Humphries coined the term in his doctoral dissertation in 1975, but it did not start to catch on until Harlan Lane used it in his writing. Humphries originally applied audism to individual attitudes and practices; whereas Lane broadened the term to include oppression of deaf people.

Bimodal bilingualism is an individual or community's bilingual competency in at least one oral language and at least one sign language, which utilize two different modalities. An oral language consists of a vocal-aural modality versus a signed language which consists of a visual-spatial modality. A substantial number of bimodal bilinguals are children of deaf adults (CODA) or other hearing people who learn sign language for various reasons. Deaf people as a group have their own sign language(s) and culture that is referred to as Deaf, but invariably live within a larger hearing culture with its own oral language. Thus, "most deaf people are bilingual to some extent in [an oral] language in some form". In discussions of multilingualism in the United States, bimodal bilingualism and bimodal bilinguals have often not been mentioned or even considered. This is in part because American Sign Language, the predominant sign language used in the U.S., only began to be acknowledged as a natural language in the 1960s. However, bimodal bilinguals share many of the same traits as traditional bilinguals, as well as differing in some interesting ways, due to the unique characteristics of the Deaf community. Bimodal bilinguals also experience similar neurological benefits as do unimodal bilinguals, with significantly increased grey matter in various brain areas and evidence of increased plasticity as well as neuroprotective advantages that can help slow or even prevent the onset of age-related cognitive diseases, such as Alzheimer's and dementia.

Deaf education is the education of students with any degree of hearing loss or deafness. This may involve, but does not always, individually-planned, systematically-monitored teaching methods, adaptive materials, accessible settings, and other interventions designed to help students achieve a higher level of self-sufficiency and success in the school and community than they would achieve with a typical classroom education. There are different language modalities used in educational setting where students get varied communication methods. A number of countries focus on training teachers to teach deaf students with a variety of approaches and have organizations to aid deaf students.

Language deprivation is associated with the lack of linguistic stimuli that are necessary for the language acquisition processes in an individual. Research has shown that early exposure to a first language will predict future language outcomes. Experiments involving language deprivation are very scarce due to the ethical controversy associated with it. Roger Shattuck, an American writer, called language deprivation research "The Forbidden Experiment" because it required the deprivation of a normal human. Similarly, experiments were performed by depriving animals of social stimuli to examine psychosis. Although there has been no formal experimentation on this topic, there are several cases of language deprivation. The combined research on these cases has furthered the research in the critical period hypothesis and sensitive period in language acquisition.

Verbal intelligence is the ability to understand and reason using concepts framed in words. More broadly, it is linked to problem solving, abstract reasoning, and working memory. Verbal intelligence is one of the most g-loaded abilities.

Language acquisition is a natural process in which infants and children develop proficiency in the first language or languages that they are exposed to. The process of language acquisition is varied among deaf children. Deaf children born to deaf parents are typically exposed to a sign language at birth and their language acquisition follows a typical developmental timeline. However, at least 90% of deaf children are born to hearing parents who use a spoken language at home. Hearing loss prevents many deaf children from hearing spoken language to the degree necessary for language acquisition. For many deaf children, language acquisition is delayed until the time that they are exposed to a sign language or until they begin using amplification devices such as hearing aids or cochlear implants. Deaf children who experience delayed language acquisition, sometimes called language deprivation, are at risk for lower language and cognitive outcomes. However, profoundly deaf children who receive cochlear implants and auditory habilitation early in life often achieve expressive and receptive language skills within the norms of their hearing peers; age at implantation is strongly and positively correlated with speech recognition ability. Early access to language through signed language or technology have both been shown to prepare children who are deaf to achieve fluency in literacy skills.

Cultural competence in healthcare refers to the ability for healthcare professionals to demonstrate cultural competence toward patients with diverse values, beliefs, and feelings. This process includes consideration of the individual social, cultural, and psychological needs of patients for effective cross-cultural communication with their health care providers. The goal of cultural competence in health care is to reduce health disparities and to provide optimal care to patients regardless of their race, gender, ethnic background, native languages spoken, and religious or cultural beliefs. Cultural competency training is important in health care fields where human interaction is common, including medicine, nursing, allied health, mental health, social work, pharmacy, oral health, and public health fields.

The deaf community in Australia is a diverse cultural and linguistic minority group. Deaf communities have many distinctive cultural characteristics, some of which are shared across many different countries. These characteristics include language, values and behaviours. The Australian deaf community relies primarily on Australian Sign Language, or Auslan. Those in the Australian deaf community experience some parts of life differently than those in the broader hearing world, such as access to education and health care.

Language deprivation in deaf and hard-of-hearing children is a delay in language development that occurs when sufficient exposure to language, spoken or signed, is not provided in the first few years of a deaf or hard of hearing child's life, often called the critical or sensitive period. Early intervention, parental involvement, and other resources all work to prevent language deprivation. Children who experience limited access to language—spoken or signed—may not develop the necessary skills to successfully assimilate into the academic learning environment. There are various educational approaches for teaching deaf and hard of hearing individuals. Decisions about language instruction is dependent upon a number of factors including extent of hearing loss, availability of programs, and family dynamics.

Language exposure for children is the act of making language readily available and accessible during the critical period for language acquisition. Deaf and hard of hearing children, when compared to their hearing peers, tend to face more hardships when it comes to ensuring that they will receive accessible language during their formative years. Therefore, deaf and hard of hearing children are more likely to have language deprivation which causes cognitive delays. Early exposure to language enables the brain to fully develop cognitive and linguistic skills as well as language fluency and comprehension later in life. Hearing parents of deaf and hard of hearing children face unique barriers when it comes to providing language exposure for their children. Yet, there is a lot of research, advice, and services available to those parents of deaf and hard of hearing children who may not know how to start in providing language.

Sanjay Gulati is a child psychiatrist in Massachusetts whose research revolves around people who are deaf and hard of hearing and whose focus is on educating professionals working with deaf and hard of hearing populations about language deprivation syndrome. He is credited with coining the concept of language deprivation syndrome and studies the constellation of behaviors that result from lacking a foundational first language in deaf children.

Steve Hamerdinger is an American deaf professional and advocate for deaf and hard of hearing people. He is the current Director of Deaf Services for the Alabama Department of Mental Health. His work revolves around contexts related to deaf and hard of hearing persons and their mental well-being from childhood to end of life. He is an advocate for Deaf rights and has been a prominent influence in this field since the early 1980s.

India is home to approximately 63 million people of the deaf and hard of hearing community (DHH). It has been argued that while India's government has focused heavily on modernizing the country with technological resources and infrastructure, the needs of the DHH residents of India have been ignored. Although sign language has been evolving within the country, it was not until 2017 that the Indian government decided to codify sign language in a dictionary format.

There are about 357,000 deaf and 3,210,000 hard-of-hearing people in Canada. The country can be split into Francophone and Anglophone regions, and has both French and English as official languages. The majority of Canada is considered Anglophone, while the province of Quebec along with small parts of New Brunswick, Ontario, and Manitoba are primarily French-speaking. The presence of these two main languages and cultures also brings forth different deaf cultures between the two regions. In Francophone regions, the official language used by deaf and hard-of-hearing people is Quebec Sign Language.

In Ireland, 8% of adults are affected by deafness or severe hearing loss. In other words, 300,000 Irish require supports due to their hearing loss.

The Windward Islands are a group of islands in the Caribbean Sea that include Dominica, Martinique, Barbados, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago, and Grenada. A variety of cultures, beliefs, languages, and views of deafness exist on the islands.

Nicaragua's total population is 6,000,000, but a reliable count of the number of deaf people in Nicaragua is difficult to obtain. In 2009, a law was passed in which Nicaraguan Sign Language (NSL) was named as the official language of deaf people in Nicaragua. NSL is a newer sign language that emerged less than 50 years ago when deaf children started attending school. Due to the country's lack of early childhood hearing screenings, hearing loss is often undetected and left untreated. Deaf and hard-of-hearing children often face language deprivation due to the lack of language input they experience until they enter school. There are many schools in different cities in Nicaragua; however, the majority of deaf children throughout the country are not attending school. Deaf and hard-of-hearing people also face struggles when finding employment opportunities. NSL isn't an endangered sign language, but the total number of people who use the language are under 10,000.

References

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