"Unique Considerations for the Deaf Needing Mental Health Care" American Sign Language (ASL)

Unique Considerations for the Deaf Needing Mental Health Care: By Jennifer Savino 5/17/2014 Unique Considerations for the Deaf Needing Mental Health Care Imagine yourself as an American who only speaks English, stranded in a psychiatric hospital where only Mandarin is spoken. The Chinese language and culture is foreign to you and this hospital does not have an interpreter or someone knowledgeable about American culture to assist you. The feeling of isolation that you could imagine feeling is the same feeling Deaf people often feel when trying to get mental health services. There are factors unique to Deaf patients that must be considered in order to provide quality mental health care. Although the true incidence of serious mental illness in the Deaf remains unknown (Horton, 2012), there have been many studies of psychiatric diagnoses in the Deaf population. One study found that post traumatic stress disorder was the most common diagnosis compared with hearing patients in the same hospital. Deaf patients were less likely to be diagnosed with psychotic or substance abuse disorders and more likely to be diagnosed with a mood, anxiety, personality, or developmental disorder (Black, 2006). However, diagnosing mental health disorders with Deaf patients is complicated, with a primary factor being difficulties in communication between the clinicians and Deaf patients (Glickman, 2007). Mental health clinicians make conclusions based on observations of behavior, reports from others, and most importantly by listening to what patients say and how they say it. For example, clinicians look for evidence of language dysfluencies (odd, unusual expressions of language) because these are often indicators of mental illness. Many Deaf patients are language dysfluent, but the language dysfluency is often not due to mental illness. Their language dysfluency is more likely due to late and inadequate exposure to American Sign Language (ASL) (Glickman, 2007). A study of characteristics of severely and chronically mentally ill Deaf people found that 75% of Deaf individuals fell into what was described as the non fluent range of communication in ASL (Black, 2006). In addition to many Deaf patients having inadequate language skills, very few clinicians are knowledgeable about ASL. One mistake that can be made is to draw conclusions about mental illness based on the spoken or written language skills of the Deaf person (Glickman, 2007). ASL is not readily translatable into syntactical and grammatical English and may give an examiner unfamiliar with ASL the impression that the Deaf ASL user thinks in holistic or concrete terms that may simulate a severe thought disorder (Evans, 1987). Another factor complicating communication between clinicians and Deaf patients/ASL users is that some psychiatric terms, such as “hearing voices”, are very difficult to interpret. Patients may not understand the concepts and therefore not understand the question being posed to them. Glickman mentions an “empty nod” problem, the fact that many Deaf persons routinely answer “yes” to questions that they do not understand so that they do not look ignorant (Glickman, 2007). He also says that clinicians, who are unfamiliar and uncomfortable with communication difficulties, sometimes take the “yes” answer without probing into language and psychological domains. Glickman also states that the language output from hearing staff can be bizarre. He gives the example of a Deaf psychotic woman signing “YOU KILL ME” to a staff person who did not understand her. The staff person responded by smiling brightly and nodding her head up and down in an apparent effort to show support (Glickman, 2007). Another factor making assessment of mentally ill Deaf patients more difficult is that culturally Deaf people and hearing people tend to hold different views about some issues. Glickman gives the example that a hearing clinician untrained in Deafness may find a Deaf person's expressed view that, for example, Deafness is good or speaking is unnecessary and oppressive, delusional or at least peculiar (Glickman, 2007). Mental health clinicians not understanding Deaf communication and culture can also have deleterious effects on treatment. One contributing factor to the higher rates of seclusion and restraint noted in Deaf psychiatric patients may be hearing staff not understanding how their communicative behaviors may be misinterpreted by Deaf patients (Diaz, 2010). Glickman states that a Deaf person may incorrectly attribute a hearing person's lack of eye contact, turning away from them, or facial grimaces as indications of hostility (Glickman, 2007). Clinicians with insufficient knowledge of Deaf culture may not understand concepts that may be important to their Deaf patients. Whyte described counseling and helping a Deaf college student with the inequity of audism, which was described as the belief that someone is superior based on their ability to hear or behave like a hearing person. She also addressed the concept of Deaf identity development during counseling with this student (Whyte, 2008). A powerful illustration of the complexity of the emotional needs of some people is the following quote by a Deaf man who killed himself in 2005: “Do you see how I feel like I'm on the fence, like I'm pretending to fit into both worlds and not feeling that I fit into anything?” (Beckner, 2006). There are unique factors that need to be considered when Deaf patients are receiving mental health care. Clinicians must consider both the expressive and receptive communication needs of the Deaf patient. Mental health professionals need to increase their knowledge of ASL both so that they can directly communicate with their patients and so that they can correctly assess and respond to communication from their Deaf patients. Clinicians need to understand which concepts are not easily interpreted into ASL and may need further clarification to ensure that their patients understand what is being asked. Clinicians also need to increase their understanding of the importance of body language when communicating with Deaf people so that their communication is more effective. REFERENCES: Beckner, Chrisanne, Thursday, June 08, 2006, “Can You Hear Me Now?” Sacramento News and Review. Retrieved 6/20/2006 from http://www.newsreview.com/sacramento/Content:oid=oid%3A60673. Black, P. (2006), Demographics, Psychiatric Diagnoses, and Other Characteristics of North American Deaf and Hard-of-Hearing Inpatients. Journal of Deaf Studies and Deaf Education, 11, 303-321. Retrieved May 16, 2014, from http://jdsde.oxfordjournals.org/content/11/3/303 Diaz, D. (2010), Exploring the Use of Seclusion and Restraint with Deaf Psychiatric Patients: Comparisons with Hearing Patients. Psychiatric Quarterly, 81, 303-309. Evans, J. (1987). The Mental Status Examination. Mental Health Assessment of Deaf Clients: A Practical Manual . Boston: College Hill Press. Glickman, N. (2007), Do You Hear Voices? Problems in Assessment of Mental Status in Deaf Persons With Severe Language Deprivation. Journal of Deaf Studies and Deaf Education, 12(2), 127-147.Retrieved May 16, 2014, from https://jdsde.oxfordjournals.org/content/12/2/127 Horton, H. (2012), Mental Health Services for the Deaf: A Focus Group Study in New York's Capital Region. Journal of the American Deafness & Rehabilitation Association, 45, 236-257. Whyte, A. (2008), Counseling Deaf College Students: The Case of Shea. Journal of College Counseling, 11, 184-192 Sample citation for article above: Savino, Jennifer. (2014, May 17). Unique Considerations For The Deaf Needing Mental Health Care. Lifeprint Library. ASL University. Retrieved May 19, 2014: <http://lifeprint.com/asl101/topics/deaf-mental-health-care-considerations.htm>. Also see: Accessing Mental Health Services for the Deaf and Hard of Hearing You can learn American Sign Language (ASL) online at American Sign Language University ™ ASL resources by Lifeprint.com © Dr. William Vicars Want to help support ASL University? It's easy: DONATE (Thanks!) (You don't need a PayPal account. Just look for the credit card logos and click continue.) Another way to help is to buy Dr. Bill's "Superdisk." Dr. Bill's new iPhone "Fingerspelling Practice" app is now available! CHECK IT OUT > Want even more ASL resources? Visit the "ASL Training Center!" (Subscription Extension of ASLU) CHECK IT OUT > Bandwidth slow? Check out "ASLUniversity.com" (a free mirror of Lifeprint.com less traffic, fast access) VISIT >

Imagine yourself as an American who only speaks English, stranded in a psychiatric hospital where only Mandarin is spoken. The Chinese language and culture is foreign to you and this hospital does not have an interpreter or someone knowledgeable about American culture to assist you. The feeling of isolation that you could imagine feeling is the same feeling Deaf people often feel when trying to get mental health services. There are factors unique to Deaf patients that must be considered in order to provide quality mental health care.

Although the true incidence of serious mental illness in the Deaf remains unknown (Horton, 2012), there have been many studies of psychiatric diagnoses in the Deaf population. One study found that post traumatic stress disorder was the most common diagnosis compared with hearing patients in the same hospital. Deaf patients were less likely to be diagnosed with psychotic or substance abuse disorders and more likely to be diagnosed with a mood, anxiety, personality, or developmental disorder (Black, 2006). However, diagnosing mental health disorders with Deaf patients is complicated, with a primary factor being difficulties in communication between the clinicians and Deaf patients (Glickman, 2007).

Mental health clinicians make conclusions based on observations of behavior, reports from others, and most importantly by listening to what patients say and how they say it. For example, clinicians look for evidence of language dysfluencies (odd, unusual expressions of language) because these are often indicators of mental illness. Many Deaf patients are language dysfluent, but the language dysfluency is often not due to mental illness. Their language dysfluency is more likely due to late and inadequate exposure to American Sign Language (ASL) (Glickman, 2007). A study of characteristics of severely and chronically mentally ill Deaf people found that 75% of Deaf individuals fell into what was described as the non fluent range of communication in ASL (Black, 2006).

In addition to many Deaf patients having inadequate language skills, very few clinicians are knowledgeable about ASL. One mistake that can be made is to draw conclusions about mental illness based on the spoken or written language skills of the Deaf person (Glickman, 2007). ASL is not readily translatable into syntactical and grammatical English and may give an examiner unfamiliar with ASL the impression that the Deaf ASL user thinks in holistic or concrete terms that may simulate a severe thought disorder (Evans, 1987). Another factor complicating communication between clinicians and Deaf patients/ASL users is that some psychiatric terms, such as “hearing voices”, are very difficult to interpret. Patients may not understand the concepts and therefore not understand the question being posed to them. Glickman mentions an “empty nod” problem, the fact that many Deaf persons routinely answer “yes” to questions that they do not understand so that they do not look ignorant (Glickman, 2007). He also says that clinicians, who are unfamiliar and uncomfortable with communication difficulties, sometimes take the “yes” answer without probing into language and psychological domains. Glickman also states that the language output from hearing staff can be bizarre. He gives the example of a Deaf psychotic woman signing “YOU KILL ME” to a staff person who did not understand her. The staff person responded by smiling brightly and nodding her head up and down in an apparent effort to show support (Glickman, 2007).

Another factor making assessment of mentally ill Deaf patients more difficult is that culturally Deaf people and hearing people tend to hold different views about some issues. Glickman gives the example that a hearing clinician untrained in Deafness may find a Deaf person's expressed view that, for example, Deafness is good or speaking is unnecessary and oppressive, delusional or at least peculiar (Glickman, 2007).

Mental health clinicians not understanding Deaf communication and culture can also have deleterious effects on treatment. One contributing factor to the higher rates of seclusion and restraint noted in Deaf psychiatric patients may be hearing staff not understanding how their communicative behaviors may be misinterpreted by Deaf patients (Diaz, 2010). Glickman states that a Deaf person may incorrectly attribute a hearing person's lack of eye contact, turning away from them, or facial grimaces as indications of hostility (Glickman, 2007). Clinicians with insufficient knowledge of Deaf culture may not understand concepts that may be important to their Deaf patients. Whyte described counseling and helping a Deaf college student with the inequity of audism, which was described as the belief that someone is superior based on their ability to hear or behave like a hearing person. She also addressed the concept of Deaf identity development during counseling with this student (Whyte, 2008). A powerful illustration of the complexity of the emotional needs of some people is the following quote by a Deaf man who killed himself in 2005: “Do you see how I feel like I'm on the fence, like I'm pretending to fit into both worlds and not feeling that I fit into anything?” (Beckner, 2006).

There are unique factors that need to be considered when Deaf patients are receiving mental health care. Clinicians must consider both the expressive and receptive communication needs of the Deaf patient. Mental health professionals need to increase their knowledge of ASL both so that they can directly communicate with their patients and so that they can correctly assess and respond to communication from their Deaf patients. Clinicians need to understand which concepts are not easily interpreted into ASL and may need further clarification to ensure that their patients understand what is being asked. Clinicians also need to increase their understanding of the importance of body language when communicating with Deaf people so that their communication is more effective.

Beckner, Chrisanne, Thursday, June 08, 2006, “Can You Hear Me Now?” Sacramento News and Review. Retrieved 6/20/2006 from http://www.newsreview.com/sacramento/Content:oid=oid%3A60673.

Black, P. (2006), Demographics, Psychiatric Diagnoses, and Other Characteristics of North American Deaf and Hard-of-Hearing Inpatients. Journal of Deaf Studies and Deaf Education, 11, 303-321. Retrieved May 16, 2014, from http://jdsde.oxfordjournals.org/content/11/3/303

Diaz, D. (2010), Exploring the Use of Seclusion and Restraint with Deaf Psychiatric Patients: Comparisons with Hearing Patients. Psychiatric Quarterly, 81, 303-309.

Evans, J. (1987). The Mental Status Examination. Mental Health Assessment of Deaf Clients: A Practical Manual . Boston: College Hill Press.

Glickman, N. (2007), Do You Hear Voices? Problems in Assessment of Mental Status in Deaf Persons With Severe Language Deprivation. Journal of Deaf Studies and Deaf Education, 12(2), 127-147.Retrieved May 16, 2014, from https://jdsde.oxfordjournals.org/content/12/2/127

Horton, H. (2012), Mental Health Services for the Deaf: A Focus Group Study in New York's Capital Region. Journal of the American Deafness & Rehabilitation Association, 45, 236-257.

Whyte, A. (2008), Counseling Deaf College Students: The Case of Shea. Journal of College Counseling, 11, 184-192

Savino, Jennifer. (2014, May 17). Unique Considerations For The Deaf Needing Mental Health Care. Lifeprint Library. ASL University. Retrieved May 19, 2014: <http://lifeprint.com/asl101/topics/deaf-mental-health-care-considerations.htm>.

Unique Considerations for the Deaf Needing Mental Health Care: