Mental Health Mental Health Services for People Services for People Who are Deaf in New Who are Deaf in New HampshireHampshire

2008 MIAB ConferenceCynthia L Whitaker, PsyDOctober 31, 2008

"Do you see how I feel like I’m on the "Do you see how I feel like I’m on the fence, like I’m pretending to fit into both fence, like I’m pretending to fit into both worlds and not feeling that I fit into worlds and not feeling that I fit into anything?"anything?"

-- Shane Spurlock, a deaf man who killed -- Shane Spurlock, a deaf man who killed himself in 2005 in California tried to himself in 2005 in California tried to explain his feelings to his therapist explain his feelings to his therapist (Beckner, 2006)(Beckner, 2006)Reference:Beckner, C. (2006) "Can You Hear Me Now?: It’s hard enough

managing mental illness. But what if nobody speaks your language? " Retrieved October 01, 2008, from Sacramento News and Review. Website: http://www.newsreview.com/sacramento/Content?oid=oid%3A60673

My BackgroundMy BackgroundStarted learning sign language at the age of 5

Formal American Sign Language classes starting in college

Licensed PsychologistLicensed NH Sign Language Interpreter

Vocabulary Vocabulary Hearing loss – general reference, could

include all groupsHard-of-Hearing – primary communication

through spoken language, use of residual hearing

Deaf/deaf – primary communication through sign language

Late-Deafened – late onset, profound loss, use visual representation of primary language

“Hearing Impaired” is considered rude to people who have a hearing loss

A Deaf Patient, How A Deaf Patient, How Likely?Likely?More than 8% of the general US population has a hearing loss

Almost 1% of the general US population is deaf

2006 estimated general NH population =1,314,895

Prevalence of Mental Health Prevalence of Mental Health NeedsNeedsDeaf children are often delayed in

social, cognitive, and emotional development, secondary to link with language development

Deaf children are 2-3 times more likely to be victims of sexual abuse

Deaf people are often subjected to demeaning terminology and discrimination, which can contribute to cultural paranoia

Prevalence of Mental Health Prevalence of Mental Health NeedsNeedsPrevalence of mental illness in

Deaf community consider similar between deaf and non-deaf groups for Axis 1 disorders

Deaf community, however, 3-6 more times Axis II disorders and childhood behavior problems

There are an estimated 40,000 deaf Americans who have “serious” mental health problems (Double if add substance abuse)

2006 Study by Black and 2006 Study by Black and Glickman Glickman PTSD as the most common diagnosis in

the deaf communityMore likely, mood, anxiety, personality

or developmental disorderLess likely psychotic or substance

abuse diagnosisHigher risk of self-harm and sexual

offending

75% of deaf individuals in a deaf inpatient psychiatric unit were non-fluent in ASL

Mental Health RisksMental Health Risks

Mistrust of people Chronic sadness-depression Chronic nervousness-anxiety Frequent anger Isolation Poor self-image/self-esteem Limited group identification Feelings of incompetence Feelings of unacceptability to others Feelings of hopelessness in social situations Extreme tension Blame hearing loss for all problems Feelings of being marginalized in one’s own

family or social circle

Unmet NeedsUnmet NeedsLess than 10% of need for mental

health services is met = greater than 90% of need is unmet

Significant barriers to treatment

Barriers to Mental Health Barriers to Mental Health TreatmentTreatment

Unaware/misconception of services – information tends to be disseminated in written English

First contact often met with hang ups, shouting, offers to provide information in Braille, insulting terminology, expectations about lipreading or interpreters, hesitancy around technology, etc

Limited number of mental health providers fluent in American Sign Language or with training in Deaf Culture

Different needs secondary to cultural and linguistic differences

Barriers to Mental Health Barriers to Mental Health TreatmentTreatmentLocation/transportation to limited providersUsing an interpreter means telling not one

person, but two peopleSmall community – risk of sharing

informationPsychological evaluations are often culturally

inappropriate (e.g., Do you hear voices?, Are people always looking at you?, or inability to explain English idioms and proverbs seen as inability to think abstractly)

Audism/Myths

Common Myths CorrectedCommon Myths Corrected American Sign Language is a language different

from English American Sign Language can convey nuance,

idoms Interpreters are professionals Therapeutic process is not too disrupted to be

effective There are interpreters in our area We are often required to provide treatment even

when it is not our area of expertise People who are deaf can benefit from traditional

services Only 30% of what is said in English is visible on

the lips (e.g., fifteen vs fifty, island view vs ….)

American Sign LanguageAmerican Sign LanguageWhat it is:

◦ A unique language with unique grammar◦ Different from English ◦ Capable of conveying all types of meanings

What it is not:◦ “English on the hands” ◦ “Just gestures”

What does this mean?◦ Not all deaf people can lipread and even

those who can will miss information◦ Often writing or typing back and forth will

lead to misunderstandings

American Deaf CultureAmerican Deaf CultureDifferent from mainstream American

CultureImportance of nonverbal behaviorImportance of shared information Limited English Proficiency (especially

under stress) ◦ Different language and different mode ◦ Imagine your own ability to write a second

language when under stress???Different life experiences (Bank,

shopping with grandchild, etc)

**Requires sensitivity as with any other cultural group**

Examples of Examples of MisinterpretationsMisinterpretations POINTING

◦ Considered rude◦ In ASL, used for pronominal reference

LOWERED BROWS◦ Considered a sign of disagreement or threat◦ In ASL, used to ask for information

DIRECT COMMUNICATION◦ Considered rude◦ Used extensively in ASL

TACTFUL COMMUNICATION◦ Considered polite◦ Considered evasive in ASL

Other◦ Body Movements◦ Definition of verbal acting out

The American With The American With Disabilities ActDisabilities ActAll agencies receiving federal

money (e.g., Medicare and Medicaid) must provide access to individuals with disabilities. This includes providing and paying for interpreters.

If you have any questions about your responsibility, you can contact the Disability Rights Center (228-0432)

Referral or Interpreter???Referral or Interpreter???Client preference Language preferenceHard of Hearing versus DeafNeed for team of interpreters Client location and ability to

travelClients level of acculturationNeed for multiple levels of

services

Proper Utilization of ASL Proper Utilization of ASL interpreters interpreters Professionals – Code of Ethics

◦Waiting room with client?Interpreter’s role

◦Colleague◦Shared information

Physical factorsSafetyNH Licensing lawCertified Deaf Interpreters (CDIs)

Resources In New Resources In New HampshireHampshireInterpreter Services◦Referral Agencies

Granite State Independent Living800-826-3700

Northeast Deaf And Hard of Hearing Services603-224-1850 or 800-492-0407

Emergency Interpreter Referral Service (24/7)800-552-3202

◦BBH Coordinator of Interpreting Services Barrie Booth, M.Ed. – GNMHC at Community

Council603-889-6147 x3203

Resources in New Resources in New HampshireHampshireMental Health Services - Deaf

Services Program at Community Council of Nashua◦BBH funded program providing full range

of CMHC services to all age groups Both certified and non-certified

◦Can contract with other CMHC for all, or a portion of, services All but Emergency Services All but ES and Medication Management FSS only Individual Therapy only

Other Resources in New Other Resources in New HampshireHampshireDeaf Services Program at

Community Council of Nashua◦Mental Health Consultation ◦Mental Health Training

Granite State Independent LivingNortheast Deaf and Hard of

Hearing ServicesNH – VR, Department of Deaf and

Hard of Hearing

Any Questions??Any Questions??For more information, feel free to

contact:

Cynthia L Whitaker, PsyDCoordinator of Deaf ServicesThe Greater Nashua Mental Health Center at

Community Council100 W. Pearl StreetNashua, NH 03060Voice: 603-889-6147 x3263TTY: 603-880-4296VP: 603-598-7134Email: whitakerc@ccofnashua.org