Deaf Mental Health Research Articles

Mental Health First Aid™ for Deaf communities: responses to a lack of national Deaf mental health service provision

PurposeFor over 15 years, Mental Health First Aid™ (MHFA) has successfully been delivered in Wales, United Kingdom, with growing interest in the MHFA programme and increasing course attendees. Trainers, aware of the need for support, know the importance of MHFA being accessible for different communities and learner groups. MHFA has always focused on increasing mental health literacy. One marginalised group, with lower mental health literacy than the general population, is Deaf people, a group with increased risk of mental health problems. This paper aims to provide insights about why Deaf people are twice as likely as hearing people to experience mental health problems.Design/methodology/approachDuring this paper, the authors have used four focal points i) exploring situational contexts for Deaf people; ii) reasons why Deaf individuals are at greater risk of mental health problems; iii) the authors explore a project, “Hear Deaf”, and implementation of MHFA Wales by Deaf MHFA trainers; and iv) initiatives to influence and impact on policymakers.FindingsDuring the project, nine MHFA courses were delivered to Deaf communities across different locations in Wales, often with information and advertisements circulated directly to Deaf communities through Deaf clubs, resulting in 120 Deaf people trained. The authors conclude with their own reflections as a researcher and an MHFA who work predominantly with Deaf communities.Originality/valueThis paper provides a discussion on the specific risks for Deaf people around mental health and the importance of mental health promotion programmes for Deaf communities. Further research is needed regarding the impact of MHFA on Deaf populations.

Seeing voices? The importance of raising awareness on Deaf Mental Health

IntroductionData regarding mental health problems in the prelingual deaf population is scarce. There is evidence that factors related to minority stress can contribute to mental illness in that population. In psychiatry, communication is key, however, most clinicians are not trained to communicate with the Deaf. Moreover, psychiatrists are often not aware of particularities in the psychopathology of these patients.ObjectivesWe aim to review important aspects of psychiatric evaluation of prelingual Deaf patients.MethodsNon-systematic review of recent literature regarding Deaf mental health and mental illness.ResultsData regarding prevalence of mental illness in the Deaf population is mostly obtained from small studies and suggest an increased burden of mental illness and significant barriers to mental health care. Psychiatry research regarding Deaf patients is about 40 years behind research on the hearing population. While communicating with a Deaf patient, clinicians should consider the preferred communication modality. Sign-language interpreters should have specific mental health training, although that is not the case for many countries. Clinicians should keep communication simple, use short sentences, concrete examples and visual aids.The mental status examination will have particularities, such as: 1) facial expressions have a specific role in sign languages and may not relate to affect; 2) There is a need to distinguish between language dysfluency and thought disorder 3) voice hallucinations may manifest as somatic or visual hallucinations; the occurrence of pure auditory hallucination in the prelingual Deaf is controversial. 4) the Deaf have little access to health information and are likely to demonstrate poor literacy on mental health matters.ConclusionsMore studies regarding the mental health issues of the Deaf population should be conducted. Raising awareness among clinicians about the needs of Deaf population is an important step to improve their access to help and treatment.Disclosure of InterestNone Declared

Deaf mental health: enhancing literacy through a hearing and deaf community collaboration

This article explores the process through which findings of a doctoral study became the impetus for the development of a Deaf Mental Health Committee and two community-based events intended to enhance the mental health literacy of the Deaf community in a large metropolitan city in central Canada. The author, a hearing professional and University professor has provided professional counselling services to clients including those who are Deaf and hard of hearing, and conducted a number of studies in and with the Deaf community. Her doctoral study reported on the experience and narratives of a sample of Deaf adults diagnosed with Major Depressive Disorder. Participant narratives highlighted gaps in understanding of mental health and mental illness. A goal of enhancing mental health literacy in the Deaf community developed into the establishment of a Deaf Mental Health Committee. This article presents the successes of that Deaf and hearing collaboration.

Understanding Language Deprivation and Its Role in Deaf Mental Health

Understanding Language Deprivation and Its Role in Deaf Mental Health

Intersecting Cultures in Deaf Mental Health: An Ethnographic Study of NHS Professionals Diagnosing Autism in D/deaf Children.

Autism assessments for children who are deaf are particularly complex for a number of reasons, including overlapping cultural and clinical factors. We capture this in an ethnographic study of National Health Service child and adolescent mental health services in the United Kingdom, drawing on theoretical perspectives from transcultural psychiatry, which help to understand these services as a cultural system. Our objective was to analyse how mental health services interact with Deaf culture, as a source of cultural-linguistic identity. We ground the study in the practices and perceptions of 16 professionals, who have conducted autism assessments for deaf children aged 0-18. We adopt a framework of intersectionality to capture the multiple, mutually enforcing factors involved in this diagnostic process. We observed that professionals working in specialist Deaf services, or with experience working with the Deaf community, had intersectional understandings of assessments: the ways in which cultural, linguistic, sensory, and social factors work together to produce diagnoses. Working with a diagnostic system that focuses heavily on 'norms' based on populations from a hearing culture was a key source of frustration for professionals. We conclude that recognising the intersectionality of mental health and Deaf culture helps professionals provide sensitive diagnoses that acknowledge the multiplicity of D/deaf experiences.

Language deprivation syndrome: a possible neurodevelopmental disorder with sociocultural origins.

There is a need to better understand the epidemiological relationship between language development and psychiatric symptomatology. Language development can be particularly impacted by social factors-as seen in the developmental choices made for deaf children,which can create language deprivation. A possible mental health syndrome may be present in deaf patients with severe language deprivation. Electronic databases were searched to identify publications focusing on language development and mental health in the deaf population. Screening of relevant publications narrowed the search results to 35 publications. Although there is very limited empirical evidence, there appears to be suggestions of a mental health syndrome by clinicians working with deaf patients. Possible features include language dysfluency, fund of knowledge deficits, and disruptions in thinking, mood, and/or behavior. The clinical specialty of deaf mental health appears to be struggling with a clinically observed phenomenon that has yet to be empirically investigated and defined within the DSM. Descriptions of patients within the clinical setting suggest a language deprivation syndrome. Language development experiences have an epidemiological relationship with psychiatric outcomes in deaf people. This requires more empirical attention and has implications for other populations with behavioral health disparities as well.

Working therapeutically with deaf people recovering from trauma and addiction.

This article reviews what is known about behavioral health treatment of deaf persons with comorbid trauma and addiction. We discuss how to work therapeutically with deaf people with comorbid trauma and addiction, both through a review of the literature and through clinical observations of the authors. The article also includes the personal stories of two people-a Deaf peer specialist and a hearing psychiatrist-who share their humbling stories about the recovery process for deaf people and the challenges of learning to become an effective Deaf mental health care provider. Deaf people report higher rates of mental health problems than the general population. Although initial empirical work with the deaf population suggests high rates of posttraumatic stress disorder (PTSD) and substance use disorder (SUD), little is known about the rates of comorbid PTSD/SUD or how to effectively address this comorbidity in treatment. Substantial work is needed to raise awareness of comorbid PTSD/SUD and provide treatment tools to agencies and providers who work with deaf clients, infusing trauma-informed care into deaf SUD services and SUD treatment into deaf mental health care. Fortunately, several endeavors are on the horizon to disseminate assessment and treatment tools to work with deaf people recovering from trauma and addiction.

Deaf Mental Health Care ed. by Neil S. Glickman (review)

Deaf Mental Health Care, ed. Neil S. Glickman (New York: Routledge, 2013, 398 pp., paperback, ISBN 978-0-415-89475-3, $61.95)Deaf Mental Health Care draws on the expertise and experience of respected American and British clinicians and educators. The ten-chapter edited volume, featuring cross-disciplinary perspectives and deaf-hearing collaborations, provides a historical context for a thorough examination of culturally affirmative approaches to mental health care with deaf and hard of hearing individuals. Acknowledging the great diversity within the deaf and hard of hearing population, the focus is on individuals who have experienced profound language deprivation, sometimes with an underlying neurological corollary, often compounded by abuse and trauma. Generally related to inadequate or extremely delayed exposure to a signed language, language deprivation affects mental health and well-being, one's fund of knowledge and literacy, social relationships, social responsibility, and socially appropriate behavior. Glickman proposes a name for this disorder: Language deprivation with deficiencies in behavioral, social and emotional adjustment (65).Testimony to Glickman s editorial experience and excellence is the consistency of style and terminology. Core themes described in the introduction and carried throughout the text include the preponderance of deaf individuals with language deprivation in the inpatient mental health population and the criminal justice system, the role of pretreatment with this population, a strengths-based approach to interventions, the balancing of cultural and clinical competence, the key role of deaf professionals, challenges in deaf/hearing partnerships, the alignment of therapeutic techniques with a visually oriented world view, signed languages, and Deaf culture. Highlights of each chapter follow.Chapter i, Lessons Learned from 23 Years of a Deaf Psychiatric Unit, by Neil S. Glickman, examines the prevalence of language deprivation and abuse histories among persons often admitted to the hospital excessively medicated and inaccurately diagnosed by providers unfamiliar with deaf and hard of hearing persons, relatively few of whom have actual major mental illnesses.The chapter also introduces the concept of pre-treatment, a process of educating and motivating clients to be ready to participate in therapy and rehabilitation, and explains how a good deaf inpatient program provides a framework for culturally and clinically competent community-based care.Chapter 2, Deaf/Hearing Cross-Cultural Conflicts and the Creation of Culturally Competent Treatment Programs, by Michael John Gournaris and Alison L.Aubrecht, describes relational postures that deaf and hearing persons assume in relating to each other which can help understand and address the cross-cultural conflicts and personnel problems that may arise in the workplace.Chapter 3, Sign Language Dysfluency in Some Deaf Persons: Implications for Interpreters and Clinicians Working in Mental Health Settings, by Neil S. Glickman and Charlene Crump, explores the role of interpreters in illuminating clients' language issues as collaborators with clinicians in evaluations. The authors address the challenge of distinguishing between distortions due to disturbance of thought related to mental illness or brain dysfunction and language dysfluency or language idiosyncrasy related to language deprivation.Chapter 4, Creating a Culturally Affirmative Continuum of Mental Health Services: The Experiences of Three States, by Michael John Gournaris, Steve Hamerdinger, and Roger C. Williams, discusses common elements essential to effective statewide systems, including centralized coordination, offering a continuum of culturally affirmative services that are trusted by the Deaf community, and the capacity to provide services across catchment areas.Chapter 5, Creating Culturally and Clinically Competent Deaf Residential Programs, by Neil S. …

Dialectical behavioral therapy informed treatment with Deaf mental health consumers: an Australian pilot program

This paper outlines the process of implementation of a dialectical behavioral therapy (DBT) informed treatment for Australian Deaf mental health consumers. The pilot project team members adapted DBT materials for the Australian Deaf population. Feedback was obtained from the pilot participants and modifications made during the pilot. Participant progress and therapeutic alliance were monitored using culturally valid tools. The DBT informed therapy approach was well received by this target group, with the observation and self report of improved interpersonal skills and emotional regulation. While labor intensive, the process of developing a DBT informed treatment program for Australian Deaf mental health consumers appears to be beneficial for this group. Culturally valid, objective measures of skill attainment need to be developed and further studies comparing different adapted therapeutic approaches would be useful.

The development and future of deaf forensic mental health services

PurposeThis paper aims to review the need for and development of specialist deaf secure mental health services.Design/methodology/approachThe paper is a review article; it begins by giving a brief overview of deafness and the relationship between deafness, mental health problems and offending. Following this, relevant literature and Department of Health (DoH) guidance is summarised and a description of the current UK services is given.FindingsIn 2001, Young et al. highlighted the needs of deaf mentally disordered offenders and the requirement for specialist forensic mental health services for this group. Since then several DoH guidance documents have been published that, amongst other things, highlighted the need to develop deaf forensic mental health services. There have now been substantial service developments in this area but substantial gaps remain – most notably, a lack of specialist mental health provision for deaf prisoners.Originality/valueThe paper offers insights into the development and future of deaf forensic mental health services.

The Psychological Treatment Needs of Deaf Mental Health Patients in High-Secure Settings: A Review of the Literature

A review of the literature relating to the psychological treatment needs of deaf mentally disordered offenders residing in high secure settings was conducted. Four literature searches were conducted relating to offending, mental illness, assessment and treatment with the deaf. The literature regarding these areas was found to be highly limited. Despite this, evidence suggests that deaf people are over represented in high secure facilities. It is also suggested that deaf offenders show higher levels of violent and sexual offences than their hearing counterparts. Most theories accounting for this difference in offending relate to the insufficient acquirement of social understanding however the finding may be an artefact of biases in the criminal justice system. Overall deaf people appear to experience similar levels of mental illness but greater levels of learning disability than hearing people. There are numerous sources of error when conducting assessments with deaf people. Similarly there are a number of challenges when delivering interventions with deaf people. These issues are discussed in terms of their implications for the psychological treatment needs of deaf mentally disordered offenders. Suggestions for future research include making use of systematic case studies to avoid some of the methodological challenges of researching this population.

Linguistic Ability and Mental Health Outcomes Among Deaf People With Schizophrenia

Cognition has become prominent in the study of schizophrenia because of its importance for understanding the etiology of the illness and its consequences for living independently. For people with schizophrenia who are also deaf, investigations of cognition and schizophrenia are infrequent. This study examines the role of linguistic ability in relation to cognition, social cognition, and functional outcome among deaf adults with schizophrenia or schizoaffective disorder. The primary finding is that linguistic ability is positively and significantly associated with functional outcome above and beyond the contribution of cognition and social cognition. A younger age of sign language acquisition is significantly associated with superior linguistic ability, but did not moderate the effect of linguistic ability on other domains. Opportunities for deaf mental health consumers to participate in sign language enrichment programs and communicate with other skilled signers may be useful additions to standard psychiatric rehabilitation programming. More research is needed to clarify the consequences of deafness with regards to schizophrenia especially as it relates to language, vision, and symptoms.

An Investigation Into the Length of Hospital Stay for Deaf Mental Health Service Users

This study looked at the average length of hospital stay for inpatients in a specialist deaf mental health service over a 10-year period, in comparison to that of a general psychiatric hearing cohort. In addition, two case studies of deaf inpatients were carried out looking specifically at the prerequisite factors governing discharge. Finally, a comparison of the types of community-based services available to deaf and hearing service users was undertaken in order to establish whether there was now a similarity of provision for both groups. The conclusion reached was that deaf inpatients are likely to remain in hospital twice as long as their hearing peers, but explanations for this difference may not necessarily be solely of a clinical nature. There is some evidence to suggest that social factors (i.e., a lack of appropriate community support, rehabilitation services, and provision) may have a negative impact on length of hospital stay. It is suggested that an increase in community-based services and provision may well shorten the length of hospital stay for deaf service users in the future. It is also recommended that further research into the relative effects of clinical versus social factors is considered.

Deaf psychiatry

Working for the National Deaf Mental Health Service can be an interesting and fulfilling career. Sara Adshead explains

S36-02 The challenge of psychiatric treatments in the deaf population

Delivering appropriate psychiatric treatments to a Deaf population faces many challenges:•The geographical spread of this client group, who comprise about one in a thousand of the general population.•The complexity of the treatment needs of Deaf people, who may have neurological, psychiatric, social, emotional and psychological difficulties, in addition to a deprived history, which can include significant language delay or deprivation.•The challenge of delivering multi disciplinary treatment programs in conjunction with locally based mainstream resources. Most specialist Mental Health services for Deaf people do cannot provide out of hours or crisis services, and some do not have sufficient community based staff, or any day or in patient provision.The specialist Deaf mental health services need to undertake major awareness, teaching and liaison programs:•With any agency in contact with Deaf people, including Health, Mental Health and Social work and voluntary organistions.•With the Deaf Community to raise awareness of mental health issues, to give information and remove stigma.All these initiatives need to take place locally as well as at national policy making level.

Telemental Health Technology in Deaf and General Mental-Health Services: Access and Use

Long-distance travel to provide mental health services for deaf people has implications for efficiency, safety, and equality of service. However, uptake of Telemental Health (TMH) has been slow in both deaf and general mental health services. A quantitative study was used to investigate access to TMH and whether staff confidence, experience, or demographics affect TMH use. It was concluded that staff in neither deaf mental health services nor general mental health services had adequate knowledge of or access to TMH. Staff expressed concerns over TMH's appropriateness in their work. Previous use of videoconferencing was assosciated significantly with confidence, but previous use of videophones was not. Neither staff in deaf services nor deaf staff were more experienced with or more confident about videoconferencing, whereas, within deaf services, deaf staff were significantly more confident about videophone use. Training implications are discussed.

Attitudes to the use of videoconferencing in general and specialist psychiatric services

Mental health professionals and support staff were invited to complete a questionnaire about their experience of using videoconferencing. Our hypotheses were that mental health professionals in the UK do not have access to videoconferencing and do not believe that videoconferencing is appropriate for their work. Of the 1 34 people who completed and returned a questionnaire, 78 worked in deaf mental health services and 56 worked in general mental health services. The majority were nurses ( n = 33) or psychologists ( n=30). A total of 109 respondents (81 %) knew what videoconferencing was, but only 16 respondents (12%) had ever used it. The majority of the 32 respondents who knew the location of their nearest videoconferencing facility said that it could be accessed in less than 30 min. The 16 people who had previously used videoconferencing identified four different benefits of videoconferencing and eight different drawbacks. We conclude that mental health staff did not have adequate knowledge of, or access to, videoconferencing.

Attitudes to the use of videoconferencing in general and specialist psychiatric services

Mental health professionals and support staff were invited to complete a questionnaire about their experience of using videoconferencing. Our hypotheses were that mental health professionals in the UK do not have access to videoconferencing and do not believe that videoconferencing is appropriate for their work. Of the 134 people who completed and returned a questionnaire, 78 worked in deaf mental health services and 56 worked in general mental health services. The majority were nurses (n = 33) or psychologists (n = 30). A total of 109 respondents (81%) knew what videoconferencing was, but only 16 respondents (12%) had ever used it. The majority of the 32 respondents who knew the location of their nearest videoconferencing facility said that it could be accessed in less than 30 min. The 16 people who had previously used videoconferencing identified four different benefits of videoconferencing and eight different drawbacks. We conclude that mental health staff did not have adequate knowledge of, or access to, videoconferencing.

Community Mental Health Teams' perspectives on providing care for Deaf people with severe mental illness

Background: Deaf sign language users encounter many barriers to accessing local services and receiving appropriate help and treatment. As a result Deaf people with serious mental illness can fall through the net of service provision.Aims: To identify and explore the issues involved in providing care for Deaf people with serious mental health problems from the perspective of community mental health teams (CMHT).Method: Eight focus groups were used to explore perceptions and experiences of providing care for this population. Discussions were recorded and transcribed verbatim and analysed using thematic analysis. Data analysis was supported by ATLAS-ti, (Scientific Software Development, ) a software package for coding and organising qualitative data.Results: Five key themes were identified: (1) CMHT lack of skills/knowledge/resources, (2) Communication difficulties, (3) Distance of specialist Deaf services, (4) Joint working between CMHT and specialist Deaf services, and (5) Issues specific to Deaf patients. Findings are discussed in the context of implications for improving the access and provision of care for Deaf people with severe mental illness.Conclusions: CMHTs frequently feel ill equipped to provide care for Deaf patients with severe mental illness. Implications require ongoing attention to ensure a more collaborative and efficient continuity of care.Declaration of interest: The first author is funded by The London Consortium for Specialist Deaf Mental Health Services who also fund the Deaf Enhanced Support Team (DEST). The second author is employed by South West London and St George's Mental Health NHS Trust at National Deaf Services (NDS) (of which DEST is a part) supporting clients funded by both the London Consortium and other Primary Care Trusts nationally.