Mental Health Mental Health Services for People Services for People Who are Deaf in New Who are Deaf in New Hampshire Hampshire 2008 MIAB Conference Cynthia L Whitaker, PsyD October 31, 2008
Dec 25, 2015
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: [email protected]