Mental Health and Deafness

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 433

Current guidelines indicate that therapeutic interactions must be in the client's primary language. This article addresses the ethical dilemmas faced by monolingual clinicians and researchers who must assess the foreign language competence of an interpreter. Guidelines are proposed for assessing language competence of staff in clinical and research settings. Las directrices actuales indican que la interaccion terapeutica debe tomar lugar en el primer idioma del cliente. Este articulo trata 10s dilemas eticos que confrontan 10s clinicos e investigadores monolingues que tienen que asesorar la competencia linguistica de un interprete. Se proponen directrices para el asesoramiento linguistico de personal en escenarios clinicos y de investigacion. n the United States, clinicians and researchers increasingly interact with clients who have limited English skills. Yet few mental health service pro-I viders and researchers in the United States are skilled in the client's first language (Sodowsky, Kuojackson, Richardson, & Carey, 1996). A survey of staff at university counseling centers approved by the American Psychological Association (APA) found that 43% had no service providers who spoke a language other than English (Sodowsky et al., 1996). Hence, when individuals for whom English is a second language attempt to access mental health treatment, language may become an obstacle to receiving quality service (Santiago-Rivera, 1995). Federal law (Title VI of the Civil Rights Act of 1964) requires organizations and individuals who are recipients of federal financial assistance from the Department of Health and Human Services to ensure that persons of limited English proficiency have meaningful and equal access to benefits and services (US. Department of Health and Human Services, 2000). In addition, the APA guidelines (1993) for ethical practice indicate that therapeutic interactions must

Purpose: Individuals who lack proficiency in the dominant language of their region experience difficulty accessing healthcare and exhibit poorer health outcomes. Utilization of professional interpreters can improve health services and outcomes for this population. Most existing studies focus on medical settings, with very little research about language barriers in rehabilitation services such as occupational and physical therapy. The purpose of this study was to explore experiences of English-speaking rehabilitation clinicians working with limited English proficient (LEP) patients, as well as LEP patients receiving rehabilitation services. Methods: A qualitative study was conducted involving four focus groups with seven Spanish-speaking patients and 13 primarily English-speaking occupational and physical therapy clinicians. Transcripts and field notes were analyzed using directed content analysis. Results: Time and resource constraints, session demands, environmental factors, previous experiences, and patient characteristics influenced clinicians' decisions about whether to use professional interpretation, rely on untrained interpreters, or go without interpretation. Clinicians discussed both challenges and joys of working across language barriers. Patients reported minimal experiences with, and expectations of professional interpretation in rehabilitation, instead describing clinicians' attempts to "get by" with limited non-English language skills. Conclusions: Findings highlight unique considerations for language access in rehabilitation compared with other settings. These findings inform structural, process, and outcomes recommendations and changes in practice guidelines to improve language access in rehabilitation services. ä IMPLICATIONS FOR REHABILITATION Rehabilitation encounters present unique challenges for language interpretation services that require creative technological, procedural, and structural solutions. Technological solutions include flexible and mobile telecommunication devices, such as headsets, which allow real-time interpreting without interfering with treatment processes. Procedural solutions include establishing a systematic mechanism for recording patients' language needs, creating a standard and seamless protocol for clinicians to obtain language supports, and hiring trained interpreters who are familiar with rehabilitation jargon. Structural solutions include budgeting for interpreter services, sponsoring trainings for staff and clinicians, and adjusting clinicians' workload and expectations to allow greater time and flexibility to meet patients' language needs.

1. Can there be meaningful work in a counseling session when the client must either use a deaf interpreter or a foreign language translator? The answer hinges on developing a common understanding of what is meant by “meaningful work. It is our view that the answer is a qualified, “yes, but…” Before addressing the main issue, it is important to clarify some terms. “Deaf interpreter ” is misleading. There are such people as “deaf interpreters”, but they are not whom we suspect the inquirer is asking about. Deaf interpreters are people who are themselves deaf and by virtue of their native fluency in American Sign Language and understanding of dysfluent language use are able to function as intermediate interpreters, relaying message between a deaf consumer with minimal or dysfluent language skills and a secondary interpreter working between English and American Sign Language. An interpreter is a person who works between the spoken (or in this case signed) forms of two languages providin...

Many deaf individuals comprise a unique cultural and linguistic minority group. This article reviews the current research literature related to the evaluation, diagnosis, and treatment of culturally Deaf individuals suffering from mental disorders. Appropriate psychiatric assessment and treatment requires that clinicians be sensitive to issues of language and differences in social norms and cultural values. Emerging trends in research indicate greater diagnostic specificity and a broader range of diagnoses being assigned in services that are specialized for the treatment of deaf people with mental health issues. Culturally sensitive evaluation and treatment involves a thorough assessment of language modality and language fluency, deafness/audiological history, and cultural identification. Failure to consider these factors during the mental status exam can lead to misdiagnosis. Important issues that confound differential diagnosis and psychiatric treatment of the deaf population are highlighted and discussed. Recommendations for the provision of culturally and linguistically appropriate care are provided.

The Deaf Community is increasingly aware of the possibility of receiving professional help in coping with normative developmental tasks as well as with more complex emotional and mental difficulties. This is partly thanks to the development of services that are accessible to this population and the introduction of sign language interpreters into the therapy room for deaf people who know sign language. Although the introduction of interpreters has greatly enhanced communication between the therapist and the recipient of therapeutic services, all three participants must contend with the unique dynamics of the triad thus formed. Using various models, including Bowen’s model of the dynamics in a triad, this theoretical article explores from three perspectives the dynamics that may develop in individual therapy of deaf people: the creation of coalitions as each of the three individuals examines the relations of power and control in the room; coping with the feeling of increased exposure ...

We conducted an interpretative phenomenological analysis of five counseling students' experiences collaborating with American Sign Language-interpreting students during counseling practice sessions. Themes were identified in developmental domains of counselor self-awareness, counseling relationship, and advocacy interventions. Interdisciplinary collaboration led students to address cultural deficiency models and increase multicultural competency and efforts in social justice.

Fagan Robinson, Kelly. Chapter 9: 'The Form that Flattens'. in Parkhurst, A; Carroll, T, (eds.) Medical Materialities: Toward a Material Culture of Medical Anthropology. CRC Press, London, UK. (2019).

This chapter examines the ways that deaf-centred authority, or ‘DEAFness,’ is diminished by contact with the mono-linear speech-text narrative formats of UK institutions, particularly when deaf people are written into/onto public sector paper forms. Using ethnographic data derived from ‘PIP’ (Personal Independence Payment) form-filling at a UK deaf-centric charity, the author presents the ways that one advocacy client is required to alter her 5D way-of-being to suit a 2D textual form. It focuses on a form called ‘How Your Disability Affects You,’ a crucial proof-collection step in the PIP claiming process. The ‘Affects You’ form requires that claimants attempt to contain the ineffable stuff of ‘long-term adverse effect’ of disability within the rigid material form of text-on-paper. The author argues that such forms fail to capture the divergent modalities and affordances present in this capturing process, and that this exchange ultimately generates insurmountable communicative fault-lines due to embedded differences in knowledge-making processes between deaf, sign language using claimants and the institutions that might support them. Especially for people who write with and through their bodies in 5 dimensions, reduction to text is proven to dangerously oversimplify communication of health, ultimately flattening underlying DEAF ontology.

About five percent of the American population suffer some degree of hearing loss while 400,000 Americans are classified as deaf. Generally given less-than-adequate education, these people are forced into the lower socioeconomic levels of society and frequently isolated from the hearing world by an inherent communication barrier that serves only to deprive them further of social interaction and elevation. The social worker called upon to counsel a deaf person often finds that the communication barrier may well be the first and foremost problem to overcome before rehabilitation of the deaf client can proceed. Unindoctrinated in the esoteric communication systems of the deaf, the social worker may ultimately realize that the services of a competent interpreter are necessary. This paper points up some of the communication problems arising in a social worker's relationship with the deaf client in the four service delivery systems highlighted in the NASW Symposium. 1) Juvenile and criminal justice: Thirty-eight states have no legal provisions to require the employment of an interpreter in court cases involving deaf persons. In addition, courts all too often press into service interpreters who may otherwise be well qualified but who have no knowledge or expertise in the peculiarities of legal interpreting. 2) Health and mental health: Adequate health and mental health opportunities are only now being afforded the deaf, but many deaf people fear to take advantage of the services offered because they have insufficient communication with the doctors and counselors. 3) Public education: The very systems that are given the responsibility of preparing deaf children for their future lives frequently deny those children their basic human rights to communicate with their natural language—American Sign Language. 4) Employment: Not only discriminated against in employment but many times rejected for job training and counseling to secure good jobs, the deaf become victims of a vicious cycle perpetuated due to a lack of proper utilization of interpreter services.

This study examines healthcare professionals' perceptions of interpreted interactions and how interactional dynamics can be affected by the presence and actions of an interpreter. Discussion of the qualitative data generated in this study with two theoretical models that provide a useful means of exploring the effectiveness of interpreter actions. The synthesis of personal and social expectations and contextual factors within the concepts of social networks and rapport management (Spencer-Oatey, 2008) usefully mirror the complexity of interpersonal and contextual elements within interpreted interactions. These theories relate to qualitative data generated through interviews with a range of healthcare practitioners, including those practicing in primary healthcare and specialist hospital settings. These data provide insight into the consequences of interpreter behaviors and the impact that use of different interpreting strategies may have on healthcare professionals. Discussion of the data covers a range of issues relating to interactional dynamics in this specialized domain with particular focus on the perceived value of interpreter continuity, how dynamics alter in interpreted interactions, the impact of specific interpreting strategies such as consecutive/simultaneous mode, and the use of first or third person when interpreting from signed language into spoken language.

A review of group literature, much of which is anecdotal or theoretical, revealed that coleadership has been a common practice in training and therapeutic settings for well over 50 years. Careful examination of group practice reveals a surprisingly small amount of empirical evidence to support what apparently is a widely practiced method for the training of group leaders. However, the anecdotal support of group coleader practice is impressive if not convincing. That scholarly work is summarized in this article, and research implications for coleader practice are discussed as they relate to counselor preparation.

Problems exist in identifying and treating deaf "survivors" of child sexual abuse.  Even once they are identified, there are still problems in effectively applying existing regimens of therapy to this special population.  While mainstreaming the deaf person into society seems to be the wave of the future, and there are positive aspects to this, careful consideration, respect, and acknowledgement must be given to the special culture of the deaf person.  Employing existing therapeutic methods, with only the adjustment of supplying an interpreter for the Deaf, may not be enough.

Five professional counselors share insights and considerations for increasing cultural competence and working effectively to empower Deaf clients. 
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Recent research suggests that Deaf people experience poorer physical and mental health than hearing people, and that Deaf people find it difficult to access services. Local services need to be aware of their local communities in order to provide and plan services. We designed a survey to find out about local Deaf people’s experiences of health and social care.

We found that although some Deaf people have good experiences of health and social services, a lot of Deaf people experience difficulties. These difficulties are not new. The problems described in the research literature also apply to Deaf people living in Nottinghamshire.

This paper primarily covers ethical issues unique to group counseling by describing the aspects of groups as well as expounds on the characteristics of the impact that it has on maintaining ethical standard in the group setting. The paper utilizes peer reviewed journal articles and manuscripts specifically written to address ethics in psychotherapy as support of its findings. This paper compares the extent of ethical issues in groups to ethics for individual counseling as well. Additionally, this paper provides several examples of groups, their characteristics and why group therapy is a better choice for an individual over individual therapy.

Mental health services in many countries undervalue the special needs of people with auditive disorders. The diagnosis and treatment of mental health issues in this group of people, however, requires special skills in communication and knowledge of language and, relevant medical, psychosocial and cultural issues related to the auditive disorder. The great variation between these aspects complicates the psychiatric diagnostic process. In addition, there is a remarkable diversity of psychiatric syndromes and special target groups; these include deaf and hard of hearing patients, deaf-blind patients, mentally retarded patients, patients with brain damage, immigrants, forensic patients, patients with special medical problems and patients who have been physically and sexually abused.In several European countries specialised services have been developed with multidisciplinary teams. These teams observed difficulties in the diagnostic process and classification. Neither were psychiatric and psychological scales reliable nor validated, because they needed to be adapted to the language skills of the patients. Symptoms such as auditive hallucinations presented differently. In special causes of deafness such as prenatal Rubella, special symptoms occurred.In this lecture, an overview of these diagnostic problems will be presented illustrated with case-histories. A research project into the validity of screening lists for mental disorders and autism in mentally retarded deaf people will be discussed.

Researchers have reported limited accessibility to mental health services and ineffective treatment for individuals who are deaf. Others have attributed the lack of accessibility and ineffective treatment to communication barriers between therapist and client, resulting in poorer therapeutic outcomes. Less information is available on the efficacy of treatment among deaf individuals in counseling, with or without an interpreter.

In this paper we review the construct, or idea, of intellectual disability (ID) in relation to working with prelingually deaf people. Intellectual disability can sometimes be missed as a contributory factor to a deaf person’s mental health difficulties. Despite some significant criticisms of the diagnosis or categorisation of intellectual disability, this in many countries acts as a gatekeeper to specialised services and has legal implications. There are a number of issues to be considered in the process of an assessment which can influence the outcome. An awareness of these criticisms and issues are helpful when considering how an assessment of intellectual disability is adapted when working with a deaf person. We briefly review the high incidence of additional disabilities that are often concomitant with a cause of deafness and highlight the difficulty in assessing deaf adults in comparison with deaf children. We end with a discussion of how an assessment of intellectual disability can be carried out with a deaf person that is equitable in terms of that of a hearing person.

Background
Most depression screening tools in Thailand are lengthy. The long process makes them impractical for routine use in primary care. This study aims to examine the reliability and validity of a Thai version Patient Health Questionnaire (PHQ-9) as a screening tool for major depression in primary care patients.
Methods
The English language PHQ-9 was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the pre-final version, as well as final adjustments. The PHQ-9 was then administered among 1,000 patients in family practice clinic. Of these 1,000 patients, 300 were further assessed by the Thai version of the Mini International Neuropsychiatric Interview (MINI) and the Thai version of the Hamilton Rating Scale for Depression (HAM-D). These tools served as gold-standards for diagnosing depression and for assessing symptom severity, respectively. In the assessment, reliability and validity analyses, and receiver operating characteristic curve analysis were performed.
Results
Complete data were obtained from 924 participants and 279 interviewed respondents. The mean age of the participants was 45.0 years (SD = 14.3) and 73.7% of them were females. The mean PHQ-9 score was 4.93 (SD = 3.75). The Thai version of the PHQ-9 had satisfactory internal consistency (Cronbach's alpha = 0.79) and showed moderate convergent validity with the HAM-D (r = 0.56; P < 0.001). The categorical algorithm of the PHQ-9 had low sensitivity (0.53) but very high specificity (0.98) and positive likelihood ratio (27.37). Used as a continuous measure, the optimal cut-off score of PHQ-9 ≥ 9 revealed a sensitivity of 0.84, specificity of 0.77, positive predictive value (PPV) of 0.21, negative predictive value (NPV) of 0.99, and positive likelihood ratio of 3.71. The area under the curve (AUC) in this study was 0.89 (SD = 0.05, 95% CI 0.85 to 0.92).
Conclusion
The Thai version of the PHQ-9 has acceptable psychometric properties for screening for major depression in general practice with a recommended cut-off score of nine or greater.