Deaf Mental Health: Enhancing Linguistically and Culturally Appropriate Clinical Practice

Abstract

This chapter will focus on the factors that contribute to the health inequities of a unique, liminal community, namely the Deaf community. Defined as a minority community, both by language and by culture, members of this community experience health inequities differently from other minority communities. Research indicates that Deaf people find it more difficult to establish relationships with health and allied professionals, and to access mental health services because of discrimination, lack of understanding, and practical obstacles experienced within the health system. It is further reported that 80–90% of Deaf and hard of hearing people with severe and persistent mental illness are not accessing mental health services. The literature suggests a higher prevalence of mental health problems for those who are culturally Deaf than in the general population. The most common factor preventing access to services, including assessment, intervention, and follow-up, as well as to mental health prevention materials is inadequate communication. This chapter will explore how a unique form of oppression that relates to the oppression by hearing people of those who are deaf (i.e., audism, the notion that one is superior based on one’s ability to hear or behave in the manner of one who hears), results in health and mental health care disparities. The chapter will conclude with a discussion on recommended practices to facilitate effective engagement with members of this minority culture.

Appendices

Resources to Facilitate Successful Engagement with Deaf Service Users

Pre and Post Assessment Meeting with Interpreter

Checklist

When conducting any type of assessment with an interpreter, complete the following checklist.

Pre-session

Item	Check
The interpreter has explained his or her role.
I have explained the overarching purpose of the session to the interpreter.
I have explained the key principles and concepts of the meeting, treatment, or therapy to the interpreter.
I have shared the relevant facts of the client’s case for the purpose of accurate interpretation.
I have provided the interpreter with a copy of any assessment item(s) I plan to use.
The interpreter has highlighted areas of the assessment that they foresee may have linguistic or cultural difficulty.
I have provided an opportunity for the interpreter to calibrate to the language that I will use in the assessment or treatment. Calibrating refers to the process of adjusting to the language level, patterns, and idiosyncrasies of each individual in the communication exchange. Calibrating is an important part of maintaining the integrity of the meaning intended in each communication exchange

Post-session

Item	Check
I clarified with the interpreter any linguistic or cultural concerns that were raised in the meeting or session.
I asked the interpreter if they had any difficulties in translation or have any culturally relevant information that may influence my assessment.
If the Deaf person and staff person myself are satisfied with the interpretation, I inquired whether it is possible to book the interpreter for regular appointments.

Metro South Health, Queensland, Australia (2016, p. 60). Adapted and used with permission

Service Accessibility Considerations

Checklist

To improve the accessibility for Deaf people, complete the checklist.

Item	Check
Have I accommodated the communication needs of the Deaf person?
Have I ensured relevant staff knows how to book and engage an ASL English interpreter?
Do I, and all necessary staff, understand the role of a Deaf interpreter (DI)? If requested, do I know where and how to book a Deaf interpreter (DI)?
Have I planned for sufficient time to accommodate the purpose of the meeting (often two to three times the length of time without an interpreter)? Depending on the length of the meeting, have I confirmed with the interpreter service whether I will require more than one interpreter?
Does the setting have sufficient lighting to accommodate visual language users?
Does the setting have sufficient space to accommodate a Deaf interpreter (if requested), and ASL English interpreter in addition to the Deaf consumer and staff person(s)?
Does the institution have access to the necessary technology to facilitate communication between the Deaf offender and community supports in a way hearing offenders have access to telephone? This may include video conferencing, or video relay services for interpretation purposes.
If the institution has appropriate communication technology, is it in good working condition? Do all necessary staff know how to use the technology and facilitate access for the Deaf offender?

Metro South Health (2016). Metro South Addiction and Mental Health Services: Guidelines for working with people who are Deaf or hard of hearing, v. 3. (p. 61). Adapted and used with permission

Educational videos for working with Deaf ASL first-language users individuals

Deaf People in Medical Setting [Video file]. (2016). Retrieved from https://www.youtube.com/watch?v=NpyvD6_uzZ0 Time: 2:26

The Holley Institute: In-Service Training for Deaf Patients [Video File]. (2017). Retrieved from https://www.youtube.com/watch?v=hzzSZYbsRyM Time: 7:17

UC San Diego Health [Video File] (2015). Improving Health Communications with Deaf Patients. Retrieved from https://www.youtube.com/watch?v=Cr0I41ZCb2o Time: 4:46