NASW-NJ FOCUS Advance Publication Article

When I was in my early 20’s, a series of overwhelming events led me to seek out a therapist. A quick Google search turned up four providers in my area who could see me as early as the next week. I submitted my information, my appointment was confirmed, and a few days later I was sitting across from the woman who would help me find the courage to leave an abusive ten-year relationship. For most, especially those who are deaf, finding a therapist is not that easy. As the search begins, many questions arise. Will this therapist know about Deaf culture, provide the interpreter requested while scheduling, or feel uncomfortable working with me because of our auditory differences?

The deaf community suffers from mental health issues at about twice the rate of the general population and encounters a great deal of problems accessing much needed mental health services.1 Communication barriers, mental healthcare providers (MHP) who lack cultural competence, and a history of negative interactions with hearing doctors often prevent the deaf community from seeking out mental health services (MHS). Additionally, lack of familiarity with the social and cultural norms of deaf patients causes conditions such as mood disorders to be frequently under diagnosed in the deaf community. 2 For example, a deaf person may stomp their foot to get the provider’s attention. Though this isn’t an indicator of anger or aggression, it may be perceived as so by someone unaccustomed to this very appropriate attention getting practice.

A Call for Change: Barriers to Mental Health Care in the Deaf

Community

By Megan Warshauer, Fairleigh Dickinson University, MSW Class of 2024

Additionally, unlike voiced language, signers cannot express volume, intonation, or tone that alters or affects the meaning of spoken words. Instead, they may use exaggerated facial expressions and rely on “tone of face.” This may be confused as a symptom instead of as a parameter of American Sign Language (ASL) referred to as “non-manual markers.” Regardless of the misconstruing of cultural norms, there is a great need for ASL interpreters who are trained to work in these settings. There are certain concepts or idioms of distress that may be challenging for an interpreter to convey accurately without significant expertise. Effective communication and cultural understanding is critical in healthcare settings where miscommunication may lead to misdiagnosis and improper or delayed medical treatment. 3

The Right to Mental Health for Individuals who are Deaf or Hard of Hearing Act (A5600/S4007) was introduced in the New Jersey State Legislature on June 15, 2023 and focuses on the specialized needs of deaf and hard of hearing communities— an communication barriers and cultural needs. The legislation finds and declares it essential that consumers who are deaf or hard of hearing have access to appropriate MHS that are provided in the primary communication method used by the individual. The bill recognizes that services should be provided by MHP who are fluent in the individual’s primary method of communication, understand the unique nature of being deaf or hard of hearing, and can collaborate skillfully with interpreters when they

are needed. To ensure service delivery, the Division of Mental Health and Addiction Services (DMHAS), in consultation with the Division of the Deaf and Hard of Hearing (DDHH), summarizes the need for adequate funding to all culturally affirmative and linguistically appropriate MHS, as well as incentives to promote the recruitment and retention of certified MPH. There is a plan in place to employ a deaf services coordinator, who will be responsible for overseeing the implementation of these services, while establishing a certification process for professionals trained to work in this capacity. This bill is currently pending in the New Jersey Assembly Human Services Committee, and as such, it is the perfect time to show support for it.

Passing this bi-partisan legislation would begin to address the inequities deaf people experience when accessing MHS. It is, therefore, crucial for your representatives to support this initiative. Contact your legislators and emphasize the importance of interpreters to ensure that all users of American Sign Language experience effective, quality communication. You can also show your support by visiting the National Association of the Deaf’s website (www.nad.org) to print and send a variety of letters that promote equal communication and access to suitable mental healthcare for the deaf community. It’s imperative that MHP employ interpreters for their deaf patients. In one study, failure to provide requested interpreter services resulted in 82% of patients being unable to understand their diagnosis, 70% not understanding the guidelines for their treatment, and 63% choosing to discontinue care. 4 Under Title III of the Americans with Disabilities Act (ADA), if you feel that you need an interpreter in order to understand what your healthcare provider is telling you, then the healthcare provider is required to provide you with one. The scarcity of trained interpreters, the monetary challenges of budgeting for communication services, and poor awareness of the needs of the deaf population all present themselves as challenges to this provision. Effective communication is crucial because language discordance in healthcare reduces healthcare satisfaction, diagnosis abilities, and treatment adherence. 5 In the absence of an interpreter, simple accommodations like adequate lighting, a face mask with a clear panel to facilitate lip reading, or having a pen and paper handy in the absence of an interpreter could deeply benefit discourse between the deaf patient and the provider.

As I reflect on my education in the field of social

work, I’m compelled to refer to the profession's primary mission: “to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable and oppressed.” 6 Mental healthcare is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships, and shape the world we live in. Failure to provide access to culturally affirmative and linguistically appropriate MHS to the deaf community denies them dignity, self-determination, and hope. The marginalization of this group is unethical, prejudicial, and in violation of the United Nations Universal Declaration of Human Rights. I implore you to recognize that deaf rights are human rights. The health care system has largely failed to both insure and provide accessible language services and health information for many deaf individuals. Denying the deaf community competent mental healthcare providers is denying them basic human rights and furthering inequalities faced by an often overlooked population. Though we can’t snap our fingers and set things right in the world of mental healthcare for the deaf, we can recognize there are major obstacles preventing this community from receiving the services they (like everyone else) are entitled to, and advocate for change.

References:

1 Batten, G., Oakes, P. M., & Alexander, T. (2013). Factors associated with social interactions between deaf children and their hearing peers: A systematic literature review. Journal of Deaf Studies and Deaf Education, 19(3), 285–302.https://doi.org/10.1093/deafed/ent052

2 Black, P. A. (2006). Demographics, psychiatric diagnoses, and other characteristics of North American deaf and hard-of-hearing inpatients. Journal of Deaf Studies and Deaf Education, 11(3), 303–321. https://doi.org/10.1093/deafed/enj042

3 US Department of Justice. (2023). ADA Business BRIEF: Communicating with People Who Are Deaf or Hard ofHearing in Hospital Settings. https://archive.ada.gov/hospcombrprt.pdf

4 Santos, A. S., & Portes, A. J. (2019). Perceptions of deaf subjects about communication in primary health care. Revista Latino-Americana de Enfermagem, 27. https://doi.org/10.1590/15188345.2612.3127

5 McKee, M. M., Barnett, S. L., Block, R. C., & Pearson, T. A. (2011). Impact of communication on preventive services among deaf American Sign Language users. American journal of preven-tive medicine, 41(1), 75-79.

6 National Association of Social Workers. (2017). NASW code of ethics. Retrieved Month, Day, Year, from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English