Deaf Community and Mental Health Care

The deaf community struggles daily with stigma, prejudice, and communication, but that's not all: medical studies have found that deaf people suffer from mental health issues at about twice the rate of the general population, and also have real problems accessing needed mental health services.

The mental health issues common in the deaf community include depression, anxiety and severe illnesses such as bipolar disorder and schizophrenia.

Mental illnesses are compounded in the deaf community by difficulties communicating with care providers — researchers have found that lip-reading isn't adequate, interpreters who know sign language are scarce, and many diagnostic tools depend on knowledge that's not common among those who are deaf.

Mental Health in the Deaf Community

Lots of people have some hearing loss — between 15% and 26% of the population, according to one study. But it's a different issue to be profoundly deaf, especially if you became deaf before you had a chance to learn spoken language. About seven in every 10,000 people fall into this category, and most regard themselves as a cultural minority that uses sign language instead of spoken language.

Struggles to function in a hearing world can lead to mental health issues. In one study involving hearing-impaired individuals, some 41% said they believed that communication problems coupled with family stresses and overall prejudice could cause or contribute to suicidal depression, substance abuse or violent behavior in some cases.

Other studies have found that about one-quarter of deaf students have learning difficulties, developmental delay, visual impairment, or autism. Deaf children who have trouble communicating with their families are four times more likely to be affected by mental health disorders than deaf children who have few or no problems communicating with family members.

Bullying of deaf children also may be common at school, and deaf boys and girls are much more likely to be victims of sexual assault.

Communication Needed, but Scarce

Mental health services are difficult for deaf people to access. One small study involving 54 people found that more than half hadn't been able to find mental health services that they, as deaf people, could use.

In addition, psychiatric conditions such as mood disorders are frequently under-diagnosed in the deaf community, in large part due to communication difficulties that include:

• few experienced interpreters between English and sign language
• problems in translation between spoken and sign language
• differences in how deaf people display feelings and perceive mental health

Reading and writing aren't an adequate substitute for spoken language in this context. Hearing loss interferes quite a lot with vocabulary, and so many deaf high school graduates read and write at a grade-school level.

In addition, lip-reading is far from 100% accurate — the average deaf adult can lip-read only 26% to 40% of speech.

How to Access Mental Health Services

Because of these communication problems, the majority of participants in one study of deaf individuals found that the deaf preferred a deaf professional to provide them with mental health services. In addition, experienced interpreters are very important ... but they're only the first step in helping the deaf access adequate mental health services.

Issues with time are important in diagnosing mental disorders — questions such as "Have you experienced difficulty sleeping for one month or more during the past year?" or "for six months or more?" are common. However, these concepts are hard to describe in sign language, as are phrases such as "feeling on edge."

Finally, questions in diagnostic interviews that rely on the knowledge of what it's like to hear pose real difficulties: How does one ask someone who's been deaf his whole life if he has been "hearing voices"?

Differences Important to Recognize

Mental health providers must also learn how to recognize and address the differences in how a deaf individual displays feelings and expressions from those who are hearing.

For example, someone who is deaf may pound on the floor to get attention. While this is considered aggressive by those who can hear, it is actually quite accepted and normal within the deaf community.

Also, while strong emotional displays are pretty much frowned upon in the hearing community, members of the deaf community count on the vivid expression of emotion to convey meaning. As a matter of fact, one study found that clinicians often labeled rapid signing as a symptom of psychotic behavior rather than the change of mood that was actually indicated. And, there are few signs within sign language that can account for subtle changes in mood.

What Can Be Done to Help the Deaf Community?

A research study of cultural and linguistic barriers to mental health found that many deaf people have a fear of being incorrectly committed because they are unable to communicate with the staff. One participant is quoted as saying, "Even if I were just asking for directions at the information desk [of a psychiatric hospital], miscommunication could lead to my being committed mistakenly ... I don't want to go there, even for a visit!"

This study further indicated that participants felt professionals erroneously consider a nominal level of communication to be adequate. One practitioner looked at bipolar disorder in patients who had become deaf before they learned to speak, and found that those making diagnoses often emphasized appearance over documented symptoms and other information.

While it will be difficult to solve these problems, some solutions are possible. Hearing-impaired people should be encouraged to consider careers in the mental health field, and mental health professionals should secure more translators to work with the mentally ill.

The National Association of the Deaf notes that deaf people have the right to push for referrals to mental health professionals who have experience working with those who are deaf or are hard of hearing. The organization also says that deaf people have the right to communicate "in the language and mode of communication that is effective for you," and to clearly understand the diagnosis and recommendations for their treatment.

Clinicians who have little or no experience working with the hearing-impaired should use extreme caution and seek second opinions when diagnosing the deaf. In addition, research and effort are needed to bridge the language barriers which now make it so difficult to communicate.