Medical practitioners need to provide culturally sensitive treatment to members of the deaf community with psychiatric disorders to ensure they are diagnosed correctly and receive appropriate treatment, says Wolters Kluwer Health.
The report was published in the March Journal of Psychiatric Practice. The authors reviewed the limited research literature available about the mental health care of deaf patients who communicate via American sign language (ASL) or gestures.
Communication strategies
Communication is challenging for deaf people who communicate in sign language or in gestures.
"Deaf individuals comprise a cultural and linguistic minority group within the United States, and culturally and linguistically appropriate psychiatric treatment must reflect these differences," according to Sarah A. Landsberger, PhD, and coauthors of the Indiana University School of Medicine, Indianapolis.
There are approximately 1.2 Americans with profound hearing loss. Some deaf people are unable to hear most sounds, even with assistive listening devices such as hearing aids. Some deaf people identify themselves as part of the deaf community, with a unique language – sign – and culture. Sign language is complex and complete with its own syntax, grammar and vocabulary. These deaf people do not think of their hearing loss as a disability.
"Ideally, clinicians most suited to working with the deaf population are those who are fluent in ASL, have had significant exposure to the deaf community, and understand deaf cultural values," Dr. Landsberger and co-authors wrote. Unfortunately, there are few mental health providers who have these skills.
Another option for mental health clinicians is to communicate via a sign language interpreter who has specialized training in interpreting in mental health settings. There are not many qualified interpreters available, so Dr. Landsberger and her collegues recommend specialized training for those who work in psychiatric settings.
Some deaf individuals never learned ASL and communicate mainly by mime, gestures, and invented signs known as “home signs.” In this case, a certified deaf interpreter who is fluent in ASL can assist the sign language interpreter by converting gestures into ASL.
Finding a Correct Diagnosis
Diagnosing mental illness in deaf people can be very difficult. For example, a key question clinicians ask to determine schizophrenia is whether a deaf person “hears voices.” This is a difficult concept to explain to deaf people who are deaf from birth. Another indicator is disorganized speech. Clinicians may mistake language deficits for symptoms of psychosis. Different types of psychotherapy also must be adapted to meet the needs of deaf patients.
"As with any cultural minority, providers should seek specific training and education to become culturally competent providers to deaf people," Dr. Landsberger and coauthors write. "At a minimum, clinicians who have large numbers of deaf patients in their caseloads should be knowledgeable about deaf culture and become fluent in sign language."
