In honor of Mental Health Awareness Month, Cloudbreak Health is spreading awareness on mental health access for the Deaf and hard of hearing community. Our language access solution, Martti by Cloudbreak, delivers video remote interpreting services in over 250+ languages, including American Sign Language (ASL).

Society rarely discusses the mental health crisis within the Deaf and hard of hearing community when examining healthcare access. However, the situation threatens the overall health and wellbeing of Deaf and hard of hearing people. The community faces mental illness at twice the rate of the general population, often attributed to communication difficulties. And yet, only 2-10 percent of Deaf and hard of hearing people with mental illness receive mental health care (Cabral). The lack of access, education, and services threaten the community’s health.

Barriers to Care

The Deaf and hard of hearing community is a cultural and linguistic minority with variations in the type and severity of hearing loss (Pertz). Researchers estimate that 35 million people in the United States identify as having some degree of hearing trouble, ranging from having a little trouble hearing to profound deafness (Galludet). Of the 35 million, an estimated 300,000-500,000 use American Sign Language (ASL) (Mitchell). Despite the large need for interpretation services, the United States only has about 16,000 ASL interpreters (Nimdzi).

Language Comprehension

Members of the Deaf and hard of hearing community face considerable barriers to mental health services, the greatest barrier being language. Many don’t realize that ASL is a different language than English, and those who use ASL are not always fluent in written or spoken English. For those who practice lip-reading/speech-reading and are familiar with spoken language, only 30–45% understand spoken English (Alexa). As a result, community members vary in their ability to comprehend mental health resources in English. This severely limits education on the topic and makes it difficult to learn where to access help.

Base Knowledge

With mental health resources rarely reaching Deaf and hard of hearing people, the community often lacks basic comprehension of the topic. In fact, one study identified a deficiency in Deaf and hard of hearing individuals’ ability to understand the term “depression” in ASL or English (Cabral). Misconception and ignorance of mental health create a crumbling foundation for Deaf and hard of hearing people to first recognize mental illness and then access needed services.

Stigma

Inadequate education on mental health also leads to misunderstanding of mental illness. The community still heavily stigmatizes those with mental illness, labeling them “crazy”. Some cite that because the community is so small, information spreads quickly about others’ mental illness. Patients worry that an interpreter will tell others in the community and negatively label the patient (Cabral). As a result, many abstain from receiving help. Fear and stigma hamper an individual’s agency in seeking mental services.

Mental Health Providers

Further complicating the problem, mental health providers rarely understand ASL or Deaf and hard of hearing culture due to lack of exposure. Providers unable to effectively communicate with patients fail to develop a trusting relationship, learn patient’s symptoms for diagnosis, and explain care plans. Cultural gaps limit providers’ grasp of Deaf and hard of hearing people’s feelings and emotions. For example, Deaf and hard of hearing people often use strong emotional displays as part of ASL. A misunderstanding of a Deaf or hard of hearing person’s typical emotional expression could lead to misdiagnosis (VeryWellMind).

Some providers claim caring for Deaf and hard of hearing patients is difficult and time-consuming. Providers cited accessing an interpreter as being the most time-consuming part of treating a Deaf or hard of hearing patient. Requesting an interpreter to be physically in the same place as the patient and provider can take minutes to hours. Providers unwilling to wait simply do not call an interpreter. One study found that only 17% of Deaf signers received a medical interpreter (Pertz). By not utilizing interpretation services, doctors fail their patients and perpetuate the language barrier.

Even when providers communicate successfully with patients, they typically do not cater their care plan to the specific experience of Deaf and hard of hearing people. This is due to insufficient research into special psychotherapy practices designed for Deaf and hard of hearing patients or their outcomes (Munro). The ensuing services and care plans are often ill-suited to the Deaf and hard of hearing community.

Poor Health Insurance

Insurance is yet another barrier to care for the community. Mental health care carries a heavy financial cost to patients. The prohibitive cost prevents many Deaf and hard of hearing people from seeking out mental health care providers. Additionally, people within the Deaf and hard of hearing community often struggle financially and depend on Medicaid. Researchers attribute low socioeconomic status to low education attainment due to language barriers (Emmett). Federal insurance provides fewer reimbursements to individuals as compared to private insurance, adding another layer of financial burden to the patient (Blanchfield).

Solutions

The barriers to mental health services for the Deaf and hard of hearing community can be overcome. Both long- and short-term action must be taken to provide better mental health care to the community.

Long-term

Long-term, we need an increased number of Deaf and hard of hearing providers who not only use ASL but truly understand the community at a personal level. A majority of Deaf and hard of hearing patients stated their preference to receive mental health care from providers who used ASL and had long-term experience with the community (Cabral). When providers understand the Deaf and hard of hearing community, patients engage in preventative healthcare more often (Moreland).

Short-term

In the short-term, we must have more interpreters certified to interpret mental health services. While medical training takes years, the mental health training is one week long. This training ensures interpreters understand the cultural and psychological aspects of working with mental illness in the Deaf and hard of hearing community. A qualified interpreter can properly advocate for the patient and assure correct transfer of information. When interpreters are used with providers, patients saw improved mental health care outcomes (MacKinney).

Conclusion

This issue can no longer be ignored, especially as the COVID-19 pandemic exacerbates the number of people with mental illness by over 28 percent (Statista). Providers must proactively educate themselves and their patients, spread information in an accessible way, and use interpreters for every patient who needs it. The Deaf and hard of hearing community deserves comprehensive mental health care services that address their specific needs.

References

https://link.springer.com/article/10.1007/s10597-012-9569-z

https://academic.oup.com/jdsde/article/23/3/240/4942212

https://www.gallaudet.edu/office-of-international-affairs/demographics/deaf-employment-reports/#:~:text=Across%20all%20age%20groups%2C%20approximately,over%2065%20years%20of%20age.

https://www.gallaudet.edu/documents/Research-Support-and-International-Affairs/ASL_Users.pdf

https://www.nimdzi.com/asl-interpreting/

https://academic.oup.com/jdsde/article/21/1/1/2404217

https://www.verywellmind.com/mental-health-issues-in-the-deaf-community-380577

https://academic.oup.com/jdsde/article/13/3/307/376442

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466103/

https://www.audiology.org/sites/default/files/journal/JAAA_12_04_03.pdf

https://journals.lww.com/academicmedicine/Fulltext/2013/02000/Deafness_Among_Physicians_and_TraineesA.27.aspx

https://www.statista.com/chart/21878/impact-of-coronavirus-pandemic-on-mental-health/