Mental Health and Deafness in New York's Capital Region

Purpose: There is evidence that deaf and hearing people use mental health services differently (DeVinney, 2002; Steinberg et al., 1998), however, little research has been conducted to clarify the disparity (Steinberg, 1991). It is clear that persons with hearing loss are far less likely to seek mental health services than the general population; it is estimated that deaf people seek mental health care at rates less than 20% the rate of hearing persons (McEntee, 1993; Pollard, 1994). The coinciding disparity in effective mental health services is problematic when considering research that suggests that the prevalence of mental disorders in the deaf is at least equal to the general population (McEntee, 1993; Pollard, 1994). The objective of the study was to explore issues involved in providing mental health services for deaf people in the capital district region of New York. The particular issues, which may be relevant to other regions of the country are similarly challenged.

Methods: A focus group was employed as a first step to addressing regional concerns related to services for the deaf. Nine community stakeholders (5 deaf, 4 hearing) were identified via leaders in the local deaf community. The focus group was video-recorded and transcribed by a native signer. Facilitators addressed four primary mental health service domains: 1) practice-related methods currently in effect; 2) barriers and facilitators to achieving effective mental health services in the capital district area; 3) research-related interests of the participants; and, 4) service-level needs that may translate into policy recommendations.

Results: Barriers to effective mental health services for deaf people in New York's capital region were characterized by the fact that most mental health providers do not accept Medicaid. In addition, service providers are county based and referrals outside of one's county are refused. Moreover, most providers will not pay for an interpreter, even though it is required by the Americans with Disability Act. Participants also identified specific system-level as well as service-level needs. It was clear that an increase in the number of agencies employing clinicians fluent in ASL with a basic understanding of deaf culture and mental health would be the most direct way to improve services. Other suggestions included video teleconferencing, the development of consumer-run services, and continued advocacy for inter-county service collaboration. Ultimately, a detailed needs assessment is needed to attain the goal of providing specialized services for the deaf.

Conclusions and Implications: Our findings support the idea that communication issues are especially relevant for the deaf, particularly in therapeutic relationships (Briffa, 1999). This often-reported sentiment in the deaf community is reflected in reports that ineffective communication between a non-signing clinician and deaf client occurs more often than not (cf. Steinberg, 1991; Steinberg et al., 1998). Moreover, interpreters lacking knowledge about deafness and mental health contribute to inaccurate diagnostic evaluations. The group decided to organize an advocacy group in the region to begin lobbying for improved services. It was agreed that primary issues concern reimbursement for interpreter services and the inefficiency of county-based service delivery in New York State.