[NYAPRS Enews] MHW: NASMHPD Addresses Tx Needs Of Deaf Pop. w/ Psych Disabilities

[Matt Canuteson]

NYAPRS Note: The National Association of State Mental Health Program Directors (NASMHPD) and the National Coalition on Mental Health and Deaf Individuals (NCMHDI) are taking up new efforts to collaboratively address the needs of people who are deaf and have psychiatric disabilities, people who have traditionally been underserved and underrepresented.

NASMHPD and NCMHDI are working on identifying and promoting research priorities, training, workforce development, and making use of technological resources. Both groups convened on August 7th and 8th  to identify action steps that can be done over the next 6 to 12 months:

• Organizing a research consensus conference to address common research goals.

• Developing a cost-effectiveness study or a study on how evidence-based practices that apply to the hearing population can or cannot be applied to the deaf population.

• Participating in SAMHSA and the National Institute of Mental Health (NIMH) advisory council meetings.

• Working with state officials to identify how many people in state mental health systems are deaf; Does the state have a mechanism for identifying sign language users? What are the demographics of the state’s deaf population? What services are currently provided/available?

 

NASMHPD Initiative To Address Treatment, Service Needs Of Deaf Population With MI

Mental Health Weekly August 17th 2009

 

With an eye toward advancing mental health treatment and access to services for the deaf population with mental illness, the National Association of State Mental Health Program Directors (NASMHPD) and the National Coalition on Mental Health and Deaf Individuals (NCMHDI) have embarked on an effort to address the needs of a population they say has traditionally been underserved and underrepresented.

 

NASMHPD and NCMHDI will work toward identifying and promoting research priorities, training and developing a workforce to understand and work with this population, and making use of technological resources. Both groups convened August 7-8 to identify incremental action steps that are doable, could impact the system and be done over the next six to 12 months.

 

“Many people don’t understand how isolated the community is,” Robert W. Glover, Ph.D., executive director of NASMHPD, told MHW. “We need to be much more culturally sensitive if we’re going to be supportive of their needs.” This population has traditionally not been well served in the public mental health system, said Glover.

 

The effort will be funded in part by the Substance Abuse and Mental Health Services Administration (SAMHSA), added Glover.

 

NCMHDI, a non-profit organization, was established in 2008 to provide leadership and support in the areas of public mental health and deaf and hard of hearing populations in the U.S. The Coalition is an affiliate of NASMHPD.

 

“The population of consumers who are deaf and mentally ill are not seen on the public radar yet,” said Candice M. Tate, Ph.D., president and chief executive of NCMHDI.

 

“There’s nobody knocking on the doors demanding they be servicing them, and if there is, their concerns are not being heard and responded to in an efficacious manner,” Tate told MHW.

 

In advancing the importance of treating the deaf population with mental illness it is important to bring to the table both state- and federal level administrators so that they will be informed and can work for positive change in a way that had not been done before, said Tate.

 

Tate, who is a licensed clinical psychologist, was 21⁄2 years old when her family noticed she had a hearing impairment. Tate noted that 35 years ago it was unprecedented to identify hearing loss that early in a child.

 

“Teaching me sign language was strongly discouraged in the belief that it would impede my learning English language,” said Tate, who was formally diagnosed as deaf when she was 16.

 

“NASMHPD’s strong interest in working with this population stemmed from its work in reducing seclusion and restraint,” said Meighan Haupt, associate to the executive director of NASMHPD, told MHW. The seclusion and restraint meeting last year hosted by NASMHPD included medical directors, deaf consumers, and those who direct mental health services for people who are deaf, and SAMHSA.

Action Steps

Suggestions Include:

• Organizing a small research consensus conference to address common research goals.

• Developing a cost-effectiveness study or a study on how evidence-based practices that apply to the hearing population can or cannot be applied to the deaf population.

• Participating in SAMHSA and the National Institute of Mental Health (NIMH) advisory council meetings.

• Working with state officials to determine how many people in state mental health systems are deaf. Potential topics might address: Does the state have a mechanism for identifying sign language users?; demographics of the state’s deaf population; and a description of the services provided.

 

There are more than 5 million deaf individuals in the U.S. who need mental health treatment every year, according to the report on the proceedings of the Expert’s Meeting on Deaf and Hard of Hearing Mental Health Systems hosted by NASMHPD last year.

 

Only about 2 percent of these deaf individuals receive appropriate treatment for mental illness due to barriers in the effective diagnosis of mental illness.

 

“Research is going to be one of our biggest goals,” said Tate. “We need to understand how DSM-IV TR diagnoses potentially manifest differently in the deaf population. What does a diagnosis look like?” Depression or schizophrenia can manifest differently in the deaf population than it would in the hearing population, she said.

‘Unique’ Culture

“The idea is that the deaf population has a unique culture, which has significant clinical implications, including over-and under-diagnosis based on differing manifestations of symptoms,” said Tate. “It’s important to show that there is a disparity in this group [in order] to initiate crucial research on how clinical symptomatology differs in deaf populations and develop evidence based practices and treatment specifically for this population.”

 

Regarding the deaf population as a whole, untrained hearing clinicians were likely to minimize the language differences of their clients, believing that an interpreter would be automatically capable of providing a 100 percent accurate translation, enough to provide an accurate diagnosis and treatment, she said.

 

Using professionals who are fluent in American Sign Language (ASL) is generally the most appropriate option in working with deaf consumers with mental illness, said Tate.

 

“Oftentimes deaf people were inadvertently committed to a psychiatric hospital when they did not have a diagnosis of severe mental illness at all,” Tate said. This created a fear and mistrust by the deaf population of the mental health field that still exists today, she added.

 

“Challenges from a system perspective are knowing that we do not have census data or survey results to determine how many are deaf and hard of hearing in the U.S.,” she noted. “Funding in the state system is typically based on population and numbers.”

 

Tate added, “It’s difficult to convey to administrators that funding is needed when you can’t define the population or show service disparities between hearing and deaf populations.” 

 

Underserved deaf populations are not covered by the Health Resources and Services Administration’s (HRSA’s) definition of underserved populations, said Tate. To that end, NCMHDI and NASMHPD will prepare a white paper to clarify the definition of HRSA’s medically under-served population to include the deaf community.

 

In the short term, the goal is to redefine this population as one covered by HRSA’s definitions, she said. “It should potentially open up a funding stream supported by HRSA,” Tate said. It would also be important to receive funding or resources in order to hire mental health professionals who can work with this population, she noted.

Collaborative Effort

Tate noted that the groups’ long-term goals for policy change will focus on examining telehealth, telemedicine and telepsychiatry as a viable resource. “A fully functioning telemedicine system, which can potentially provide needed services to the deaf community, can also be used for numerous other non-deafness related services,” she said.

 

For example, telemedicine can be used by specialty doctors for peer-to- peer consultation, by other minority populations to gain access to culturally appropriate professionals, or to provide services to rural populations and those that cannot travel far for medical reasons, said Tate.

 

It is important that the field know that there are cost-effective and practical ways to address this issue, Tate said. “If you don’t, there’s risk in not providing appropriate services, especially in today’s economy,” she said. “It’s very important that officials and the field realize that we are not pointing fingers at them.”

 

Tate added, “We want to work with them and meet on their turf and propose practical solutions,” she said. Our goal is to help states provide appropriate services that are not a drain on the system.”

 

 

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