Connecting with the Deaf Community
Network, Summer/Fall 2004
Misunderstandings of Deaf culture and a lack of sign-language interpreters are only two of the barriers faced by people with hearing loss when they try to get help for their mental health needs. A recently expanded program in Ontario is beginning to overcome those obstacles.
CONNECT Counselling Services is a program of the Canadian Hearing Society (CHS). The service has been in Toronto since 1986, but last year received funding from the Ministry of Health and Long-Term Care to expand across the province. It is now available in all regional offices and some area offices.
The program is free and open to any person with hearing loss, regardless of age. Staff members include counsellors, case managers, community outreach workers, and mental health sign-language interpreters. Staff are qualified professionals who are hearing, deaf, and hard of hearing. They work with people with severe mental illnesses, such as schizophrenia or bipolar disorder, as well as anyone who needs general counselling, including family members. CONNECT also offers public education workshops and provides consultation to service providers to increase sensitivity and awareness of the mental health and access needs of deaf, deafened and hard of hearing people.
The CONNECT counsellor in the London office is Rebecca Grundy. She is a social worker who has worked with CHS for 12 years. Grundy offers individual, couple, family and group counselling, and works with all consumers and their families around education, advocacy and support. If necessary, she may also refer her clients to a psychologist, or help them ask their family physician for a referral to a psychiatrist.
Grundy explains that there is more than one group within the deaf community. There are people who were born deaf and see themselves as members of a distinct community — often denoted by capitalizing the first letter in “Deaf” — and there are those who lost their hearing, gradually or suddenly, later in life. Grundy says this distinction is important. “Their mental health and access needs are very different,” she says.
Deb Selwyn, who works with Grundy as a consultant, agrees that people in the deaf community face a variety of challenges. Selwyn is a community support coordinator for the London-Middlesex branch of the Canadian Mental Health Association. She says that many people in the deaf community are unaware that counselling services are available. “Often they don’t even understand what counselling means,” she says, “because it has never been provided to them.”
Gaining access to health care depends on being able to communicate. Studies show that approximately 45 percent of deaf patients who have seen doctors without interpreters have medical problems that remain undiagnosed. The shortage of sign-language interpreters in Ontario is a major barrier, Selwyn says. Even though the government is required to provide an interpreter for medical appointments, there are not enough to go around.
As well, having an interpreter sit in for a counselling session can be intimidating, especially if very personal issues are being discussed. “If it is something really significant, like in the post-trauma population where women are discussing abuse and horrific things that have happened to them at a very young age,” explains Selwyn, “you are telling it not only to the counsellor, whom you don’t know and who is from another cultural background, but also to a third person, and that process is so intimidating.”
Dr. Cathy Chovaz McKinnon, a clinical psychologist who works with the deaf community, says that using an interpreter in a counselling session is doubly difficult because the deaf community is small and well connected. The client may be relying on an interpreter they know personally, making it hard to freely disclose sensitive information. Dr. McKinnon, who is herself deafened and fluent in American Sign Language (ASL), has an advantage in being able to work without an interpreter. But her situation is rare.
In her submission to the Romanow Commission, Dr. McKinnon wrote, “It is common for Deaf individuals not to have a family doctor given the huge barriers inherent even in phoning for an appointment, let alone trying to communicate with the doctor.”
Aren’t there other ways for health care professionals to communicate? Written notes may be the most frequently used method, but they are time-consuming, impractical, and largely ineffective, since only 12 percent of the deaf population is fluent in English. The average pre-lingual deaf person — that is, someone who is either born deaf or loses their hearing before language is acquired — reads English at a grade three to six level, regardless of intelligence.
“Reading and writing in English isn’t a good way to communicate about these types of issues,” says Grundy. “People may not know the English term. The language is just very, very different. It’s a little bit like an immigrant coming over into our community and not knowing English. It’s difficult to communicate what your needs are and what your emotional experience is.”
“We use a variety of methods to communicate,” explains Grundy. “If I have a deaf person who signs, quite often I sign myself. But if I’m meeting with a family, for example, that’s too much for me to be able to sign and provide the therapy at the same time, so I’ll have a sign-language interpreter for that situation. If I have a deafened person who understands English, then I’ll type while I talk so they can read what I’m saying. If it’s a hard of hearing person, then we have different choices. I can either type while I talk, or there are some amplification devices that I can use, or I can give them certain keywords, so they can follow my conversation easier. So for each person it may be different. We identify the best way to communicate, and then I adapt to their needs.”
Another obstacle is the deaf community’s mistrust of the hearing community. Dr. McKinnon explains some of the reasons for this mistrust. “There is an extensive history of oppression, whereby deaf people were considered ‘dumb’ and unable to function in society as intact individuals.” There is also a history of physical abuse, notably by hearing adults who take advantage of the vulnerability of deaf children who “can’t tell,” says Dr. McKinnon. “This legacy has unfortunately been found in many schools for the deaf, as well as out in the community.”
Cultural differences add to the mistrust. “It is critical that the clinician have a good understanding of Deaf culture in order to appropriately recognize symptoms, diagnose disorders, and plan for treatment within the patient’s context,” says Dr. McKinnon. To illustrate her point, she gives the example of an inexperienced counsellor thinking that a person is agitated or manic because they are signing rapidly, when in reality it’s just a function of the language (ASL). Or the counsellor may think that someone who doesn’t make eye contact is simply shy. In fact, eye contact is a very important aspect of Deaf culture and an integral part of ASL. The absence of eye contact could indicate a trust issue or have many different diagnostic implications.
Linguistic barriers also present a challenge for mental health professionals working with deaf clients. Selwyn uses the example of a deaf person being asked if they are hearing voices during an assessment for a psychotic episode. “You’ll never get an accurate response to that question, because you’re asking a deaf person if they’re hearing,” she says. Deaf people don’t understand the question in the same way that hearing people do. If they answer yes, it may be because they are hearing residual sounds. But if they answer no, they may be released from hospital with an inaccurate diagnosis.
Lack of respect from people who don’t understand can isolate and ostracize deaf people from the larger community. “The self-esteem of a person with hearing loss tends to be chipped away at so much that they can become very depressed,” says Grundy. “They may withdraw from society, stop going out in the community, or stop socializing with friends.” People who lose their hearing later in life tend to get depressed because they have to redefine themselves and learn the basics over again.
“There is a great need for our service,” Grundy continues. “If you think about most services that people go to, it’s a lot of talk therapy, and when your communication is different or troubled, or you don’t have the ability to hear the person, that impacts all the treatment you receive from professional services.”
“The mental illnesses themselves are not unique to our community. It’s the same across all communities. The problem for deaf and hard of hearing people is access to services.”
For more information about CONNECT Counselling Services, visit the Canadian Hearing Society website at www.chs.ca, or call 416-928-2500 ext. 250 (phone) or 416-964-0023 (TTY). For more about Dr. Cathy Chovaz McKinnon, visit www.deafpsych.com.
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