Mental Health: Is There A Problem?–Julie Eckhardt, MA, LPC
Consider these true stories (identifying information has been eliminated or changed):
A man in his 30’s:
A man, deaf since birth, lives in a small town near the rest of his family. He is a friendly man who enjoys socializing. Unfortunately, few other people in town know sign language. His own family communicates with him through simple gestures. They feel that American Sign Language is too hard to learn. He often feels isolated and lonely. At the tavern, he finds others who, with the help of a few beers, are willing to spend time with him. They kid around, play darts, and drink until the early hours of the morning.
When he is caught drunk driving for the 3rd time, he is faced with choices. If he stops drinking, he will lose his only friends. He went to an AA meeting once, but without an interpreter, was left out of the conversation. He felt more alone after that experience and never returned. He went to a therapist for while. The woman could sign a little, but couldn’t understand him very well and it was just too much effort. She wasn’t much help anyway.
After one of his arrests, he was sent to a treatment facility in another town. It was fun being there with other Deaf people. They were all trying to stay sober, and with them, he felt he could do it too. But he didn’t live in the same town they did. When he returned to his hometown, alone and sober, he couldn’t handle the loneliness. In a short time, he was back with his friends at the bar.
A 70–year–old woman:
Margaret had lived in mental health institutions for as long as any of the social workers knew. She was placed in an adult foster care home when the mental hospitals closed. She never spoke and didn’t respond when people talked to her. Some thought she might be deaf but didn’t know for sure. Her mental illness and a developmental disability might be the reason she refused to talk. No one knew and no one bothered to find out. She often made hand gestures, but they were bizarre movements, similar to finger spelling, not coherent sign language.
Margaret began clawing at her face. She could not be stopped from scratching at her nose. When her entire nose had been scratched off and her caretaker feared infection, she was sent to a nursing home for the mentally ill. At this facility, they put mittens on her hands to prevent her from doing further damage.
A concerned social worker called a friend who knew American Sign Language. This man was willing to meet Margaret. When the mittens were removed from her hands, the woman immediately began signing, “Spiders, spiders, spiders” and scratched at the hole that had once been her nose. The man told the social worker what she said. A psychiatrist was contacted who recognized this hallucination as a side effect of medication. He changed her prescription and Margaret stopped scratching. Unfortunately, she no longer had a nose and had spent many months tortured by visions of spiders before anyone asked her what was wrong in her own language.
A recent high school graduate:
Melissa was adopted when she was a toddler. Her new parents were aware that she was deaf. As she grew, it was discovered that she also had cognitive impairments. Although she was not considered mentally retarded, she had a great deal of trouble learning, even in a special program for the hearing impaired. Melissa went to the state School for the Deaf during high school.
After graduation, Melissa returned to live with her parents. An agency helped her to get a job. Then she began having tantrums. She would lock herself in a room, at work, and bang her head on the wall. She was violent at times, throwing heavy objects at her mother.
The parents contacted the local mental health agency. The agency met with Melissa without an interpreter and reviewed high school records. They determined that Melissa was not eligible for their services because school testing showed her I.Q. was slightly above their limits. The parents explained the behavioral problems that were occurring. The mental health agency believed the problem was the parents, assuming they did not want their daughter living with them. They continued to deny services.
An advocate became involved. The advocate demanded that Melissa receive a psychological evaluation, with an interpreter. The agency hired someone to interpret who was not certified. The psychologist had no prior experience testing a deaf person. Services were again denied.
Over the course of the year, Melissa’s behavior deteriorated. She lost her job, and her parents were frightened for her safety and their own.
Finally, at the advocate’s insistence, Protection and Advocacy (P & A)became involved. When the P & A attorney contacted the mental health agency they agreed to have Melissa evaluated by another psychologist. This psychologist was experienced in deafness and fluent in American Sign Language. He quickly determined that Melissa was suffering from schizophrenia. A comprehensive treatment program was initiated only after several years of denied services and the intervention of an attorney.
These may seem like extreme situations, but they are all too common. Equally tragic are the many deaf and hard of hearing people who are not treated for milder, but still devastating, mental health problems such as depression and anxiety. Laws mandate equal access to mental health treatment. However, the realities of under–funded agencies, and lack of training and awareness of deaf and hard of hearing issues, result in extremely poor access to mental health services for people with hearing loss.
This situation has been compounded by changes in Medicaid in recent months. Medicaid requires most recipients to receive services under Health Maintenance Organizations (HMO). In areas where only a few treatment providers understand deafness, patients are unable to see them due to HMO restrictions.
For example, a deaf woman has been seeing a culturally competent social worker for a year. This treatment has resulted in many improvements in her life, and the life of her children. Unfortunately, although her social worker’s agency accepts Medicaid, the agency has not been approved by the specific HMO that carries this woman’s Medicaid. The deaf woman is forced to change therapists, and is directed to a new social worker, approved by the HMO, who neither signs nor understands the implications of deafness.
There are some important exceptions. More deaf and hard of hearing people are becoming doctors, social workers, and psychologists. These professionals bring cultural sensitivity and a strong knowledge base to the services they provide. Hearing people who strive to understand the experience and culture of deaf and hard of hearing people provide quality services. The Michigan Coalition for Deaf and Hard of Hearing People is working towards improved mental health services in Michigan. With continued effort and education, it is hoped that more deaf and hard of hearing people will have access to quality mental health services.