[dbaust] article about Deaf & Depression

From: "Trudy Ryall" <trudy.ryall@xxxxxxxxxxx>
To: <dbaust@xxxxxxxxxxxxx>
Date: Wed, 30 Jul 2014 04:03:45 +1000

Please see article below written by Gary Kerridge for your interest as there
are deafblind people who suffer from Depression too.
Trudy Ryall
Accessing the System - Mental Health and the Deaf! written by Gary Kerridge
Earlier this year I had a nervous breakdown. This later lead to depression and
anxiety over a period of a few months. For the first time I became a client of
Victoria's mental health support system. It was a revealing experience.Last
week I had dinner with a few deaf friends who have had firsthand experience of
the Victorian mental health support system. the experience of my friends
mirrored my own.

I have no wish to be disparaging of the wonderful people who make up the
Victorian mental health support system. They are, by and large, a wonderfully
dedicated group of professionals. They work in a stressful and challenging
environment and do a terrific job. The problem is that they are expected to be
able to meet the needs of such a wide range of people, including people who are
deaf. This is an impossible task.

My own experience began when I broke down. I was at work and began sobbing
uncontrollably. I sought the support of a colleague. My colleague acted quickly
and organised for me to see a counsellor later that day. Obviously, being deaf,
I needed to arrange communication support to access the counsellor. This is no
easy task when you are already distressed. Auslan interpreters are also in
short supply.

Interpreters are generally not available at short notice. I was largely out of
control and I was expected to organise my own support. I could have requested
that the counsellor organise the interpreter but experience tells me that most
counsellors would not even know where to start.

Luckily enough I still had the presence of mind to reach out for help. I sent a
text to my wife and closest friends, one who happened to be an interpreter.
When I went to this first counselling session my interpreter friend interpreted
for me. There was no payment involved. It was totally pro-bono. I was very
lucky indeed.

There are plenty of people who are deaf and experience mental health issues but
do not have the same knowledge or contacts that I do. What happens to them? Who
supports them? How will they get the same quality of support that I did? Lots
of questions and so few answers. The reality is that, more than likely, they
are required to fend for themselves.

The risks from lack of communication during a mental health crisis are many.
These risks are compounded by the diversity of needs of many people who are
deaf. What of those that rely on sign language interpreters, how do they get
one at short notice when there is a crisis? What about people who are deaf who
also have literacy and English language issues? Or what of people who are deaf
who do not sign and rely on lipreading and quiet environments? The risks of
misdiagnosis from communication breakdowns are many.

Sarah Bowen, B.A., M.Sc. notes that, "It is generally agreed that the best
communication is achieved where health care providers and patients speak the
same language." Bowen also notes, "There is compelling evidence that language
barriers have an adverse effect on initial access to health services. These
barriers are not limited to encounters with physician and hospital care.
Patients face significant barriers to health promotion/prevention programs:
there is also evidence that they face significant barriers to first contact
with a variety of providers." Finally Bowen notes that, ".evidence also
demonstrates that they have reduced access to mental health and
counselling-related services.[1]

Bowen is from Canada and her paper relates not only to people who are deaf but
also to people from ethnic backgrounds who do not speak in the official
languages of Canada. What is clear is that language is a significant barrier at
the first point of contact in the health system. This includes mental health
crisis type situations.

My experience of accessing support based on my own mental health crisis was far
from ideal. A few weeks after my initial breakdown I had an episode that
required me to attend hospital. My wife attended with me. She is also deaf but
hears much more than I. She acted as my interpreter. Of course this is not
ideal. My wife was already stressed from the distress that I was in. To have to
interpret for me compounded this stress immensely.

Upon being admitted an interpreter was requested. We were told that there could
be up to a 48 hour wait. While the nurse and doctors were wonderful, the burden
placed on my wife was immense. I was admitted early in the morning. My wife had
to return home to check on the kids so I was left on my own for a time. During
the time alone I was visited by a woman. The role of this woman I am still not
sure because communicating with her was difficult. She could have been a
doctor, a nurse or simply a social worker, I have no idea.

The woman was obviously part of the mental health support team. She had a
disability, cerebral palsy. She walked with some difficulty. Her speech was
probably ok to understand but because of the muscle coordination issues that
she had she was difficult to lip-read. She communicated with me in a mixture of
writing and speech. We got by but it was not a smooth experience. I managed to
understand that - 'I needed a rest' - and that she wanted to admit me to a
clinic for a few days.

After finding out my health insurance status would not cover the cost she later
changed her mind. She said that I would go home and be assessed by the mental
health team at home. It was not easy to garner this information because I was
also distressed and exhausted. I am lucky that I have strong language ability
and managed to get enough information to understand the basics. I do wonder
what would have happened had I been a person who did not have strong language
skills. It really is a recipe for disaster.

Poor communication could lead to any number of mistakes. It could lead to the
wrong diagnosis and hence prescription of the wrong medication. Lack of
communication could also lead to medication being taken wrongly. Or even worse,
medication being prescribed that the patient might be allergic to. Indeed Bowen
confirms these risks in her paper when she states that there are often, "
.differences in patients understanding of their conditions and compliance with
treatment when a language barrier is present."

After leaving hospital I was told that the mental health team would be visiting
my home the next day to carry out a thorough assessment. Naturally I requested
that an interpreter be present at this meeting. I was promised that this would
be arranged. It was not. In total I was visited by the assessment team and then
the mental health nurse three times - An interpreter was never booked for any
of these appointments.

During the assessment I again had to rely on my deaf wife for communication
support. Medication was prescribed. The possible side effects were explained.
Any number of questions were asked about my condition to assist the team with
diagnosis and planning of my support. Again I have to ask that if I had been
someone without communication support and who did not have a strong language
base what might have happened. It is really quite scary.

My experience of depression and the use of medication was relatively short. A
friend who is deaf told me that they were in hospital with depression for three
and a half months. When one is admitted to hospital for depression there are
any number of treatments. Of course there is medication but there are support
programs like group counselling, activities and so on. My friend noted that
when in hospital there was no way that they could fully participate because
interpreters were not provided for any of these activities. She was told an
interpreter was too costly.

Indeed if interpreters were provided it was only for a limited time. This meant
that for the most part, while in hospital, my friend was extremely isolated. My
friend felt quite sure that the reason they took so long to become well again
was that the isolation experienced in the hospital actually contributed to the
worsening of their depression.

At some mental health type clinics treatment involves the imposition of limited
access to social media and the outside world through technology. For the
patient who is deaf this can be extremely isolating. For them there is little
by way of access to facilities and activities because most of these activities
require hearing.

Another friend commented that at the clinic that they attended there was only
one communal television. While it had captions they were never turned on. My
friend would get up and watch TV after everyone had gone to bed just so that
they could get some access to captions. The rest of the day was spent largely
alone. The isolation did not assist my friend to get well. It in fact
contributed further to their depression.

The recent report from Deaf Victoria showed that in most cases, at most
hospitals, people who are deaf rarely get access to interpreters or any
communication support. Reliance on family members is common. Whether it is
medical or mental health good clear communication at the entry point is
essential and throughout treatment. This is particularly so in the area of
mental health where treatment is so diverse.

Perhaps as advocates we need to turn our attention to this very important area
that is mental health. Developments and improvements in the area of mental
health support for patients who are deaf is desperately needed. Make no
mistake, patients who are deaf can be at extreme risk when accessing the mental
health support system. Improvements are desperately needed.

[1]
http://www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2001-lang-acces/2001-lang-acces-eng.pdf

Trudy Ryall
E: trudy.ryall@xxxxxxxxxxx
M: 0401324381

[dbaust] article about Deaf & Depression

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