Mental health services are effective when there is a direct connection between an individual in need of services and the treating professional, and the professional is familiar with the cultural and development norms of the individual. Such a direct connection and familiarity is critically important for individuals who are deaf or hard of hearing, particularly with respect to the need for direct services from treating professionals who have the ability to communicate with deaf individuals in their language or communication mode.
The National Association of the Deaf (NAD) has set forth position statements in 2003 and 2008 that promote the full continuum of mental health services to the deaf and hard of hearing community.
Significant research has shown that culturally and linguistically affirmative mental health services (direct services provided in the native language and appropriate cultural context) to deaf and hard of hearing individuals is effective, but the availability and delivery of such services to this population is deficient. Due to the lack of such culturally and linguistically affirmative mental health services in many regions of the country, mental health services are often provided indirectly with the assistance of auxiliary aids and services such as sign language interpreters. While auxiliary aids and services are necessary in many circumstances for deaf and hard of hearing individuals to access mental health services, such indirect services are not always effective given that the treating professional may not be familiar with the cultural norms and communication needs of this population.
Therefore, culturally and linguistically affirmative mental health services are the optimal means for deaf and hard of hearing individuals for treatment and recovery purposes. Accessible mental health services – the provision of mental health services through interpreters or other auxiliary aids and services – are not always effective, albeit usually preferable to the outright denial of mental health services or access to such services.
In 1997, mental health professional organizations representing 600,000 professionals came together to promote a Joint Initiative advocating for a “Mental Health Bill of Rights” which ensured that all individuals seeking mental health services had fundamental protections.
The NAD supports the protective nature of the Mental Health Bill of Rights, and seeks to promote additional protections through a separate bill of rights addressing the need for direct mental health services to deaf and hard of hearing individuals. The NAD encourages advocates and State Associations of the Deaf to work with their legislators to enact this bill of rights in each state for the provision of mental health services to deaf and hard of hearing individuals. The proposed bill of rights is a means to achieve the recommendations contained within the NAD’s 2003 and 2008 mental health position statements
Mental Health Services for Deaf and Hard of Hearing Individuals bills of rights should include certain elements to be effective:
Presence of a state mental health authority as well as a state coordinator with the authority to oversee and fund a full continuum of mental health services for deaf and hard of hearing individuals.
Some states have formed a division or component within the state mental health authority, and granted powers to such a division or component to oversee and fund mental health services to deaf and hard of hearing individuals. Mental health services are more readily available and more directly accessible to deaf and hard of hearing individuals in such states with a dedicated division or component within the mental health authority. While formation of a division within the state mental health authority is not the sole means of ensuring effective provision of direct mental health services to deaf and hard of hearing individuals, the oversight and funding of such direct services typically require specialized management familiar with the unique needs of this population.
For most states, a dedicated coordinator is necessary to ensure that appropriate mental health services are provided to deaf and hard of hearing individuals throughout the state. The coordinator must be appropriately qualified and adequately authorized to be effective in this capacity.
Availability of qualified and licensed mental health professionals who can communicate directly with deaf and hard of hearing individuals.
For mental health services to be effective for a deaf and hard of hearing individual, there must be direct communication with a qualified licensed mental health provider who is fluent in the language or communication mode of the individual being treated and familiar with that individual’s cultural norms.
Use of qualified and licensed mental health professionals in remote locations to provide needed mental health services to deaf and hard of hearing individuals.
Many geographical areas do not have qualified and licensed mental health professionals that are fluent in American Sign Language (ASL) or other languages or communication modes to provide culturally and linguistically affirmative mental health services to deaf and hard of hearing individuals. Steps need to be taken to modify state laws and regulations to allow the use of technology and/or interstate agreements making it possible for out-of-state professionals with the necessary fluency to provide services to deaf and hard of hearing individuals not adequately served within their respective geographical area.
Regional and interstate compacts
To ensure effective direct delivery of mental health services in a culturally and linguistically affirmative manner to deaf and hard of hearing individuals in any geographical area, qualified licensed mental health professionals with the appropriate level of language fluency and culture familiarity are needed. If no such mental health professional is available in a specific geographical area, then a process needs to be developed to utilize the services of such qualified licensed mental health professionals who may be outside the customary service area or in a different state.
Development of qualified sign language interpreters and other auxiliary aids and services to ensure accessibility for deaf and hard of hearing individuals to the full continuum of mental health services.
While direct mental health services is the optimal means of treating deaf and hard of hearing individuals, appropriate auxiliary aids and services are often required to provide the full continuum of services to this population. It is critically important that the auxiliary aids and services being provided are effective and, where necessary, qualified. Sign language interpreters need to be fully trained and familiar with mental health terminology and treatments to be effective as communication facilitators between the treating professionals and the deaf or hard of hearing individual. The bill of rights needs to mandate the development and training of qualified sign language interpreters for the purpose of interpreting mental health services and treatment.
Depending on the existing laws in a specific state, the bill of rights may incorporate definitions already codified in state law and may need to be adjusted to reflect the powers and limitations of the state mental health authority. Some states may reject the inclusion of certain provisions of this model bill of rights, but the bill should include the above described essential components. Some parts may vary according to existing state laws.
The definitions provided in the model Bill of Rights Act are one possible version. Many states have their own definitions for the same terms, and consideration of the definitions already contained in state law may be considered and preferable to state legislators.
State mental health authority & state coordinator of mental health services
The structure and powers granted to the state mental health authority should be considered when drafting the bill of rights to comport with the system already existing in the state. When ever possible, the bill of rights should include a requirement that the state has within its mental health authority a dedicated state coordinator of mental health services for deaf and hard of hearing individuals.
Developing a Bill of Rights: What Can You Do?
Ideally, a bill of rights for the provision of mental health services to deaf and hard of hearing individuals should include the concepts discussed in this article. The enactment of such a bill in your state may be possible by keeping your legislators informed of deaf and hard of hearing mental health issues, working with your State Association of the Deaf, and maintaining open communication with local, state and national service providers, programs, organizations, agencies, and other appropriate individuals and entities.
Deaf and hard of hearing communities throughout the country should help develop and implement state bills of rights for the provision of mental health services to deaf and hard of hearing individuals. You should continually educate legislators about the unique mental health needs of deaf and hard of hearing individuals, including the need for deaf culture and sign language.
Legislators may be more likely to support a state bill of rights if apprised that the provision of mental health services enable deaf and hard of hearing individuals to become productive citizens. Educate your legislators about the mental health needs and rights of deaf and hard of hearing individuals, and help them to become knowledgeable and enthusiastic about this cause.
Seize the opportunity to pass legislation that guarantees full and appropriate continuum of mental health services for deaf and hard of hearing individuals in all states.
Amended June 18, 2014 by NAD Board vote pursuant to NAD Council of Representatives Priority for 2012-2014 term, with great appreciation to the 2012-2014 Mental Health Expert Group of the Public Policy Committee.