The combination of mental health issues and hearing loss creates a unique relationship that requires specialized training for the professionals working with deaf or hard of hearing individuals in a clinical setting. A review of the literature reveals various aspects of the unique dynamics created by hearing loss and mental health concerns with respect to communication in a clinical setting as well as in a rural state. However, there is limited literature respective to the state of Arkansas. The survey conducted for this article assessed the accessibility to mental health services in the state of Arkansas as perceived by deaf and hard of hearing individuals. It revealed the need for qualified professionals to provide services geared towards deaf culture. Interviews provided insight to experiences in the context of mental health services and accessibility. The survey also showed strong demand for a centrally located office to provide services to the deaf and hard of hearing community. The aim of this research is to draw the attention of mental health professionals and other stakeholders in Arkansas to the additional element of hearing loss. The impetus for not only mental health services tailored for issues arising out of an individual's hearing loss, but also the need for mental health providers to make available clinicians who have a profound understanding of the language and the culture of the deaf community.
Degrees and Prevalence of Hearing Loss
The deaf population is a subpopulation that exists within the hearing population that includes individuals who have a hearing loss within a spectrum that varies from mild hearing loss to total hearing loss. It is important to differentiate lower case "d" deaf and uppercase "D" Deaf. Steven Barnett explains that Deaf, as in Deaf Community refers to the subculture in which members are self-selected, whereas deaf, as in deaf population, refers to individuals who have a medically diagnosed hearing loss. (1) Hearing loss, hard of hearing, and deafness are synonymous as they refer to an individual who has impairment to his or her ability to process the environment around them auditorily. The level of correction needed to bring the auditory input to a detectable range by the individual determines the degree of hearing loss. This is measured in decibels of hearing loss (dB HL). Clark provided a breakdown in the classifications of hearing loss. The classifications on a spectrum of hearing loss in terms of dB HL are as follows: 16 to 25 as slight, 26 to 40 as mild, 41 to 55 as moderate, 56 to 70 as moderately severe, 71 to 90 as severe, and anything over 91 as profound. (2)
Ross E. Mitchell and his co-authors provided a brief description of the estimates regarding the total number of deaf people in America using information from the National Health Interview Survey (NHIS) and the Survey of Income and Program Participations (SIPP). They reported approximately 2 to 4 per 1000 of the total population has profound hearing loss, 9 to 22 severely hearing impaired, and 37 to 140 with hearing loss in general. (3) According to the Census Bureau, in 2010 there were 2,915,918 people living in Arkansas at the time of the census report. (4) Given the population data of Arkansas residents reported in the census and the approximation of the ratio of the population with a hearing loss, it would be logical to assume there are roughly estimated to be anywhere from 583 to 11,664 individuals with profound hearing loss living in Arkansas, 26,243 to 64,150 severely hearing impaired, and 107,888 to 408,229 with hearing loss in general.
Hearing Loss and Mental Health Issues
Margaret Du Feu and Kenneth Fergusson conducted a study in 2003 to better understand the relationship between hearing loss and mental health. What Du Feu and Fergusson found was the stigma attached to hearing loss had social implications. Alongside the loss [or lack of] sensory ability, the social implications had an equal impact on the deaf population's mental health. They acknowledged the age of onset as well as the speed of onset had different levels of impact. They found early onset, which includes acquired deafness via illness/injury and ascribed deafness, had a deep impact on children's social development and mental health in childhood as well as adulthood. They also found the sudden loss resulting from injury or illness had the most devastating consequences if psychological support was not provided. In their report, they acknowledged that hearing loss is a byproduct of aging; however the growing effect on a person's confidence and independence as a result of decline of the ability to communicate cannot be ignored. (5)
Seeking out mental health services can be an apprehension-filled task for those with a hearing loss. The uneasiness can be attributed to the fact that hearing loss beyond a mental disorder or simply a physiological pathology is still a relatively new concept. Clear communication is crucial to proper diagnosis and effective treatment. Historically, deaf individuals seeking mental health services have been misdiagnosed or not diagnosed at all due to miscommunication. Du Feu and Fergusson explained that mental health workers' lack of understanding deafness and the associated culture has led to patient institutionalization as a result of poor writing skills or/and lack of communication. They reported the prevalence of mental health disorders within the deaf community can be attributed to the "delays in access to [mental health] service...increase[s] the duration of mental health problems. (5)
Hearing Loss and Suicide
The general consensus on the relationship between depression and suicide for individuals with a mental health condition, especially depression, is further supported by Ian Gotlib and Constance Hammen's research, which reported that twenty percent of the population that has been diagnosed with depression commit suicide. (6) There is limited data on the exact prevalence of depression among individuals with hearing loss in the United States, much less Arkansas. However, studies conducted by Richard Hallam and his cohorts in Britain indicated the prevalence of depressive symptoms among individuals with a hearing loss to be significantly higher than the general population. (7)
There is a lack of suicide data specific to the deaf population in Arkansas; however the Arkansas Life Expectancy website used data from the Center of Disease Control, National Institute of Health, and individual state/county databases to report suicide rates for the general population of Arkansas. According to the website, there are 14.51 suicides per 100,000 deaths. (8) When the ratio is applied to the estimated deaf population in Arkansas, the projected number of suicide among individuals with a hearing loss is sixteen to sixty.
Oliver Turner and his co-authors' review of the literature focusing on suicide in the deaf community reported an expected national rate of eleven per one hundred thousand (.00011). (9) A projected number of twelve to forty-five suicides based on that calculation provided further support of proximity of previous projection when applied to the estimated deaf population in Arkansas.
Furthermore, Turner et al.'s analysis of the literature found it was not having the hearing loss per se that was a high risk factor, but the stigma resulting from having hearing loss that causes low levels of social support as well as interpersonal relationships. They also reported individuals with hearing parents were more likely that their counterparts to suffer from depressive symptoms with the difference being statistically significant. They emphasized higher rates of depression and perceived risk for the deaf population than their hearing counterparts.
Given the risk of suicide for individuals who are facing a dual diagnosis of depression and hearing loss, there is an immediate need for mental health services tailored to the communication and cultural needs of this population.
Communication in Clinical Settings
With two individuals who do not speak the same language - as in the case of a clinician who speaks English and a client who has a hearing loss - the first thing that typically takes place is dialoging through writing. This presents a conflict of cognitive mapping with respect to language. What this means is what is said by one is not perceived as it was intended by the speaker.
Helen Meador and Philip Zazove provide an example in their article addressing clinical issues that exist when working with individuals with a hearing loss. The conversation hypothetically takes place via writing in English; Physician writes "you may need surgery," but the deaf client perceives the physician to be saying, "you need surgery in May." To further clarify how a linguistic commonality such as communicating through an interpreter can prevent misunderstandings, the authors explain how the physician's statement would be signed "you maybe need surgery." (10)
Even with interpretation services, there still arise issues from using interpreters for facilitating communication between deaf individuals and the hearing practitioners. Traditionally, deaf individuals use an interpreter who has been certified as a sign language interpreter by a state licensing board, such as Arkansas Registry of Interpreters for the Deaf (ARID) or Registry of Interpreters for the Deaf (RID). The certified interpreter is bound by an established set of code of ethics and professional conduct expectations set forth by the ARID or RID. When sensitive information is passed between client and clinician, not only is full comprehension on the clinician's part about deafness and deaf culture crucial, but also the client's sense of security of confidentiality on the interpreter's part. As if these were not enough factors needed for successful treatment, the lack of willingness of service providers to provide interpreters leads individuals in this...