Mental Health Services for Deaf People

Treatment Advances, Opportunities, and Challenges

Benito Estrada Aranda, Ines Sleeboom-van Raaij, Benito Estrada Aranda, Ines Sleeboom-van Raaij

• Publisher: Gallaudet University Press
• Year: 2015
• ISBN:
  9781563686559
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The World Congress on Mental Health and Deafness first met at Gallaudet University in October 1998, and it has convened five more times in the succeeding years. This volume collects the very best research presented at the Fifth World Congress, which took place in Monterrey, Mexico, in 2012. The eighteen international contributors represent the pioneers of mental health and deafness services in their respective countries.       Volume editors Benito Estrada Aranda and Ines Sleeboom-van Raaij have divided the book into three parts—Mental Health Issues and Treatment, Deaf Populations, and Deaf Children and Their Families. In the first part, the contributors provide in-depth analysis of specific challenges and treatment modalities ranging from the provision of mental healthcare as a basic human right to psychopharmacological treatment, the challenges in developing mental health services for deaf and hard of hearing people in countries where none exist, and new treatment therapies.
       Part two looks at issues of self-esteem and cultural identity among deaf and hard of hearing adults in Greece and Cyprus, the services for deaf people at a public health clinic in Austria, and the quality of life among Latino Deaf bilinguals in the United States. In the last part, the contributors focus on mental health issues found in deaf children and adolescents and on the relationships between deaf teenagers and their hearing mothers. The volume concludes with a case study of a prelingually deaf child diagnosed as autistic. Taken all together, these cutting-edge articles explore the important issues within the specialized area of mental health and deafness.

Part 1

Mental Health Issues and Treatment

1

Mental Health Care for Deaf People: An Approach Based on Human Rights

__________________________________________________

Ana María García García

Javier Muñoz Bravo

Since Deaf people who have a mental illness are often viewed as a minority within a minority, this topic would seem to be of interest to very few people. In fact, the number of professionals interested and/or active in this field is quite small worldwide. However, we believe that the experiences of Deaf people who suffer mistreatment and/or discrimination at the hands of health-care services are universal and therefore not minor. Given that health care is considered a fundamental human right, denial or ignorance of the specific mental health–care needs of Deaf people may be a violation of this right and thus should be of concern to the treating professionals, the governing representative, and every citizen as well.

HEALTH AND HUMAN RIGHTS

In 1946 the right to health was spelled out in the Constitution of the World Health Organization (WHO) as follows: “The enjoyment of the highest attainable health is one of the fundamental rights of every human being without distinction of race, religion, political beliefs, economic or social condition.” The right to health care was reaffirmed by the Declaration of Alma-Ata in 1978, by the World Health Declaration, which was adopted by the World Health Assembly in 1998, and by a number of other international and regional human rights instruments.¹

Because health is a variable beyond the direct control of governing states and depends on a variety of environmental, genetic, cultural, and individual factors, the right to health is not the right to good health or freedom from disease.

The right to health refers to the obligation of states to create conditions that permit all citizens to live as healthily as possible. These include, of course, the guaranteed availability of equitable and appropriate health services, as well as of the primary health-determining conditions, such as access to potable water; adequate sanitation services; a nutritious food supply; appropriate housing; a healthy work environment; and access to education and to information on health issues, including sexual and reproductive health. Established as a fundamental and universal human right that is guaranteed under and protected by international law, the right to health is therefore very important inasmuch as human rights protect individuals and groups of people from actions that undermine their fundamental freedoms and human dignity.

The right to health imposes three types of obligations on the states that ratify them:

• Respect: the enjoyment of the right to health

• Protection from actions of third parties (with the possible exception of the state) that would interfere with the enjoyment of the right to health

• Compliance: the implementation of positive measures to make the right to health a reality by establishing policies and action plans that provide access to health care for all people as soon as possible. States must adopt measures in accordance with the principle of progressive realization. This means that they must go forward as quickly and efficiently as possible, by their own means as well as with international help and cooperation up to the maximum extent of the available resources.

Human rights are interdependent and interconnected. The Vienna Declaration and Programme of Action states the following:² “The international community must treat human rights globally in a fair and equal manner, on the same footing, and with the same emphasis . . . [I]t is the duty of States, regardless of their political, economic and cultural systems, to promote and protect all human rights and fundamental freedoms.” Since health as a right is affected by other rights having to do with the maintenance of an adequate standard of living, such as access to education or employment, then people who live in poverty or are inadequately educated are more likely to have poorer health than those who enjoy economic security and decent living conditions. It is significant that poverty, inadequate access to education, and other factors that have a negative impact on human rights appear disproportionately among people with disabilities, including Deaf people.

The universality of human rights means they are applicable to everyone worldwide, including people with disabilities and/or mental health problems. Despite the fact that the United Nations resolutions that protect individuals with mental health problems explicitly forbid discrimination against them,³ these individuals continue to be widely stigmatized and thus are especially susceptible to violation of their human rights as a result of discrimination and increased barriers to medical treatment, housing, education, employment, and so on.

The Human Rights Committee (General Comment⁴ no. 14, 2000⁵) sets out the following four evaluation criteria to assess the respect of the right to health:

1. Availability. Functioning public health and health-care facilities, goods and services, as well as programmes, have to be available in sufficient quantity . . .

2. Accessibility. Health facilities, goods and services have to be accessible to everyone without discrimination, within jurisdiction of the state party. Accessibility has four overlapping dimensions.

• Non-discrimination: health facilities, goods and services must be accessible to all, especially the most vulnerable or marginalized sections of the population, in law and in fact, without discrimination on any of the prohibited grounds.

• Physical accessibility: health facilities, goods and services must be within safe physical reach for all sections of the population, especially vulnerable or marginalized groups, such as ethnic minorities and indigenous populations, women, children, adolescents, older persons, persons with disabilities and persons with HIV/AIDS, including in rural areas.

• Economic accessibility (affordability): health facilities, goods and services must be affordable for all. Payment for health-care services, as well as services related to the underlying determinants of health, has to be based on the principle of equity, ensuring that these services, whether privately or publicly provided, are affordable for all.

• Information accessibility: accessibility includes the right to seek, receive and impart information and ideas concerning health issues. However, accessibility of information should not impair the right to have personal health data treated with confidentiality.

3. Acceptability. All health facilities, goods and services must be respectful of medical ethics and culturally appropriate . . . [and] sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned.

4. Quality. . . . Health facilities, goods and services must also be scientifically and medically appropriate and of good quality. This requires, inter alia, skilled medical personnel. . . .

In summary, the right to health is a central human right protected by international rules that obligate countries to adopt and implement a national public health strategy. As a universal right and thus applicable to everyone, health should be promoted by national policies that include a participatory and transparent process of review and evaluation and pay particular attention to vulnerable or marginalized groups.

Human Rights, Disability, and Health

In 2001 the United Nations began developing a comprehensive and integral international convention that would protect and promote the rights and the dignity of persons with disabilities.⁶ Beginning formally with the Mexican government’s appeal to the international community, first at the World Conference against Racism, Racial Discrimination, Xenophobia, and Related Intolerance⁷ and later during the fifty-sixth session of the United Nations General Assembly in November 2001, the process of crafting an international treaty aimed at improving the quality of life of persons with disabilities was set in motion.

Thus, the General Assembly of the United Nations decided to establish a special committee⁸ with the mission of preparing the International Convention on the Rights of Persons with Disabilities.⁹ The text of the convention was adopted by the United Nations General Assembly on December 13, 2006, and opened for signature on March 30, 2007.

The goal of this convention was to ensure that people with disabilities and people without disabilities had equal rights and access to health. In addition to reviewing the existing rights, as discussed earlier, proposals were presented for measures that can be taken by states and civil societies to ensure the reduction or elimination of discrimination against people with disabilities.

Article 25 of the convention refers specifically to health rights. In other words, states are expected to take all appropriate measures to ensure equal access to health services and health-related rehabilitation for persons with disabilities. These proposed measures include the following:

1. Provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons . . . ;

2. Provide those health services needed by persons with disabilities specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities, including among children and older persons;

3. Provide these health services as close as possible to people’s own communities, including in rural areas;

4. Require health professionals to provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent . . . ;

5. Prohibit discrimination against persons with disabilities in the provision of health insurance, and life insurance when such is permitted by national law . . . ;

6. Prevent discriminatory denial of health care or services or food and fluids on the basis of disability.

In summary, the International Convention on the Rights of Persons with Disabilities can be considered an official document whose purpose is to ensure the full enactment of human rights for persons with disabilities.

DEAF PEOPLE AND MENTAL HEALTH SERVICES

The foregoing discussion also applies to the health-care provisions for Deaf people; in this section we provide further comment on the mental health issues for this population. All too often, Deaf people experience two main types of discrimination: direct and indirect.

Direct Discrimination

Direct discrimination is the different or less favorable treatment experienced by a person with a disability in comparison to the treatment received by a person without a disability in the same or a similar context. The following are illustrations:

1. Access to information. The most fundamental area in which Deaf people experience discrimination is communication, the lack of which denies them access to needed information, especially during medical diagnosis, treatment, and aftercare. Although diagnosis may be enhanced by diagnostic tests, biopsies, X-rays, endoscopy, ECGs, palpation, auscultation, and so on, it is still essential to interview patients directly, make note of their perceptions, mood, and behavior, and communicate with others who know them. This is especially important in mental health situations, and it is essential to communicate with patients directly by using a shared communication system.

2. Communication constraints. Since most health professionals are unfamiliar with sign language and may even refuse to accept the use of sign language, interpreters, and other assistive resources, the risk of misdiagnosis and treatment errors increases.

Good mental health care for Deaf persons tends to require at least twice as much time and twice as many personnel as required for hearing people.¹⁰ Even when Deaf individuals are treated for about the same length of time as hearing people, they may still receive lower-quality care. Furthermore, with rare exception (e.g., Wechsler Intelligence Scale for Children, 4th ed.; Rhode Island Test of Language Structure), psychodiagnostic tests (e.g., IQ, personality) are designed for and standardized on the general hearing population; thus, without proper adaptation or accommodation, the use of these instruments with Deaf patients may increase the chance of errors in diagnosis.

3. Confidentiality. Since health professionals are often more likely to provide medical or mental health information to relatives or other significant people in a Deaf person’s life—even without the patient’s consent—there is a higher risk of violation of confidentiality.

4. Disinformation. Deaf patients often do not receive adequate information about their condition (diagnosis, prognosis, or proper care). Examples of disinformation, with potentially serious consequences for the (right to) health of Deaf patients, include the following:

• Inappropriate medication or treatment management due to insufficient information about dosage or possible side effects

• Deaf patients’ receipt of inadequate information at discharge about appropriate aftercare, which puts them at high risk of reentry. This is compounded by the fact that many Deaf patients have no opportunity to access social or similar resources to obtain this information if it is not provided during treatment.

• Most informed-consent forms signed by Deaf persons before any medical intervention occurs may not be valid because the information on the forms is presented in an incomprehensible format, leaving these individuals in a situation of helplessness with regard to medical decisions.

5. Physical accessibility. Health facilities often provide insufficient accommodations to the needs of Deaf patients, particularly with respect to visual accessibility (e.g., they ma...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Contents
• Acknowledgments
• Introduction: Purpose, Structure, and Contents of the Book
• Part 1 | Mental Health Issues and Treatment
• Part 2 | Deaf Populations
• Part 3 | Deaf Children and Their Families
• Final Conclusions
• Contributors
• Index