One of the greatest challenges for psychiatry, the specialty that relies most on verbal communication, is treating the deaf and hard-of-hearing mentally ill. At this year’s Institute on Psychiatric Services in New Orleans, panelists discussed some of the key obstacles to good psychiatric care for this population of patients and how their needs are being addressed by public sector mental health providers in Chicago.

Teri Hedding is the statewide coordinator for mental health services for the deaf and hard of hearing in the Illinois Office of Mental Health. Using sign language, Hedding spoke through an interpreter on the challenge of providing effective services for the deaf mentally ill.

"Communication is the handicap, not deafness," said Hedding. Deaf people often mistrust hearing psychiatrists, in the reasonable belief that hearing persons often misunderstand the deaf. This, in turn, may contribute to misdiagnosis if the psychiatrist misperceives this rational mistrust as paranoia, she explained.

The only reliable method of communication between the mentally ill deaf and hearing health care providers who lack sign language fluency is use of certified interpreters trained in the lexicon of mental health, said Hedding. Other methods, including writing back and forth and lip reading, are unreliable, she said. Writing back and forth is cumbersome and assumes a literacy level that many deaf children accessing mental health services through the public sector do not have, Hedding said. Lip reading is simply ineffective, resulting in a loss of about 70 percent of the message.

Data from the 1990 national census found 103,500 deaf people in Illinois, of which 17,388 had a diagnosable psychiatric disorder, according to Hedding. Of those, 7,038 had either a "schizophrenic spectrum or major affective disorder," she noted. A total of 1,061 required psychiatric hospitalization in a six-month period.

A 1997 survey of Chicago area services for the deaf and hard-of-hearing by the Illinois Department of Mental Health found 1,113 deaf or hard-of-hearing adults and 236 deaf or hard-of-hearing children received services at Chicago area community mental health centers that year. Hedding’s personal observations were confirmed by the survey, which found the greatest barriers reported by respondents were lack of signing skills and lack of interpreters.

In the last few years, the state has moved to establish several special treatment centers for the deaf and hard-of-hearing mentally ill in the Chicago area, according to Hedding. Although there is still a dearth of such resources, there has been a "vast improvement" in the provision of mental health services for the deaf and hard of hearing in Illinois in the last few years, Hedding said. She is optimistic that things will continue to improve.

Psychiatrist Thomas Simpatico, M.D., who chaired the panel, is chief of the Bureau of Chicago Network Operations, which oversees mental health services for three area hospitals and about 80 community mental health centers serving more than 12,000 people. When it comes to identifying the need for psychiatric services for Chicago’s deaf and hard of hearing, said Simpatico, it is only recently that "providers have begun to collaborate with colleagues through a specialized subcommittee of the Mental Health Service System Planning Council of Greater Chicago." The subcommittee "helps them to be aware of each other and to coordinate their resources so that they no longer function as isolated islands of care for the deaf," Simpatico explained. "It also helps us know which services to purchase to augment existing services efficiently."

The subcommittee "has created a radically new spirit of cooperation and collaboration," said Simpatico. "It has brought the deaf community inside the machinery of the state in a much more systematic way, which means that services for this population can be implemented much more methodically." The new approach has eliminated the need for external advocacy since now the deaf and hard-of-hearing mentally ill "are an integral part of the state mental health system," he added.

In part two, Psychiatric News will look at Chicago’s innovative approaches to outpatient commitment and reintegrating the jailed mentally ill.