from Medical News Today, March 2012
Deafness has a far-reaching impact on people’s social, emotional, and cognitive development. The condition is heterogeneous, and about 7 in 10,000 people are severely or profoundly deaf, with about 70,000 people in the UK alone being profoundly deaf. About 15 to 26% of the global population suffers from hearing loss; most of them come from the poorest countries. Most hearing impaired people see themselves as a cultural minority, the deaf community, that has to use sign language in order to communicate. A study in this week’s Lancet by Dr Johannes Fellinger and his team in Austria, demonstrates that deaf people are twice as likely to suffer from mental health problems, compared with the general population. The study also reveals disparities in terms of access to and the quality of mental health care that deaf people receive.
U.S. research has established that about one in four deaf students also suffers from other disabilities, such as learning difficulties (9%), developmental delay (5%), specific learning difficulties (8%), visual impairment (4%), and autism (2%). Fellinger and his team discovered that deaf children who cannot communicate efficiently within their own family have a four-times higher risk of being affected by mental health disorders, compared with those who can. Deaf children also have a higher risk of being maltreated at school. For instance, one study of deaf young Norwegian people revealed that deaf boys had a three times higher risk and deaf girls double the risk of sexual abuse compared with their hearing peers. Deaf patients have reported they mistrust, fear and are frustrated in health-care services, given that aside from having to overcome communication barriers in clinical situations, they also reported that deaf patients’ have limitations in accessing health information.
The researchers highlight two documents that can potentially reduce inequities in access to mental health care and improve the quality of services. The first document is the UN Convention on the Rights of Persons with Disabilities, which several countries have already approved and which describes the positive value of sign language. The second is the UK Government document Mental health and deafness - towards equity and access, which offers guidelines for best practice, that include establishing eye-contact with the patient, explanations with added visual elements, ensuring the patient has a good view of the speaker’s face, and avoiding simultaneous comments during examination. The document recommends treating each part of an examination process as an individual step, i.e. explain first what is about to be examined, examine the patient, and then explain what has been found. Fellinger and his team conclude:"Improved access to health and mental health care can be achieved by provision of specialist services with professionals trained to directly communicate with deaf people and with sign-language interpreters."
Dr. Andrew Alexander from the Royal United Hospital in Bath, UK, Dr Paddy Ladd from the Centre for Deaf Studies at the University of Bristol, UK, and Steve Powell from SignHealth in Beaconsfield, UK, emphasize in a linked comment that lip-reading is unreliable, writing notes inadequate, and British Sign Language (BSL) interpreters are rare amongst health-care settings for the deaf. They write:"Patients from the Deaf community have the same need for good communication and safe care as everyone else. Clinicians have a responsibility to recognize that communication is a two-way process, and that they need assistance to communicate with this group of patients. So what should you do when you meet your next patient from the Deaf community? Putting yourself in their shoes and asking them how best to communicate would be a good start."
The comment will be available for viewing in British Sign Language. The Lancet editorial summarizes:"The poor state of communication between the UK Government and medical professionals and patients must be addressed. Deaf patients face the prospect of a fragmented health service under the current Health and Social Care Bill. Fragmented services cause poor communication between agencies, and poor communication damages patient care.
If this government continues to ignore the warnings, a Deaf Clinical Network of the kind proposed by SignHealth will be more important than ever. Deaf people have long been denied the services they need. The Lancet looks forward to publishing more on the wellbeing of deaf people in future, and hopes to contribute to a new era of better communication and access to health care.”
The intersectionality of disability is a very important issue. Hopefully research like this will bring more much needed attention in medical communities to the joint experience of mental health problems and deafness, as well as other disabilities and physical illnesses.
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