Mental Health Services

Existing Services

At present, few states offer their Deaf populations a satisfactory continuum of mental health services that meet inpatient and outpatient mental health, cognitive or intellectual disabilities, and substance [Page 688]abuse needs. Major barriers to specialized services include the dearth of professionals fluent in ASL and trained to work with Deaf clients, funding and political challenges faced by statewide mental health programs and the widespread lack of qualified mental health interpreters. Many state-run programs accept only clients with severe mental disorders, while others refuse private insurance payment, restricting services to Medicare and Medicaid recipients. Additionally, some insurance companies limit Deaf clients to working with in-network plan providers, refusing to make accommodations to allow them to go out-of-network to obtain services from more appropriate and qualified therapists. Geography as a rule determines access, with most services located near major cities and almost none in rural areas.

Particularly noteworthy is the fact that many state programs serving Deaf people came into existence as the result of actual or threatened lawsuits. The Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990 (ADA) and other federal legislation gave weight to Deaf people’s claims for equal access to mental health services. The staying power of legal intervention can still have limits. In Maryland, for example, the National Association of the Deaf Legal Defense Fund and the Maryland Disability Law Center sued the state in 1982 for confining a Deaf patient with schizophrenia to 20 years of custodial isolation in a psychiatric hospital. The 1986 settlement spurred the establishment of the Springfield Hospital Center Deaf Inpatient Unit, which offered Deaf patients with severe mental illnesses 24-hour access to fluent signing staff members or certified interpreters. The program has since been terminated in recent years, converted to serving a small number of Deaf forensic patients. General population Deaf patients are now relegated to “mainstream” psychiatric hospital programs where language barriers impede communication with staff and fellow patients. Interpreters are available on a sporadic basis, primarily for doctor’s appointments and the occasional individual or group therapy session. What was once heralded as a model inpatient unit for Deaf clients no longer exists.

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