The National Health and Nutrition Examination Survey has estimated that severe to profound deafness occurs in about 2-3 people per 1,000. The incidence of serious mental illness in the deaf population is thought to be about the same as in the hearing population—an estimated 5.3% among women and an estimated 3.0% among men. Scant research is available, but some investigators think the incidence of substance use disorders is higher in the deaf population as compared to the overall hearing population. Researchers have also found a higher prevalence of childhood trauma, which resulted in higher rates of suicide attempts and deaths, interpersonal partner violence, and obesity.
North Carolina is a national leader in that it has one of the largest specialized deaf mental health service programs in the country. Supported by the NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS), the statewide program offers a behavioral health benefit package to individuals who are deaf or hard of hearing. DMHDDSAS contracts directly with RHA Behavioral Health, which is a recognized provider in all LME/MCO provider networks (download a copy of the RHA brochure from https://files.nc.gov/ncdhhs/DHH%20Services%20Rev%202018%20Brochure.pdf.
RHA offers a benefit package to individuals that are deaf and use American Sign Language (ASL) and have a mental health and/or substance use disorder. Basic benefits include outpatient behavioral health services, peer support, outreach and support, case consultation and education, and contract psychiatry. RHA maintains six staffed sites—Charlotte, High Point, Lenoir, Raleigh, Wilson, and Wilmington—and accepts referrals from anyone including self-referrals. No health insurance is required. RHA staff see the consumer in one of their offices or at a location convenient to the individual. In addition to RHA services, Broughton Hospital has a Deaf Services unit, which provides sign language accessible behavioral health programming.
Equal access to publicly funded mental health and substance use disorders (MH/SUD) services remains challenging. Barriers to equal services remain in housing, the availability of community supports and Enhanced Services, and MH/SUD residential treatment services. Most community providers have little experience working with individuals who are deaf or hard of hearing, and due to costs, may not offer appropriate accommodations.
The National Association of the Deaf (NAD) has recognized the need for quality mental health services to be available to deaf and hard of hearing individuals. The NAD, researchers, and clinicians have promoted the building of trust between consumer and provider and the modification of existing evidence-based practices (e.g., cognitive based therapy) into culturally affirmative and linguistically accessible approaches to treatment. Dr. Robert Pollard, a well-known researcher, has argued that Deaf people have their own language (ASL), culture, and unique treatment needs. These aspects need to be considered in revamping educational materials and clinical practices.
The NC Division of Services for the Deaf and Hard of Hearing (DSDHH) has developed a series of fact sheets on topics including ASL and sign language interpreting, deafness, deaf-blindness, tips for communication, different types of hearing aids, and deaf support groups. These fact sheets can be downloaded from: https://www.ncdhhs.gov/document/dsdhh-brochures-and-fact-sheets.