Historical Overview of Inpatient Care of Mental Patients Who Are Deaf
Vernon, McCay, Daigle-King, Beth, American Annals of the Deaf
A review of published studies of deaf mentally ill inpatients is reported. While there are conflicts in the findings of some of the studies, several generalizations seem fairly universal across countries and time periods. For example, the data indicate a greater overall prevalence of mental illness in the deaf population than in the general population as a whole, based on the relative number of each group who are patients in psychiatric hospitals. In general, deaf patients have longer hospital stays. Characteristic symptoms leading to hospitalization of deaf people tend to be different from those of hearing patients. It was thought by most investigators that restriction of sign language use in schools was one reason for these differences. For both hearing and deaf inpatients, dual diagnosis (mental illness and substance abuse) is far more common today than in years past. All investigators found frequent misdiagnoses among deaf patients. The paucity of research on deaf inpatients over the last 2 decades is noted.
In the past, the care of hospitalized people with mental illness who were also deaf was a neglected area of psychiatry and psychology. This changed somewhat with enactment of the Americans with Disabilities Act (ADA) in 1990 and passage of related legislation at the state and national levels (Dubow & Geer, 1992). Public-interest attorneys have begun to initiate class-action suits using the leverage provided by these laws. Decisions in recent cases and precedents set by relevant decrees have resulted in a significant improvement in care rendered to patients who are deaf (Katz, Vernon, Penn, & Gillece, 1992; Raifman & Vernon, 1996).
Our intent in the present article is to provide a historical overview of treatment of hospitalized persons in special wards for patients who are both deaf and mentally ill. Included are the findings gleaned from the last 70 years, the period during which such services have existed. The issues involved are important because deafness has serious effects on general psychological adjustment and on the nature of mental illness in people with profound hearing loss (Vernon & Andrews, 1990). Furthermore, deafness, especially when it is of prelingual onset, provides an experiment of nature that yields knowledge of human behavior that can be generalized to the entire population (Braden, 1994; Vernon & Andrews, 1990; Vernon & Rothstein, 1968). Finally, an affluent nation such as the United States has an ethical responsibility to provide proper care to all citizens with mental illnesses severe enough to require hospitalization. This should include those mentally ill persons who are deaf.
As best as can be determined, until the late 1950s patients in the United States who were deaf and mentally ill were hospitalized in wards with other mentally ill people. Little or no support service was made available. In a very real way, this represented antitherapeutic custodial isolation of the deaf individual. In a sense, this was done more for the convenience of society than for the benefit of the deaf patient, who had been removed from the Deaf community and thrust into a hospital with psychotic patients with whom he or she could not communicate adequately. Once the deaf patient was in the hospital, treatment was usually provided by doctors, nurses, and support staff lacking sign language skills. It was, in many respects, the essence of a snake pit environment for a deaf person needing mental health care.
Past Research on Hospitalized Deaf Mentally III Patients
The first formal research reported on deaf psychiatric inpatients was a Norwegian study by Hansen (1929). Since then, in the United States and other parts of the world, nine other such investigations have been noted in the literature. In the present article, we review the major findings of these studies, recognizing that exact comparisons cannot be made between them due to changes in diagnostic categories, criteria, and terminology since 1929. …