Dr. Kim Mathos
Psychiatrist Consultant to the HealthBridges Team
For Deaf, DeafBlind and Hard of hearing people there have been some uniquely complicated issues. We will divide these topics into the following topics/subheadings:
- The new broad use of telehealth in access to technology
- Issues related to socialization and changes in group supports
- Issues related to heightened anxiety from seeing negative news events and watching constantly for information about the pandemic and case data
- Issues related to wearing a mask and major limits on capacity to speech read
- New need for adopting unique accommodations in work and social and mental and medical care access
Since March of 2020, telehealth has become the first line option for conducting visits between health care providers and the people they serve. Telehealth has been approved in most states for services provided by doctors, peer supports, case managers, and therapists. Telehealth has been approved by insurers in order to minimize health risk to both patients and providers related to COVID. Many patients have used telehealth because live patient encounters have been discouraged to minimize risk of spreading the corona virus. This service has many unique advantages for people who are Deaf. Native users of American Sign Language, ASL are at ease with the technology of such virtual platforms as Vidyo, Zoom and Doximity. In addition, native users of ASL are also used to communicating on video phones in ASL and often have internet and smart phone access.
One of the silver linings throughout the COVID pandemic is that many patients have appreciated the reduced costs related to gas, parking, time off work and confidentiality which are realities of the benefits of telehealth. The antithesis however is that, not all deaf and hard of hearing people have internet services. More disheartening is that people who have intellectual disabilities, serious mental illness, and other intersecting marginalization such as lower socioeconomic status or unstable housing, are often most inclined to not have such access to technology. Making matters worse, some mental health providers may also not have high levels of sophistication with technology or home access to videophones or webcams.
For some agencies, group therapies have been the mainstay of treatment and a transfer to virtual platforms of conducting groups has not been so graceful. Group homes and community-based habilitative aid service providers who work with individuals with developmental disabilities have had to alter their services dramatically. A new edict for minimizing crowd size has led to severe limits on group-based therapies. Such therapies are very important in the lives of Deaf and DeafBlind people.
Saul, a 55-year-old Deaf man who attended a therapeutic and social rehabilitation program, has been devastated that his day social rehabilitation program is shut down. He no longer eats, and he does not leave his home. He has lost thirty pounds since March and he has become a recluse. He came to live with his brother, but not knowing ASL, his sibling has become frustrated by his decline in functioning. Saul was hospitalized and is now receiving treatment for depression. Included as part of his treatment plan now are regular psychiatric treatment and frequent check ins with an individual service provider who meets with him twice weekly in order to provide access to language and socialization. The limit in his social contacts has clearly led him to develop profound depression.
For individuals who are DeafBlind in our community, a temporary ban on support group meetings had devastating consequences. The high need for close physical contact when engaged in communication with tactile based sign where the hand of the patient is in the hand of the provider has led some interpreters, support service providers and family members alike to be leery/cautious/guarded of communal gatherings and in home supports which have been the mainstay of social opportunities for our deafblind citizens.
For all people with hearing differences, mask wearing has led to less visual cues to enable communication. Everyone must wear a mask to prevent the spread of the COVID virus. Many people with hearing loss rely on speech reading in order to better understand what is being said and to read the intent and emotions of the person who is speaking to them. Such visual clues are no longer present because people’s faces are covered. As a consequence, many deaf and hard of hearing people report heightened anxiety and new feelings of depression for those inclined to such conditions. What is true, is that we are all learning new technologies to meet communication needs across the work place. Some work environments have been more inclined to make new adaptations to continue the workflow and some employers have recognized the need for a sense of continued unity among employees. Other employers have not been as aware of unique accommodations needed by employees with hearing loss at this time. In addition, some deaf and hard of hearing people have lost their jobs as many Americans have who work in industries which have been particularly hard hit such as private businesses, restaurants and malls. If you provide mental health services to people who are Deaf, DeafBlind of Hard of hearing, it is important to investigate the unique ways that COVID has impacted the lives of people that you serve and work to establish new ways to think about providing therapies that match consumer need.
Life is certainly different this year. The COVID virus has rocked our worlds. Changes in the economy, in our sense of security, and new concerns about health and wellness are very real to all of us. People who have few social supports have had the most negative mental health consequences from the COVID infection and the impact of mandated social distancing. In Pittsburgh, we aim to capture our experiences and observations documented by providers who serve people who are Deaf or are with hearing loss in the mental health care system during this difficult time.