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Deaf & Hard of Hearing People Lack Access to Communication in Mental Health & Substance Use Treatment Facilities

November 1, 2022
Meg Brunner, MLIS
Citation: James TG et al. Communication access in mental health and substance use treatment facilities for Deaf American Sign Language users. Health Affairs 2022;41(10):1413-1422.
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Sign Language

What’s the Question?

Deaf and Hard of Hearing (DHH) American Sign Language (ASL) users experience significant disparities compared to non-DHH English speakers, partly caused by lack of access to accessible communication. Those disparities include higher rates of under- and unemployment and lower rates of having private health insurance and educational attainment, all of which are attributable to the oppressive system of “audism” (discrimination against DHH people) and associated with worse health outcomes. 

Importantly, DHH ASL users also experience higher rates of interpersonal violence, suicide, and a 2- to 3-fold higher risk for mood and anxiety disorders, lifetime trauma exposure, and substance use. 

Given all of this, providing accessible mental health and substance use disorder care for DHH people is vital. It’s also required by law for publicly-funded organizations under the Americans with Disabilities Act Section 1557. These federal regulations define what constitutes effective communication access and describe requirements to provide accommodations to DHH ASL users, including on-site ASL interpreters, web-based interpreting services (like remote interpreters on video sessions), and captioning services. 

There’s a lack of research on treatment facility language accessibility for DHH ASL users, so it’s difficult to say what kinds of services are being made available or how difficult it is for DHH ASL users to find facilities close to them that provide accessible care.

This study aimed to determine the scope of the problem by assessing ADA Section 1557 non-compliance among U.S. mental health and Substance Use Disorder (SUD) treatment facilities and examining geographic distribution by state of facilities that self-report not providing services in sign language to DHH patients.

How Was This Study Conducted?

Researchers used data from the 2019 National Mental Health Services Survey (N-MHSS) and the 2019 National Survey of Substance Abuse Treatment Services (N-SSATS), both administered by the federal Substance Abuse and Mental Health Services Administration (SAMHSA).

These two surveys represent a census of all known mental health and SUD facilities in the U.S. and provide information on whether or not a facility receives federal funds (making it subject to Section 1557) and provides services in sign language.

What Did Researchers Find Out?

Based on survey responses, researchers determined that a majority of both mental health (96%) and SUD (78%) facilities were classified as covered entities under Section 1557 (i.e., they received federal funds and were subject to Section 1557 requirements). 

Analysis also found that being a covered entity made a facility more likely to offer services in sign language; however, 41% of covered mental health facilities and 59% of covered SUD facilities were not actually doing so (compared to 77% and 85% of non-covered mental health and SUD facilities respectively).

Geographically-speaking, 50% or more of mental health facilities in 17 states were not providing sign language interpreters or other accessible communication for DHH patients. South Carolina had the lowest prevalence of non-compliant facilities (16%), and Wyoming had the highest (64%).  

For substance use disorder treatment facilities, 35 states had 50% or more facilities that were non-compliant, with Missouri having the lowest prevalence of non-compliance (23%) and Idaho the highest (88%).

What are the Implications for the Workforce?

These widespread geographical disparities in compliance, paired with existing disparities in mental health and SUD conditions among the DHH population, indicate an urgent need for facilities to remedy their non-compliance and ensure that their DHH clients are receiving accessible services.

Though some of the solutions to this issue need to come from the top – for example, policymakers need to provide increased funding and training to help facilities better access these services and expand efforts to grow the workforce of ASL-fluent providers - mental health and SUD providers can take an active approach to providing accommodations to DHH ASL users by talking to their clients about their communication needs and advocating in their own organizations for providing these services. 


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