I awoke to the buzzing of my phone under my pillow. I was drowzy and chose to ignore it, flu tablets will do that to you. The buzzing was incessant and eventually I checked my phone to see what was up. It was my friend at the psych ward. My friends anxiety was extreme. Rapid fire texts virtually every ten seconds were coming my way. There was even a photo of a bald man. He had olive skin and was short and squat. He was standing at the door, feet slightly apart and arms folded. He was apparently the lead psychiatrist.
The psychiatrist and his team had arrived at my friends room to discuss her care. The promised interpreter was not there. My friend was livid in her anxiety. The texts did not stop:
” They are here there is no interpreter, they promised!”
” They are trying to write me notes I wont read them, I am tired, it’s not fair”
” Eight hours yesterday I wrote notes with them over and over. I am exhausted, no more!!”
“They are rude. Bad body language.Won’t listen to me. I want them out!!!”
They had apparently provided my friend with written notes which were promptly screwed up and thrown across the room. I sent my friend a text to show the doctors. The text simply said that my friend had appointed me as advocate and that I would be there later this afternoon. I stated that I would be happy to meet them. I am not sure what happened from there but the doctors seem to have decided that agitating my friend further was pointless and they left. I told my friend I would be there in the afternoon and implored my friend to cooperate as much as possible, at least until I got there.
I arrived about 1 pm and spent an hour talking to my friend. My advice was quite simple. I advised that it was possible that they had tried to get an interpreter but no one was available. Indeed my friend showed me one of the notes from the doctor that she had thrown in the corner. The doctor had been trying to inform my friend that an interpreter was not available, that they were trying to organise one and that they would come back later when they had more information.
It seems that an earlier booking had been made but had been cancelled. Why or by whom was not clear. I advised my friend that cooperation was essential as this would expedite treatment and allow support to be put in place. In the meantime I promised to meet with the doctor and try to get to the bottom of what was happening. There was grudging acceptance and agreement from my friend to cooperate with the treatment team. In the meantime I would attempt to make some sense of everything.
After meeting with my friend I sought out a nurse. I explained who I was and she was clearly aware that I may show up. She hurried to get the psychiatric registrar to meet with me. The registrar met with me straight away. My friend did not want to be part of the meeting. I have to say the registrar was fantastic. He explained that they were trying very hard to find an interpreter. They were putting in requests for bookings but it seemed that no-one was available. I offered to help out and asked if he could find out who they were booking through. He did not know.
We spent over an hour chatting with me. I was able to explain a little bit about deafness and how some people who were born deaf actually had English literacy issues that were not always obvious. I explained how this could impact on their treatment and diagnosis. He was aware of most of the information that I provided him but together we were able to identify some strategies to better assist my friend. One was having an advocate present to help explain some of the more difficult concepts and help my friend to provide more detailed information. He advised that an interpreter had been secured for the following day and I was to attend the meeting as my friends support person.
The meeting the next day was not without its dramas. Unsurprisingly my friend was extremely anxious. The lead psychiatrist was the same guy that had been standing defiantly at her door with his arms folded. My friend refused to look at him. Asked him to move over and have another of the team lead discussions. After a bit of a battle of wills he did indeed move over and a female led the discussions. My role was just to help with clarification or advise on deaf issues that may be relevant to the situation. By the end of the session the lead psychiatrist had managed to develop a strong rapport with my friend. He even apologised for his behaviour the day before. He admitted that he needed to learn more about his body cues and how a person who is visual might interpret them.
There have been other meetings with the psychiatric team. My wife and I have supported my friend at these meetings. A constant has been that the medical team are consistently frustrated at the inability to confirm interpreters. The team clearly follow the process and but their trust in the system. Somewhere this system breaks down. There is no easy answer to this. Interpreters at short notice are hard to get but certainly we need a system that can respond and communicate what is going on. The medical team were often left in limbo and frustrated. My friend even more so.
Obviously for accurate diagnosis clear communication is essential. For my friend this is an interpreter and a support person. The support person is crucial as it is difficult for the interpreter to step out of their role when misunderstandings might be happening,
In desperation to help my friend I even tried using social media to find interpreters. This is not something I would recommend generally and I certainly wont do it again. The interpreter that is used in a mental health situation must be highly experienced and qualified. Sure I would have ensured that anyone I identified met that criteria and I have the experience to know the who has the experience to meet this criteria. Nevertheless, using social media in situations like this is a risky strategy. It was a case of desperate measures for desperate times. But as I said, I don’t recommend anyone do this and I certainly wont again in the future.
But for many deaf people who may have literacy issues even an interpreter may not be enough. Some people born deaf have gaps in their conceptual development. Even though they may have strong Auslan skills they still sometimes have gaps in their conceptual development simply because they have not been able to access communication and language easily. In such cases support is needed beyond just an interpreter.
For example, yesterday my wife had to help my friend fill in a 200 question questionnaire that was part of my friends diagnosis and treatment. My friend admitted that many of the questions went straight over her head and would have been left unanswered. Without my wife’s support there is much valuable information that would have been missed.
I have learnt much from this experience. I have learnt that lack of access to communication and support for the deaf mental health patient can actually mean a longer stay in the ward than might otherwise have been necessary. I have learnt, particularly, that the treatment team will go above and beyond to seek advice and act on it. I learnt that the treatment team are hampered by systems. It is not just interpreter availability but the ability of the interpreter booking system that is in place at the hospital to respond quickly and communicate availability of interpreters. This has to change to become more responsive.
Mostly I learnt that when the system breaks down, particularly in a mental health crisis, the stress this causes the patient is immense. In no shape or form should a deaf person who is mentally ill and suffering from extreme anxiety be made to advocate for themselves. Sure some may be able to but many will not. This highlighted to me that we need specialist mental health services for the deaf that can assist the psychiatric team, not only with advice, but in ensuring that appropriate communication and support strategies are implemented.
Hopefully all of this will be on the table at the Lets talk About – Deaf People and Mental Health conference at Deakin University on the 16th and 17th November, 2015. Be there, register now by clicking on the link below:
THIS STORY IS TOLD WITH PERMISSION