Model Mental Health For Deaf and Hard of Hearing Individuals Bill of Rights Act
This Bill of Rights Act for the provision of mental health services to deaf and hard of hearing individuals is intended solely as a model for advocates to promote and for state legislatures to consider for codification into state law. Some words that are defined in this Act may already have definitions in existing state laws, and advocates and legislators are encouraged to refer to the definitions already used in their state laws. The definitions included in this model Bill of Rights Act are provided as one option, and may be compared against the prevailing definitions prior to submission to the state legislature for consideration of enacting this bill into law. Similar considerations should be accorded to structuring the state mechanism for oversight and funding of mental health programs directly serving the deaf and hard of hearing population.
SECTION 1.
This Act shall be known and may be cited as the “Mental Health for Deaf and Hard of Hearing Individuals Bill of Rights Act.”
SECTION 2.
(a) The Legislature finds that:
(1) Individuals who are deaf or hard of hearing, as a group, represent an underserved population in many respects, particularly mental health services; and
(2) Individuals who are deaf or hard of hearing often require highly specialized mental health services.
(3) Research shows that individuals who are deaf or hard of hearing are subject to significantly more risks to their mental health than individuals who are able to hear due to many factors including but not limited to: lack of communication access in general as well as with family members, educators, and treating professionals; lack of access to appropriate educational services; and lack of appropriate physical and mental health treatment services.
(4) Some individuals who are deaf or hard of hearing may have secondary disabilities that impact the type and manner of mental health services to be provided to such individuals.
(b) The Legislature further finds that:
(1) Being deaf or hard of hearing impacts the most basic of human needs, which is the ability to communicate with other human beings. Many deaf and hard of hearing individuals use a specific communication mode, sign language, which may be their primary language, while others express and receive language orally and aurally, with or without visual signs or clues. Still others lack any significant language skills.
(2) It is essential for the mental health well-being of deaf and hard of hearing individuals that mental health programs recognize the unique nature of being deaf or hard of hearing, and ensure that all deaf and hard of hearing individuals have appropriate and fully accessible counseling and therapeutic options;
(3) It is essential that deaf and hard of hearing individuals have mental health options in which their unique communication mode is respected and utilized, and the mental health professionals are proficient in the primary language mode of these individuals;
(4) It is essential that deaf and hard of hearing individuals have mental health options in which psychiatrists, psychologists, therapists, counselors, social workers, and other mental health personnel understand the unique nature of being deaf or hard of hearing and are specifically trained to work with deaf and hard of hearing individuals;
(5) It is essential that deaf and hard of hearing individuals have access to mental health professionals who are familiar with their unique culture and needs;
(6) It is essential that deaf and hard of hearing individuals are involved in determining the extent, content, and purpose of mental health programs and services;
(7) It is essential that deaf and hard of hearing individuals have programs in which they have direct and appropriate access to a full continuum of services, including, but not limited to all modes of therapy and evaluations;
(8) It is essential that deaf and hard of hearing individuals have specialized programs in which their unique mental health needs are provided for, including appropriate research, curricula, programs, staff, and outreach;
(9) Each deaf or hard of hearing individual should have a determination of the most accessible mental health treatment program and/or services that takes into consideration these legislative findings and declarations; and
(10) Given their unique communication needs, deaf and hard of hearing individuals would benefit from the development and implementation of state and regional programs for the mental health needs of such individuals.
SECTION 3.
The Legislature intends for the words used in this Act to have the following definitions:
(a) “Deaf individual” means an individual who has a hearing loss which is so severe that the individual has difficulty in processing linguistic information through hearing, with or without amplification or other assistive technology.
(b) “Hard of hearing individual” means an individual who has a hearing loss, whether permanent or fluctuating, which may be corrected by amplification or other assistive technology or means but nevertheless present challenges in processing linguistic information through hearing.
(c) “American Sign Language” means the visual language used by deaf and hard of hearing people in the United States and Canada, with semantic, syntactic, morphological, and phonological rules, which are distinct from English.
(d) “English-based manual or sign system” means sign systems which use manual signs in English word order, sometimes with added affixes that are not present in American Sign Language.
(e) “Oral, aural, or speech-based system” means a communication system which uses a deaf or hard of hearing individual’s speech and/or residual hearing abilities, with or without the assistance of technology or cues, to any extent possible.
(f) “Communication mode, style, and language” means one or more of the following systems or methods of communication applicable to deaf and hard of hearing individuals:
(1) American Sign Language;
(2) English-based manual or sign systems;
(3) Minimal sign language system to communicate with those who use home-based signs, idiosyncratic signs, or a sign system or language from another country;
(4) Oral, aural, or speech-based systems.
(g) “Primary communication mode, style, and language” means the communication mode, style, and language which is preferred by and most effective for a particular individual, as determined by appropriate language assessment undertaken by individuals proficient in the communication mode, style, or languages being assessed.
(h) “Culturally and linguistically affirmative mental health services” means the provision of the full continuum of mental health services to a deaf or hard of hearing individual through appropriately licensed mental health professionals fluent in the primary communication mode, style, and language as well as the cultural needs of the individual requiring such services. These services are provided directly between the individual being served and the service provider. Such services are to be distinguished from “accessible mental health services” defined in subsection (i) below, which involves the use of interpreters or other auxiliary aids and services that provide access to mental health providers and services.
(i) “Accessible mental health services” means the provision of the full continuum of mental health services with the use of auxiliary aids and services necessary for a deaf or hard of hearing individual to communicate with appropriately licensed mental health professionals who are not fluent in the primary communication mode, style, or language of the individual requiring such services. Such auxiliary aids and services include but are not limited to: qualified interpreters (utilizing whichever language or mode used by the individual in need such as ASL, Signed English, Cued Speech, or oral); Certified Deaf Interpreters; written communications, assistive listening devices.
SECTION 4.
(a) It is the intent of the Legislature that the State mental health authority shall ensure the provision throughout the State of all of the following:
(1) Implementation and maintenance of mental health programs or options that provide for appropriate culturally and linguistically affirmative mental health services to deaf and hard of hearing individuals in their primary communication mode, style, and language.
(2) Development, training, and maintenance of sufficient professionals needed to ensure appropriate culturally and linguistically affirmative mental health services to deaf and hard of hearing individuals in their primary communication mode, style, and language.
(3) Development, training, and maintenance of sufficient resources and professionals needed to ensure appropriate accessible mental health services to deaf and hard of hearing individuals in their primary communication mode, style, and language. Such professionals include but are not limited to: qualified interpreters certified or otherwise able to render effective communication in the mental health setting; relay or certified deaf interpreters; foreign sign language interpreters; occupational therapists familiar with such individuals’ unique needs; prevention specialists; chemical dependency counselors; social workers.
(4) Monitoring of all mental health programs subject to the jurisdiction of the State mental health authority to ensure that deaf and hard of hearing individuals of all ages are adequately served, including but not limited to: children in need of various services in school, private therapy, or hospitals; parents needing services to qualify for restoration of child custody; adults needing the full continuum of services; chemical dependency services for all ages; prevention and psycho-educational programs for all ages; and senior citizens in need of elder care services.
(5) Adequate funding of all mental health programs that provide appropriate mental health services to deaf and hard of hearing individuals.
(b) In geographical areas where there are insufficient mental health professionals adequately trained in any communication mode, style, or language necessary to treat deaf or hard of hearing individuals, the State mental health agency shall develop and implement strategies and plans to address such a need, including but not limited to:
(1) Permit treatment by qualified mental health professionals licensed by another state to treat or otherwise service the needs of deaf or hard of hearing individuals in this State.
(2) Permit treatment through technology (including but not limited to: videophones or tele-psychiatry or tele-medicine) which would allow deaf or hard of hearing individuals to get appropriate culturally and linguistically affirmative mental health services from mental health professionals who are licensed in this State or another state.
(c) No deaf or hard of hearing individual shall be denied access to appropriate culturally and linguistically affirmative mental health services in a particular communication mode, style, or language solely because:
(1) The individual has residual hearing ability, whether assisted or not; or
(2) The individual has previous experience with some other communication mode, style, or language.
(d) Nothing in this Code section shall preclude mental health treatment in more than one communication mode, style, or language for any particular individual. Any individual for whom treatment in a particular communication mode, style, or language is determined to be beneficial shall receive such treatment as part of the individual’s mental health services.
SECTION 5.
(a) To accomplish the goals of providing appropriate culturally and linguistically affirmative mental health services to deaf and hard of hearing individuals on a state-wide level, the State mental health authority shall employ at least one individual to coordinate these services.
(b) The Coordinator of state mental health services for the deaf and hard of hearing must be competent and be selected based on extensive experience in treating deaf consumers and an ability to lead. The Coordinator should have the following skills:
(1) Fluent in American Sign Language (ASL) and possess a thorough understanding of Deaf Culture;
(2) Have completed clinical training and possess a minimum of 5 years of experience providing direct services to deaf consumers with mental health needs;
(3) Possess a Master’s degree in a behavioral health or clinical field, with a preference towards individuals with a state board-issued license to practice independently;
(4) Know and understand applicable federal and state laws and regulations;
(5) Capable of or have experience in creating or integrating programs within the existing mental health service delivery system in the state in order to set up a true service continuum; and
(6) Demonstrate the aptitude to adapt and/or develop policies and procedures based on the actual service needs of the consumers.
(c) The Coordinator of state mental health services for the deaf and hard of hearing shall be responsible to ensure that there are appropriate culturally and linguistically affirmative mental health services to deaf and hard of hearing individuals on a state-wide level, and shall have the following authority:
(1) Ensure the provision of appropriate consultation, training, and technical assistance to mental health service providers in various settings such as inpatient, outpatient, and residential programs serving deaf consumers with mental health needs, addiction, or substance abuse;
(2) Serve as a skilled liaison with other state agencies or departments (e.g., behavioral health, health, and vocational services) for the collaboration needed to maximize the use of in-state resources and joint planning;
(3) Develop, oversee and directly supervise staff responsible for the statewide delivery of mental health services;
(4) Establish statewide mental health standards care for deaf consumers, including standards for ASL skills in mental health settings;
(5) Possess fiscal authority to create and distribute mental health funds or grants to public and private providers to achieve optimum service delivery within the system of care; and
(6) Collect and evaluate clinical and programmatic outcomes data from each mental health service provider serving deaf or hard of hearing individuals.
SECTION 6.
(a) Each consumer admitted for treatment must be assigned to an appropriately qualified staff member or clinical treatment team who has the primary responsibility for coordination/implementation of the treatment plan.
(b) The program shall have and implement written procedures to assure that consumers who are deaf or hard of hearing are provided culturally sensitive, linguistically appropriate access to services to include but not limited to the following:
(1) The first priority at all times is to provide each deaf or hard of hearing individual with direct mental health services by an appropriately qualified staff member fluent in the language or communication mode that the individual is most comfortable with, be it American Sign Language, Cued Speech, speechreading, captioning, or any other means. The State mental health authority and/or the coordinator of state mental health services shall establish guidelines to measure the proficiency of the direct mental health service provider in sign language or any language or mode of communication.
(2) Should direct mental health services not be available by an appropriately qualified staff member who is able to communicate directly with the deaf or hard of hearing individual, free language assistance shall be offered to consumers who are deaf or hard of hearing pursuant to Federal and State laws. All interpreters must be qualified to work in the assigned mental health treatment setting pursuant to standards set by the State mental health authority or the coordinator of state mental health services.
(3) While in-person interpreter services are optimal in most mental health treatment settings, the State mental health authority or the coordinator of state mental health services shall implement procedures that specify how services will be secured when in-person interpreters are not available, such as through the use of video remote interpreting (VRI) services. Whenever such remote interpreters are provided, the provider of mental health services shall be responsible for ensuring that the remote interpreters are appropriately qualified to handle interpreting of mental health services.
(4) If qualified interpreters (whether in-person or remote) are offered but refused by the deaf or hard of hearing individual in need of mental health services, the mental health service provider must secure a signed waiver from the consumer and place this waiver in the consumer’s file. Family members should not be used as interpreters under any circumstances as such individuals are not neutral or impartial.
(c) Diagnostic testing of deaf and hard of hearing individuals require expertise in the administration and interpretation of standardized objective and/or projective tests of an intellectual, personality, or related nature. Testing of consumers who are deaf or hard of hearing must be done by appropriately qualified mental health professionals with the requisite level of fluency in sign language or other mode of communication as defined by regulations, or by using an appropriately qualified interpreter as defined by regulations.
SECTION 7.
All laws and parts of laws in conflict with this Act are repealed.
Amended June 18, 2014 by NAD Board vote pursuant to NAD Council of Representatives Priority for 2012-2014 term, with great appreciation to the 2012-2014 Mental Health Expert Group of the Public Policy Committee.