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March 1, 2005

Breaking through silence

From: - Hackensack,NJ,USA - Mar 1, 2005


Most people aren't fluent in Jermaine Newsome's language. That includes his parents and many of his doctors.

Newsome speaks in sign language. His deafness adds to the challenge of being schizophrenic. But thanks to ACCESS, a program based at Barnert Hospital in Paterson, Newsome, 30, is getting the counseling - and companionship - he needs.

Severe mental illnesses like schizophrenia and bipolar disorder occur at the same rate among the deaf and hard-of-hearing as they do in the general population. But services for the hearing-impaired mentally ill are scarce. ACCESS, which is funded by an $850,000 annual grant from the New Jersey Division of Mental Health Services, is one of only two community-based mental-health service providers in the state geared toward serving hearing-impaired people and their families.

A residential and outpatient program, ACCESS serves 150 people each month. To handle its diverse client list - adults with bipolar disorder, teens isolated from family and peers by communication barriers - the program's 22 employees require expertise in both deaf culture and the intricacies of treating people with an array of psychiatric problems.

"The range of deaf people mirrors the range of hearing people," says Lauri Rush, director of the Mental Health Center at Gallaudet University in Washington, D.C. "There are very psychologically healthy deaf people who are very successful and happy. Then you have, as you would in the hearing community, people struggling with depression, marital problems, financial issues and so on."

There is, Rush says, "a real paucity of services throughout the country" for people who are deaf and struggling with mental illness. So programs like ACCESS need to be multipurpose.

The only other community-based mental-health program for the hearing-impaired in the Garden State - South Jersey Behavioral Resources - is based in Camden. Greystone Park Psychiatric Hospital, in Morris Plains, has a 20-bed unit for in-patient services; the unit is equipped with closed-captioned televisions, TTY phones and has a clinical treatment team trained in American Sign Language and deaf culture. Greystone also has an eight-bed cottage-style "living unit" for the deaf and hard-of-hearing.

Other states have similarly limited services, an oversight that translates to a higher rate of misdiagnosis and under-diagnosis of mental illnesses among the hearing-impaired population, says Robert Pollard, associate professor of psychiatry and director of the Deaf Wellness Center at the University of Rochester.

"There is no blood test for a mental illness," Pollard said. "The mental-health field depends heavily on communication, more than any other medical field." He said that in some cases, particularly psychosis, mental illness manifests itself in disrupted language patterns. An untrained clinician may not recognize disordered communication in sign language.

ACCESS counselors are trained to recognize such instances. They make emergency visits to mental-health screening centers across the state to interpret and assess patients, deciphering when sign-language skills are underdeveloped, and when evidence of psychosis exists.

The counselors recognize the challenges faced by deaf and hard-of-hearing people: They know that some, especially immigrants, might not have had the opportunity to learn sign language or experience a deaf community. They know that some have been left out of family communication (a condition experts call "dinner table syndrome"). They know that 90 percent of deaf people are born to hearing parents, only a minority of whom become fluent in sign language. They know the psychological repercussions that can result from attending a school for the deaf - feelings of being outcasts - and the isolation that can arise from attending public school.

"Hearing people can be assigned to a counselor with a specialty," says Rush, of Gallaudet University. "Practitioners who work with people who are deaf need to be trained in every area. Commonly, you're the only provider in the area, so you have to be a generalist."

Michelle Cline, a senior mental-health clinician at ACCESS, can identify with that.

Cline, who is herself hard-of-hearing, is one of six counselors who meet with high-functioning deaf and hard-of-hearing patients on an outpatient basis. Some cope with mental illnesses ranging from anxiety disorders to depression and schizophrenia. Cline helps them understand their illness and their medications and helps them cope with relationship and communication problems.

"The goals for any person in mental-health treatment are always going to be individualized, whether they're hearing or deaf," says Carol Uckar, director of ACCESS. "But the general goal for any mental-health program is that the person be able to develop or enhance their skills so they can better cope with everyday life so they don't need (the program) anymore."

Jermaine Newsome, who experienced the onset of schizophrenia five years ago, is getting closer and closer to that point every day. After two years in Greystone, he was released in May 2004 and now lives in one of ACCESS' two subsidized apartments.

Every weekday, Newsome makes the 30-minute walk to attend a voluntary, partial-care day program from 9 a.m. to 3 p.m. at ACCESS. The program, Uckar says, is aimed at clients who are more seriously mentally ill than are outpatients. The group of 12 - some live independently or with family, others live in the program's eight-bed group home - participates in group-therapy sessions that cover everything from nutrition and medication regiments to money management and job-seeking. They also take practical field trips, learning to shop within budget at a local grocery store. Education about deaf culture and history is also an important component of the program, says Krista Epps, a mental-health clinician for the partial-care program.

For Newsome, it all seems to be coming together.

"I feel like I'm a good man here," he said, signing through an interpreter after a group-therapy session. "I'm into making the best out of my life and here, I feel like I do. But it's not like I want to be here forever. I expect to get a job. I want to become fully independent."

Reach Jessica Adler at (973) 569-7169 or

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