What Do We Know About Deaf Clients After Thirteen Years of

Ambulatory Mental Health Care? An Analysis of the PsyDoN

Database, 1987-1999

Ed de Bruin, Ronald P. de Graaf

American Annals of the Deaf, Volume 149, Number 5, Winter 2004/2005,

pp. 384-393 (Article)

Published by Gallaudet University Press

DOI: https://doi.org/10.1353/aad.2005.0009

For additional information about this article

https://muse.jhu.edu/article/178275

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11148-AAD-Winter 04/05 1/5/05 3:31 PM Page 384

WHAT DO WE KNOW ABOUT DEAF CLIENTS

AFTER THIRTEEN YEARS OF AMBULATORY MENTAL
HEALTH CARE? AN ANALYSIS OF THE PSYDON
DATABASE, 1987–1999

L
ITTLE IS KNOWN about demographic, deafness-related, and diagnostic
characteristics of deaf and partially hearing people with psychosocial or
psychiatric problems. A study was conducted derived from data from
intake assessment interviews of people with hearing loss treated at a
Dutch ambulatory mental health center for the deaf between 1987 and
1999. Both sexes were equally represented. People who were postlin-
gually deaf, hard of hearing, below age 22 years, or above age 65 years
were less likely to ask for help than other groups in the study. Men pre-
sented more psychiatric disorders, and women more psychosocial
problems, especially partially hearing women. The authors recom-
mend stronger emphasis on mental health care for postlingually deaf
people, severely hard of hearing people, adolescents, and retirement-
age people. They also recommend development of skills for rational
and emotional self-expression in the education and rearing of children
ED DE BRUIN AND RON DE GRAAF with hearing loss.

In the past, very little was known
DE BRUIN IS HEAD OF PSYDON, THE
about the mental health problems of
NORTHWEST NETHERLANDS MENTAL HEALTH
deaf and hard of hearing people. Help
CENTER FOR THE DEAF AND PARTIALLY
for such problems was often inade-
HEARING, MENTRUM COMMUNITY MENTAL
quate, too. Care professionals were
HEALTH INSTITUTE, AMSTERDAM,
unfamiliar with the experiential world
NETHERLANDS. DE GRAAF IS A SENIOR
of deaf and partially hearing people,
SCIENTIST IN THE MONITORING AND
and were unaware of the role that
EPIDEMIOLOGY DEPARTMENT, PSYCHIATRIC
deafness could play in their emotional
EPIDEMIOLOGY UNIT, NETHERLANDS
problems. Most professionals could
INSTITUTE OF MENTAL HEALTH AND
not even communicate adequately
ADDICTION, UTRECHT.
with deaf people. Usually this resulted
in inadequate diagnoses and in unpro-
ductive or prematurely terminated
treatments (Gerber, 1983; McEntee,
1993; Steinberg, 1991). Some limited
information was available about the
mental health status of deaf people in
a few countries, among them the
United Kingdom (Adams, 1989; Den-
mark, 1966; Denmark et al., 1979),
Norway (Basilier, 1964), and the
United States (Althshuler, 1971).
In the Netherlands, this lacuna in
the social services to the deaf was
pointed out in 1988. At that time, social
work with deaf and partially hearing
people was done by deaf institutes,
which meant that adults with mental
health problems had to go “back to
school” to get help. Much has changed
since then. Social work services have
become independent of the deaf in-
stitutes, and the Regional Institutes for

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Community Mental Health Care
(RIAGGs) have set up five teams spe-
cialized in ambulatory mental health
counseling and treatment for people
who are deaf or partially hearing. Two
specialized residential facilities for psy-
chiatric treatment have also been
opened, one for adults and one for
children and adolescents (De Bruin,
1997). Most other Western European
countries have also seen numerous ini-
tiatives to improve mental health care
for deaf and partially hearing people
(Lawler, 1986; Meyers, 1993).
An estimated 11,000 people in the
Netherlands, or 0.74 per 1,000 inhab-
itants, have a severe auditory impair-
ment (De Graaf, Knippers, & Bijl,
1997). Recent research on the general
population of deaf and severely hard of
hearing people in the Netherlands has
found them to have a poorer state of
mental health than the general hearing
population (De Graaf & Bijl, in press).
In people who are prelingually deaf,
poorer mental health is particularly as-
sociated with additional physical or
psychological impairments, communi-
cation problems, low self-esteem, and
poorer acceptance of the hearing loss.
The RIAGG Centrum/Oud-West in
Amsterdam has had a separate sec-
tion for mental health care for deaf
and partially hearing people since
1993. It is known as PsyDoN (North-
west Netherlands Mental Health Ser-
vice for the Deaf and Partially
Hearing). PsyDoN’s catchment area
spans the provinces of North Holland
and Flevoland, which have a total
population of 2,640,000. The target
group includes deaf and partially
hearing people, their family mem-
bers, and the children of deaf adults
(CODA), but not people who have
become deaf from old age. To better
understand the nature and preva-
lence of the emotional and psychi-
atric problems facing the people who
call on PsyDoN, we developed a data-
VOLUME 149, NO. 5, 2004/2005
Page 385
base in 1989 in which we recorded a
wide range of anonymized informa-
tion about our clients (De Bruin,
Delpeut, & Sperber, 1989).
In the present article, we describe
the demographic, deafness-related,
and diagnostic characteristics of deaf
and severely hard of hearing clients
who applied to PsyDoN in the 13-
year period from 1987 to 1999. We
also analyze how demographic and
deafness-related characteristics in
combination may be linked to the
severity of mental health problems.
Because our data were collected over
an extended period, we further ex-
amine whether our client profile has
altered over time in terms of the two
major demographic variables, gender
and age.
Method
Sampling and Procedure
Deaf and hard of hearing clients who
applied to PsyDoN underwent a stan-
dard assessment interview (Adams,
1988; De Bruin et al., 1989), which
was conducted in Dutch Sign Lan-
guage (NGT) or in Dutch Supported
by Signs (NMG). The interview was
administered by a deaf or hearing
professional. The resulting data was
anonymized and input into a data-
base accessible only to authorized
persons.
The present article is based on the
data from the period January 1, 1987,
to December 31, 1999. A total of 288
clients applied to PsyDoN in that pe-
riod, including 214 from the intended
research population. (The remainder
were family members or CODAs who
either applied for mental health care
themselves or took part in someone
else’s therapy.) Since the database
first became operative in 1989, intake
data from 1987 and 1988 were later
taken from client files and entered
into the database in anonymized
form.
Measures
Four types of data were recorded at
intake: sociodemographic, deafness
related, communication related, and
mental-health related (psychosocial
and psychiatric).
Sociodemographic Variables
Demographic characteristics were
gender, date of birth, civil status, living
arrangements, place of residence, ed-
ucational attainment, current occupa-
tion, cultural origin, and nationality.
Deafness-Related Variables
Data related to the auditory impair-
ment were nature and cause of the im-
pairment, presence of other types of
physical or psychological impair-
ments, existence of other deaf family
members, and affinity with the hearing
and Deaf communities (Kyle, 1994).
The latter item was determined by the
interviewer on the basis of client self-
reports and the extent of the client’s
activities in the hearing or Deaf com-
munity, such as leisure-time partici-
pation in Deaf clubs. The distinction
between deafness and hardness of
hearing corresponded to a hearing
loss greater than or less than 90 dB.
Data on Communication
The data collected on communication
were mode of communication at in-
take and in various social situations,
and communication level (on a 4-
point scale). Communication mode
was categorized by the interviewer in
terms of the language mode used in
the interview. Communication level
was assessed by gauging whether the
client was “understandable” in “word
and gesture”; comprehension level
was not assessed.
Data on Mental Health
Problems
Psychosocial and psychiatric diagnoses
at intake were determined in accor-
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WHAT DO WE KNOW ABOUT DEAF CLIENTS?

dance with the DSM-IV classification
system (American Psychiatric Associa-
tion, 1994). The database allowed for
the entry of several Axis I scores, with
the most prominent symptom always
entered first. In the present analysis,
we used this primary Axis I diagnosis
only.
Data Analysis
X2 tests were used to identify statisti-
cally significant differences between
subgroups.
Results
Demographic Data
Over the 13-year period, the clients
(N = 214) were almost evenly distrib-
uted between females (108) and
males (106). Table 1 shows that the
large majority of both male and fe-
male clients were in the age category
22 to 65 years. About half the clients
of both genders were single at the
time of intake; about a third were
married or cohabiting. About three
quarters of the males and nearly half
of the females lived in Amsterdam, a
significant gender difference. As ex-
pected, most clients had received
their primary education in a school
for the deaf or a school for the par-
tially hearing, but it is worth noting
that as many as 7% had not finished
primary school at all. About three
quarters of the males and a little over
half of the females had completed
only lower vocational school after
their primary education. Significantly
more women than men had com-

Table 1
Demographic Data at Intake for 214 Deaf or Severely Hard of Hearing Clients, Northwest Netherlands Mental Health Service for
the Deaf and Partially Hearing (PsyDoN), 1987–1999

Males Females Total Gender differences

Age (years) n % n % n % X2 df P
0–21 25 24 19 18 44 21
22–65 79 75 86 80 165 77
> 65 2 2 3 3 5 2 1.31 2 .52
Civil status
Single 55 52 56 52 111 52
Married/cohabiting 31 29 34 31 65 30
Divorced 10 9 8 7 18 8
Living with parents 10 9 10 9 20 9 0.34 3 .95
Residence
Amsterdam 77 73 53 49 130 61
<50 km from Amsterdam 14 13 23 21 37 17
>50 km from Amsterdam 15 14 32 30 47 22 12.74 2 .002
Primary education
School for the deaf 68 64 75 69 143 67
School for the partially hearing 21 20 12 11 33 15
No primary school completed 8 8 6 6 14 7
School for the hearing 9 815 14 24 11 4.56 3 .21
Secondary and postsecondary education
Lower vocational 82 77 55 51 137 64
Middle secondary 4 4 16 15 20 9
Middle vocational 15 14 26 24 41 19
Higher education 5 5 11 10 16 7 17.12 3 .00
Employment
No paid employment 66 62 56 52 122 57
Paid employment 33 31 47 44 80 37
Student 7 7 5 5 12 6 3.59 2 .17
Cultural origin
Ethnic Dutch 76 72 85 79 161 75
Not ethnic Dutch 30 28 23 21 53 25 1.41 1 .24
Note. Because of rounding, percentages may not total 100 in all cases.

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pleted higher education. Nearly two
thirds of the males and more than half
of the females did not have paid em-
ployment. More than a quarter of the
males and more than a fifth of the fe-
males were of non-Dutch extraction.
Data on Deafness and
Communication
Table 2 shows that about three quar-
ters of the male clients and about two
thirds of the female clients were
prelingually deaf—that is, they had be-
come deaf before their third birthday,
before speech and language develop-
ment had gotten underway. Very few
postlingually deaf people (i.e., people
with hearing loss occurring at age 3
years or later) applied to the facility.
More than half the clients did not
know the cause of their deafness. The
vast majority had no additional physi-
cal or psychological impairments. A
similar proportion reported no deaf-
ness in their direct family line. Just un-
der half reported affinity with both the
hearing and the Deaf cultures. No sig-
nificant gender differences emerged
on these deafness-related variables.
During the initial assessment, the
clients were almost equally as likely to
use speech and speechreading as to
use some other language mode such
as NMG or self-devised gestures. NGT
was far less common. For social set-
tings such as the parental family,
school, or work, deaf clients reported
predominantly using speech and
speechreading. Interviewers assessed
communication levels as normal or
good in 61% of the male clients and
75% of the female clients. Significant
gender differences in communication
mode were evident for the specific en-
vironments of the parental family (fe-
males relatively more likely to use
speech and speechreading), school
(relatively more females using speech
and speechreading), and work (rela-
tively more females using NGT).
VOLUME 149, NO. 5, 2004/2005
Mental Health Diagnoses
Table 3 summarizes the psychological
and psychiatric presentations at in-
take, as assessed with the DSM-IV clas-
sification system. Notably, the milder
problem pattern “psychosocial prob-
lems” was significantly more prevalent
in females (50%) than in males (35%).
Anxiety disorders and substance use
disorders were significantly more
common among males, and schizo-
phrenia was marginally more com-
mon.
Associations Between
Demographic Characteristics
and Severity of Mental Health
Problems
As Table 4 shows, none of the variables
revealed significant differences be-
tween male clients with serious mental
health problems and males with milder
problems. Although higher propor-
tions of the more seriously affected
males were single, were hard of hear-
ing as opposed to prelingually deaf,
and used speech and speechreading
rather than NGT at intake, these differ-
ences were not statistically significant.
Female clients (see Table 5) with more
serious problems were relatively more
likely to be hard of hearing and less
likely to be prelingually deaf. They had
a nonsignificantly higher rate of paid
employment.
Numbers of Clients by Gender
and Age Over Time
Table 6 shows the numbers of clients,
differentiated by gender and age, who
applied to PsyDoN in two different pe-
riods, 1987 to 1992 and 1993 to 1999.
The year 1993 marked the launch of
the current organizational structure
and team composition of PsyDoN. In
the second period, the number of
clients under age 22 years more than
tripled for both genders. A sizeable ex-
pansion also occurred in the group
aged 22 to 65 years, which grew three-
fold for men and fivefold for women.
The group above age 65 years was tiny
in both periods. Overall, males consti-
tuted the majority of clients in the first
period (58%), but not in the second
(47%).
Discussion
We first wanted to know our clients’
characteristics in terms of demogra-
phy, auditory impairment, and mental
health problems. Viewed over the en-
tire 13-year period, PsyDoN served
about equal numbers of male and fe-
male clients. This contrasts with the
Dutch population study of deaf and
severely hard of hearing people we
have cited, which found that females
were more likely than males to use
some form of care, and also to use
mental health care services (De Graaf
& Bijl, 1999, in press). We have no
clear explanation for these divergent
findings. Interestingly, more than
three quarters of our male clients
resided in Amsterdam, against only
half of the female clients.
Another distinctive feature of our
clientele was its generally low level of
education. This was considerably be-
low the level found for the general
deaf population, although the authors
of the population study could not rule
out that better-educated deaf people
were overrepresented in their sample.
Their study did suggest that the less
educated deaf people were more
likely to use some type of care,
though not mental health services.
Based on our general knowledge of
our research population, we have rea-
son to believe that the education level
of our clientele is lower than that in
the general deaf population.
As we have seen, the over-65 age
category was very weakly represented
in our study. This is largely consistent
with the population findings, which
indicated that the oldest age group
was unlikely either to receive care or
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WHAT DO WE KNOW ABOUT DEAF CLIENTS?

Table 2
Data on Hearing Impairment and on Communication for 214 Deaf or Severely Hard of Hearing Clients at Intake, Northwest
Netherlands Mental Health Service for the Deaf and Partially Hearing (PsyDoN), 1987—1999

Males Females Total Gender differences

n % n % n % X2 df P

Type of auditory impairment

Prelingually deaf 78 74 70 65 148 69
Postlingually deaf 1 1 6 6 7 3
Hard of hearing 27 25 32 30 59 28 4.68 2 .10
Cause of impairment
Unknown 62 58 62 57 124 58
Virus infection 18 17 14 13 32 15
Genetic 11 10 14 13 25 12
Other 15 14 18 17 33 42 1.12 3 .77
Addition al impairments
None 89 84 91 84 180 84
One or more 17 16 17 16 34 5 0.00 1 .98
Hearing impairments in family
None 94 89 93 86 187 87
One or more cases 12 11 15 14 27 13 0.32 1 .57
Cultural affinity
Both hearing and Deaf culture 47 44 54 50 101 47
Hearing culture 35 33 29 27 64 30
Deaf culture 24 23 25 23 49 23 1.05 2 .59
Communication mode at intake
Speech and speechreading 51 48 45 42 96 45
Other language mode 43 41 41 38 84 39
NGT (Dutch Sign Language) 12 11 22 20 34 16 3.35 2 .19
Communication mode in parental family
Speech and speechreading 84 79 91 84 175 82
Other language mode 19 18 9 8 28 13
NGT (Dutch Sign Language) 3 3 8 7 11 5 6.11 2 .05
Communication mode at school
Speech and speechreading 77 73 93 86 170 79
Other language mode 24 23 13 12 37 17
NGT (Dutch Sign Language) 5 5 2 2 7 3 6.04 2 .05
Communication mode at work (present or past)
Speech and speechreading 95 90 86 80 181 85
Other language mode 8 8 5 5 13 6
NGT (Dutch Sign Language) 3 3 17 16 20 9 10.92 2 .004
Communication mode outside home, school, or work
Speech and speechreading 43 41 39 36 82 38
Other language mode 36 34 30 28 66 31
NGT (Dutch Sign Language) 27 25 39 36 66 31 2.90 2 .23
Communication level
Good 22 21 37 34 59 28
Normal 42 40 44 41 86 40
Fair 33 31 22 20 55 26
Poor 9 8 5 5 14 7 7.19 3 .07
Note. Because of rounding, percentages may not total 100 in all cases.

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Table 3
Diagnostic Data on 214 Deaf or Severely Hard of Hearing Clients at Intake, Northwest Netherlands Mental Health Service for the
Deaf and Partially Hearing (PsyDoN), 1987—1999

Males Females Total Gender differences

DSM grouping (Axis I) n % n % n % X2 df P

Psychosocial problems 37 35 54 50 91 43 4.99 1 .03
Adjustment disorders 17 16 18 17 35 16 0.02 1 .90
Depression 12 11 16 15 28 13 0.57 1 .45
Anxiety disorders 10 9 6 6 16 7 8.56 1 .003
Substance dependence/abuse 9 8 2 2 11 5 4.84 1 .03
Schizophrenia 7 7 2 2 9 4 3.00 1 .08
Other psychotic disorders 5 5 3 3 8 4 0.56 1 .46
Impulse control disorders 5 5 1 1 6 3 2.82 1 .09
Disorders of infancy, childhood,
or adolescence 2 2 1 1 3 1 0.36 1 .55
Somatoform disorders 2 2 2 2 4 2 0.00 1 .99
Sexual dysfunction 0 0 2 2 2 1 1.98 1 .16
Dissociative disorders 0 0 1 1 1 0 0.99 1 .32
Note. Because of rounding, percentages may not total 100 in all cases.

to report any unmet care needs. But
even in relation to those figures, our
over-65 clientele was extremely small.
The vast majority of our clients were
prelingually deaf. Substantially fewer
hard of hearing people, and virtually
no postlingually deaf people, applied
for mental health care. This came as no
surprise, since the facility had originally
been launched because prelingually
deaf people were thought to need spe-
cial attention. In the course of time,
the duties of the mental health care
teams were expanded to include other
types of people with severe hearing im-
pairments.
That such a large percentage of
clients used speech and speechread-
ing did not seem unusual, since deaf
education was long oriented to that
communication mode. At the same
time, one notices that NGT tends to be
used more frequently in environments
outside home, school, or work. This
raises the question of why deaf clients
nevertheless used more speech and
speechreading while talking to an
NGT-speaking professional. Possible
explanations are that clients may feel
that a professional will understand
their problems better if they are ex-
pressed in speech, or that the clients
themselves may have an inadequate
NGT vocabulary for articulating emo-
tional problems. Language teaching
about such skills is still not very well
developed (Kitson & Fry, 1990; Stein-
berg, Sullivan, & Loew, 1998).
The most prominent demographic
gender difference was in educational
attainment. Male clients were signifi-
cantly more likely than female clients
to have low levels of education, and a
(nonsignificantly) higher percentage
were outside paid employment. It
seems possible that deaf men were
(and still are) more commonly trained
for traditional manual trades, and
women for the care and clerical sec-
tors. Traditional low-skilled manual
jobs are increasingly scarce nowadays,
whereas deaf women may be finding
growing opportunities in the clerical
and service sectors—a supposition
that deserves further study.
In terms of mental health diag-
noses, female clients were more likely
to present with psychosocial problems,
and male clients with more serious,
psychiatric conditions such as anxiety,
substance use, and schizophrenic dis-
orders. This leads us to conclude that
even though similar numbers of males
and females applied for help, males
faced more serious mental health
problems than females, in addition to
doing worse on demographic meas-
ures such as level of educational at-
tainment and employment status. One
possible explanation for the severity of
males’ problems is that they may wait
longer than females before seeking
help for emotional difficulties, so that
the problems they finally present with
have become aggravated. It thus
stands to reason that a sizable group of
deaf males with psychosocial prob-
lems may now be going unnoticed by
professionals.
Demographic and deafness-related
characteristics in combination showed
little connection to the severity of the
mental health problems. The only ap-
parent association was that hard of
hearing females were more likely to
present with psychiatric problems than
prelingually deaf females. This is consis-

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WHAT DO WE KNOW ABOUT DEAF CLIENTS?

Table 4 problems. No such difference was

Diagnostic and Demographic Data on 106 Deaf or Severely Hard of Hearing Male found for females (who, as we have
Clients at Intake, Northwest Netherlands Mental Health Service for the Deaf and seen, used distinctly more NGT in
Partially Hearing (PsyDoN), 1987—1999, Differentiated by Severity of Mental work settings). How should we inter-
Health Problems
pret these results? Doornkate (1994)
Differences between found in her small-scale study that deaf
MDis a and PSoc b people who grew up using speech and
MDis a PSoc b X2 df p speechreading were more likely to re-
n = 69 n = 37 ceive mental health care than those
n % n % brought up with NGT. The latter group
Age (years) tended to approach problems more
0–21 15 22 10 27 positively and to use less professional
22–65 52 75 27 73 help in doing so. De Graaf and Bijl
>65 2 3 0 0 1.38 2 .50 (1999, in press) found that communi-
Highest level of education cation problems in deaf and hard of
Lower vocational or below 53 77 30 81 hearing people predicted a poorer
Middle vocational 10 14 5 14 state of health and a higher rate of use
Middle secondary 4 6 0 0
of care services, but they found no link
Higher education 2 3 2 5 2.62 3 .45
between the mode of communication
Employment
and service use (though this was not
No paid employment 45 65 22 59
the primary focus of the study). Hind-
Paid employment 20 29 12 32
Student 4 6 3 8 0.42 2 .81
ley (1993) similarly found no signifi-
cant connection between mode of
Civil status
communication and mental disorder.
Single 39 57 16 43
Married/cohabiting 18 26 13 35
Greenberg (1982) identified three
Divorced 6 9 4 11 major skills that deaf people need to
Living with parents 6 9 4 11 1.72 3 .63 effectively solve problems: (a) ade-
Type of auditory impairment quate communication skills, (b) the
Prelingually deaf 47 68 31 84 ability to recognize and understand
Postlingually deaf 1 1 0 0 one’s own feelings, and (c) the ability
Hard of hearing 21 30 6 16 3.25 2 .20 to accept other people’s point of view.
Communication mode at intake These skills have both linguistic and
Speech and speechreading 37 54 13 35 cognitive dimensions. Failure to ac-
NGT (Dutch Sign Language) 5 7 7 19 quire such skills at an early age could
Other language mode 27 39 15 41 4.67 2 .10 have lasting effects in adulthood, such
Cultural affinity as emotional problems. Greenberg
Both hearing and Deaf cultures 31 45 15 41 stressed that it is not mode of com-
Hearing culture 23 33 12 32 munication that matters, but personal
Deaf culture 15 22 8 22 0.04 2 .98
skills in communicating.
Notes. Because of rounding, percentages may not total 100 in all cases.
a
MDis, DSM mental disorder. A final focus of our study was on
b
PSoc, psychosocial problems. whether any changes occurred in our
client population over time. That in-
deed proved to be the case. A sharp
tent with population research, which sounds more intensely, and thus have increase occurred in the total number
indicates that the prelingually deaf are more trouble accepting their auditory of clients, as well as a relative increase
less likely to experience poor mental impairment. in the number of women in the 22–65
health than other types of deaf or se- Males with psychiatric problems age group. The most weakly repre-
verely hard of hearing people. One rea- were marginally more likely to commu- sented category remained the group
son could be that hard of hearing and nicate with speech and speechreading above age 65. A possible explanation
postlingually deaf people may miss the at intake than males with psychosocial is that this category of people is not

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being adequately reached by the pub- Table 5

lic relations efforts of deaf services— Diagnostic and Demographic Data on 108 Deaf or Severely Hard of Hearing Female
and by PsyDoN in particular. Clients at Intake, Northwest Netherlands Mental Health Service for the Deaf and
One limitation of the present study Partially Hearing (PsyDoN), 1987—1999, Differentiated by Severity of Mental
Health Problems
is that the data we report cover only
two provinces of the Netherlands and MDis a PSoc b Differences between
are possibly not representative of the n = 54 n = 54 MDis a and PSoc b
entire country. For this reason, the n % n % X2 df p
mental health care teams throughout
Age (years)
the country are now collecting nation-
0–21 9 17 10 19
wide data on deaf and partially hear- 22–65 45 83 41 76
ing people. It is to cover the 3-year >65 0 0 3 6 3.24 2 .20
period that started in 2001, and will be
Highest level of education
based on the interview forms used in
Lower vocational or below 27 50 28 52
the present study.
Middle vocational 10 19 14 26
A further limitation of the present Middle secondary 13 24 5 9
study is that the intake interviews Higher education 4 7 7 13 5.01 3 .17
were administered by different inter-
Employment
viewers, whose assessments may have
No paid employment 27 50 28 52
varied despite the standardized inter-
Paid employment 26 48 22 41
view schedules. A deaf interviewer, for Student 1 2 4 7 2.15 2 .34
example, might have judged a client’s
mode of communication differently Civil status

from a hearing interviewer, even if the Single 29 54 27 50

Married/cohabiting 17 31 17 31
latter were completely fluent in NGT
Divorced 4 7 4 7
(Young & Ackerman, 2001). Living with parents 4 7 6 11 0.47 3 .93
What implications do these find-
ings have for mental health practice Type of auditory impairment

with deaf and partially hearing people, Prelingually deaf 29 54 41 76

Postlingually deaf 1 2 5 9
and for PsyDoN specifically? First of all,
Hard of hearing 24 44 8 15 12.72 2 .002
our study has highlighted yet again
that low numbers of partially hearing Communication mode at intake
people apply for mental health serv- Speech and speechreading 24 44 21 39
ices, even though they are intended to NGT (Dutch Sign Language) 10 19 11 20
Other language mode 20 37 21 39 0.26 2 .88
be part of the target group—and even
though many are known to have seri- Cultural affinity
ous mental health problems (Den- Both hearing and Deaf cultures 24 44 30 56
mark et al., 1979). Postlingually deaf Hearing culture 16 30 13 24
people are even less likely to apply. Deaf culture 14 26 10 19 1.63 2 .44
Notes. Because of rounding, percentages may not total 100 in all cases.
This means that at levels of both policy a
MDis, DSM mental disorder.
and practice, the mental health care b
PSoc, psychosocial problems.
sector needs to put more effort into
reaching people with acquired deaf-
ness or with severe hardness of hear- therefore needs to put more emphasis Netherlands need to coordinate their
ing. The mental health care teams now on broad knowledge than on further programs more effectively, for in-
face both physical and therapeutic ob- specialization. To ensure the continu- stance by jointly developing and shar-
stacles: The target group is so diverse ance of a specialized range of mental ing their specialized expertise.
that it is virtually impossible to provide health care to all the different groups The growth of the PsyDoN clientele
optimal care to every subgroup. In fur- of deaf and partially hearing people, above age 65 and below age 22 has
ther developing its expertise, PsyDoN the five teams that now exist in the failed to keep up with that of other age

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11148-AAD-Winter 04/05 1/5/05 3:31 PM Page 392
WHAT DO WE KNOW ABOUT DEAF CLIENTS?
Table 6
Numbers of Clients Applying for Mental Health Care at Northwest Netherlands
Mental Health Service for the Deaf and Partially Hearing (PsyDoN), 1987—1992
and 1993—1999, by Gender and Age
1987–1992 (N=43) 1993–1999 (N = 171)
Age (years) Gender n % n %
0–21 Male 6 14 19 11
Female 4 9 15 9 vante achtergrondkenmerken [Deafness
22–65 Male 19 44 60 35
Female 14 33 72 42
> 65 Male 0 0 2 1
Female 0 0 3 2
segments. The lower level of represen- problem-solving skills. Several types
tation of young people is especially of informative and preventative pro-
puzzling, because PsyDoN maintains grams could also be developed, such
direct contacts, including consultancy, as social skills training courses or psy-
with a variety of organizations that choeducational programs that cover a
work with that age group. With one range of psychosocial problems and
such organization we are now planning mental disorders.
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