Specialist help for deafblind people with mental health difficulties is still rare and yet we know that becoming isolated, including by being deprived of sight and hearing makes people much more vulnerable to serious mental health problems. In this article from the National Centre for Hearing Impairment and Mental Health in Oslo, Maj Volden, Specialist Psychologist, and Dr Hege Saltnes, Senior Psychiatrist, describe the support the services offer.

Our goal is to offer mental health support to people with sensory impairments that is just as good as anything available to the hearing population. We have a team made up of different professionals who offer assessments, diagnosis and treatment of a range of mental health conditions and psychosocial problems. In fact, in some cases we offer a range of services to our clients which go above and beyond the traditional psychiatric services, as we are well aware that many disabled people in Norway face difficulties in getting the treatment and support that they require from the national health service.

Who do we help?

The people who visit our unit are affected by deafblindness in many different ways and have a range of diagnoses. Some:

• are born deaf, or become deaf later in life;
• have become dual sensory impaired
• were born deafblind
• have cochlear implants.

They may communicate in all sorts of ways; sign language, spoken language, signed Norwegian, written communication, using technical aids or through an interpreter.

We ensure that the centre’s therapists have an acute awareness of the unique challenges facing deafblind people, and ideally can communicate directly with the deafblind person using their preferred communication method. Good therapeutic skills and the ability to document treatment methods are also vital. The number of people with acquired deafblindness in Norway is estimated at 300 (registered) so getting significant experience of a particular type of deafblindness, combined with a specific mental health diagnosis, isn’t easy, so an individual approach is vital.

In some cases, we feel that someone’s difficulties are primarily caused by isolation because they are not getting the right support services. In these cases, we work closely with other services to make sure that these are put in place.

How we help

We often work with someone who has suffered a sudden loss of sight or significant deterioration in vision. They may feel overwhelmed by strong feelings of sadness, anger and fear, feel unable to cope with simple tasks and their personal relationships may suffer. They can feel very lonely and frightened. (Nordeng 1998).

People like this haven’t had the chance to adjust over time to a gradual loss of vision and to develop coping strategies, so we try to help the patient to understand their reactions. It is important to empathise with their feelings of sadness and grief but at the same time to help them to feel hope for the future, offering concrete examples of how people in similar difficulties have overcome their situation. It is also important to remind an individual about how they have dealt with difficulties in the past, and to get their own coping strategies working again.

Today we know that people react in different ways at times of crisis. Strong feelings can come and go and there is no set path to follow. The individual situation is also significant, both in terms of their personality and environment. Consideration of the patient’s age is also very important. The worries of a young man starting his adult life are likely to differ from the worries of a middle-aged man leading a well-established life.

Different types of mental health problems

The experience of loss, disappointment and lack of stimulation can trigger depressive symptoms in many people. For acquired deafblind people, loss is often a particularly prevalent emotion. In assessing depression with deafblind people it is important to consider individual factors of vulnerability. For example, does the person have a history of loss? Do they struggle with low self-esteem?

In looking at the effects of the sensory loss and the patient’s life experiences, and taking into account their personality, we have been able to encourage individuals to widen their perspective so that they can understand their depression more fully, as well as demonstrating the numerous possibilities still available and within reach. The sensory loss may be permanent, but self esteem and coping strategies can change.

Depression is one of the most common conditions we confront. We believe that cognitive interventions have an effect in treating this and we combine this with advising the patient on ways they can manage stress. We also give them the chance to participate in various activities which will strengthen their relationships and rebuild their self-esteem. With moderate and grave depression anti-depressive medication may also be beneficial

Some of the deafblind people we support will have a psychotic illness, although this is not easy to assess (Hobberstad, 2010). People with a profound loss of vision and hearing do not receive the same sensory input as seeing and hearing people and some studies indicate that people with Usher are more vulnerable to psychotic breakdown than people in general. The reason for this is hard to tell as it is difficult to ascertain whether the psychosis is due to genetics, or to a person’s sensory deprivation. There is evidence that people experiencing sensory deprivation for other reasons can experience hallucinations, paranoia and anhedonia (an inability to experience pleasurable emotions). An individual’s personal predisposition will also contribute (Masons et al., 2009).

When assessing psychosis at our unit we have to ask the following questions:

• Does the person live in a situation of severe isolation and/or where they are unable to communicate with those around them?
• Is it possible that the person may have a personal predisposition to psychosis? Or do both factors contribute?
• Do other emotional strains contribute to the breakdown?

When we worked with a young man called `Paul’ at the centre for example, all these factors were considered. He had Usher 1, had other relatives with psychosis and didn’t have many opportunities to communicate with other people. He also had a cognitive functioning below normal. In this case, the support we gave him included supportive therapy, guidance for the staff where he lived, medication and work with his family.

For anyone who works with a deafblind person who is depressed, or perhaps has a psychotic illness, it is important that they don’t also start to feel hopeless themselves, what we call counter-transference reactions of hopelessness. A therapist who can see or hear can all too easily understand how a deafblind person can become very depressed given their situation.

For this reason, we encourage our staff to attend meetings with organisations for deafblind people, where they meet and talk with deafblind people who have been able to deal with their challenges, without developing severe symptoms of depression. With these resilient people in mind it reminds us of the possibilities out there and the achievements that all deafblind people can accomplish.

The National Centre for Hearing Impairment and Mental Health is part of Oslo University Hospital and consists of three units: for adults; for children and adolescents, for research and development. The centre serves patients from all over Norway with regional treatment centres in Bergen (west) ; Trondheim (middle) and a new unit is being developed in Tromsø in the north.

 The unit has no beds but cooperates with other clinical units if an individual needs a hospital bed. To be accepted for treatment, referral from a general practitioner or from another outpatient clinic is required.

This article appeared in Talking Sense, Summer 2010 Read other Talking Sense articles