South Africa has limited – almost non-existent – mental health services for Deaf people. Before a Deaf person can access counselling or therapy, a sign language interpreter must be arranged. This introduces an additional barrier to mental healthcare. 

“Often the issue is who should pay for the interpreter –  the Deaf person, therapist, or the government? Most of the time this issue is never resolved. Especially for Deaf people who are unemployed and uneducated, they are forced to bottle up their feelings,” says Jabulane Blose, executive director of the South African National Deaf Association (SANDA), an advocacy organisation established in 2004. 

There’s another side to this problem. There are few resources available to train people to become interpreters.

“The priority is not about training healthcare providers to become fluent in sign language. It’s about making interpreters available physically or remotely to healthcare centres and providers. At the moment, we have interpreters but they are not enough. There also aren’t enough of them who are trained in mental health,” explains Blose. 

SANDA estimates that the country has less than 200 sign language interpreters, while there are more than four million people who are Deaf or Hard of Hearing. It is unclear how many of the interpreters are trained in mental health.

No official figures

Professor Claudine Storbeck is the founder of the Centre for Deaf Studies at the University of Witwatersrand. She says that there is no official research available on the number of interpreters. Infact, the number could be much less than 200. 

In addition, many of these sign language interpreters aren’t formally trained, quality assured or skilled sufficiently in the specific areas in which they interpret. For example a sign language interpreter in a court case may not have any legal training. 

“There is also no official research on the number of people who are Deaf in the country. The census statistics are hard to see as accurate because the figure given includes all people [with any] disabilities. Many Deaf people don’t identify as a disabled.” 

Storbeck explains that the estimate of four million includes people born Deaf (profound or mild, one or two ears), those who become Deaf later due to genetic reasons or illness, those who become Deaf due to accidents, become deafened due to medication use (one of the potential side effects of TB medication/ oncology medication can sometimes be some hearing loss). The elderly who lose their hearing as they grow older are also part of this figure. 

Language as a barrier 

Blose became Deaf at the age of ten. Reflecting on his own experience of being born into a hearing family and growing up as a Deaf child, he says he didn’t have much information about mental health. 

The first time he went to see a psychologist was with his partner in his adult life, following a car accident that she had been involved in. She is also Deaf.

“It was difficult because we were struggling to follow the conversation. There was no interpreter present. The psychologist tried her best to understand and assist us, but she could only do so much. I wished I could give her more information.”

That was the first and only time that Blose sought mental health care. He says the difficulty in trying to find an interpreter has discouraged him.

“When a Deaf person sits in a room with a psychologist and there’s no interpreter, there is no cultural understanding. There’s no way for the psychologist to actually get a hold of the information,” says Ayesha Ramjugernath, South African Sign Language (SASL) coordinator and training facilitator at DeafSA, an organisation that trains interpreters. 

Ramjugernath was born Deaf to a Deaf family in Mpumalanga. Both her parents and her sister are Deaf. Being born into a Deaf family meant that Sign Language was her first language and she received a lot of support from her immediate community. 

As a child growing up, she says she never had any facilities with psychologists or counsellors who could work with interpreters. 

“I didn’t even know about mental health services because they were non-existent for Deaf children or adults,” says Ramjugernath.

“When I needed mental health services as an adult, I couldn’t afford an interpreter. The psychologist was a hearing person and we relied on lip reading. There were times when I would know the sign for the word but not know the word to express my feelings. I only went once or twice.”

Ramjugernath ultimately ended up relying on familial relationships as support structures when she needed this. 

Training interpreters for mental health 

Ramjugernath agrees that there are too few Sign Language interpreters in the country but notes that there is a need for interpreters who are trained in mental health counselling. 

She adds that there are currently only three Deaf people who have been accredited with DeafSA to become a Deaf counsellor for mental health. But there is a dire need for more. 

A Deaf counsel is a Deaf person trained to work in mental health as an advisor for the psychologist and for the Deaf client. 

SASL is a step forward

In May this year South African Sign Language (SASL) became recognised as the 12th official language.    

Blose hopes the official recognition will give the whole Deaf community access to education and health services, including mental health. Until now these have been a privilege or luxury mostly available to those who can afford trained interpreters.

“The official recognition will result in SASL being increasingly integrated into all facets of planning, policy and decision making. It will also facilitate inclusive development of Deaf people,” he says. 

Ramjugernath says that the recognition of SASL as an official language is the first step towards closing the gap between the Deaf community and mental health services. 

“Establishing more structures that encourage and motivate healthcare providers like psychologists and counsellors to learn SASL is the next step, and then having these same structures training existing interpreters to be mental health counsels can follow.” 

Interpreter for Ayesha Ramjugernath is Caitlyn Nair. 

Interpreter for Jabulane Blose is Thoriso Mndawe. – Health-e News