title: Intersecting Cultures in Deaf Mental Health: An Ethnographic Study of NHS Professionals Diagnosing Autism in D/deaf Children.
abstract: Autism assessments for children who are deaf are particularly complex for a number of reasons, including overlapping cultural and clinical factors. We capture this in an ethnographic study of National Health Service child and adolescent mental health services in the United Kingdom, drawing on theoretical perspectives from transcultural psychiatry, which help to understand these services as a cultural system. Our objective was to analyse how mental health services interact with Deaf culture, as a source of cultural-linguistic identity. We ground the study in the practices and perceptions of 16 professionals, who have conducted autism assessments for deaf children aged 0-18. We adopt a framework of intersectionality to capture the multiple, mutually enforcing factors involved in this diagnostic process. We observed that professionals working in specialist Deaf services, or with experience working with the Deaf community, had intersectional understandings of assessments: the ways in which cultural, linguistic, sensory, and social factors work together to produce diagnoses. Working with a diagnostic system that focuses heavily on 'norms' based on populations from a hearing culture was a key source of frustration for professionals. We conclude that recognising the intersectionality of mental health and Deaf culture helps professionals provide sensitive diagnoses that acknowledge the multiplicity of D/deaf experiences.
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. natassia.brenman@lshtm.ac.uk.
authors.forename: Natassia F
authors.identifier: http://orcid.org/0000-0002-6567-2129
authors.initials: NF
authors.lastname: Brenman
authors.affiliation: Department of Anthropology, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands.
authors.forename: Anja
authors.initials: A
authors.lastname: Hiddinga
authors.affiliation: Hull York Medical School and Leeds and York Partnership NHS Foundation Trust, Lime Trees Child, Adolescent and Family Unit, 31 Shipton Road, York, YO30 5RE, UK.
authors.forename: Barry
authors.initials: B
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D000884:Anthropology, Cultural; D001321:Autistic Disorder / Q000175:diagnosis*; D002648:Child; D065246:Culturally Competent Care; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D000070516:Intersectoral Collaboration; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration*; D019986:Persons with Hearing Disabilities / Q000523:psychology*; D006113:United Kingdom
keywords: Autism; Child and adolescent mental health; Deaf culture; Diagnosis; Intersectionality