While she was living in university accommodation, Catherine Dunn was raped.
She was referred to counselling by her accommodation service, but there was an important consideration they didn't take into account — Ms Dunn is deaf.
"There were no online booking options and I was frequently called despite clearly specifying that I do not use the phone," Ms Dunn said, via an Auslan interpreter.
"During sessions, I was communicating through spoken English, but was not able to communicate freely. I didn't feel culturally safe."
Ms Dunn said she knows there are some counselling services that are deaf-friendly, but it was never made clear to her if she could access a counselling service of her choice and still have it subsidised by the university mental health service.
At the time, Ms Dunn was not offered an Auslan interpreter to help her communicate with the counsellor, and she said she would be reluctant to use one for such a sensitive situation given the potential for a breach of privacy.
"As a deaf professional within my community, I know that the pool of Auslan interpreters is very small and that there are not enough opportunities for them to further their training within the mental health field," she said.
"Additionally, the deaf community is not unlike a small country town like the one I grew up in. Our privacy is hard to protect when you might bump into service providers at the supermarket or even at work."
About one in six Australians have hearing loss, with thousands of Australians using Auslan as their main form of communication.
Ms Dunn grew up in Horsham, Victoria. While her family know some Auslan, they weren't fluent.
"I used spoken English and lipreading in order to communicate. With virtually no access or adequate support, my mental health was drastically impacted," she said.
Due to barriers communicating Ms Dunn felt isolated and contemplated suicide. Concerned for her wellbeing, her parents arranged for her to move to Melbourne to live with a deaf host family and attend a Deaf unit in a mainstream school.
This move allowed Ms Dunn to communicate in Auslan on a daily basis.
"I had the opportunity to be fully immersed in [deaf] culture and Auslan for the first time. My mental health really improved," she said.
"I felt validated within my deaf identity. With a strong sense of who I am, I felt comfortable and confident within myself in how I chose to navigate the world."
Removing the frustration
Miscommunication or a lack of cultural awareness can have significant consequences for how deaf people are assessed for mental health conditions.
Karli Dettman is a deaf counsellor based in Melbourne.
"There is a higher percentage of misdiagnosis for the deaf population," Ms Dettman said, via an Auslan interpreter.
"For example, if a psychiatrist is observing a deaf person who is really angry when they're signing, the [psychiatrist] might misconstrue it as aggression. Whereas it really might just be the language or frustration with communication problems."
Ms Dettman believes that having more mental health professionals who are fluent in Auslan would improve the diagnosis and treatment of mental health conditions in deaf people.
"If you can communicate and make that language transfer easier," she said, "then you will remove that frustration that's underneath it."
Deaf mental health services in high demand
Karla Daly is a registered counsellor based on the Gold Coast.
Mrs Daly believes that this process should also include educating the general public about what it's like to be Deaf in a hearing world.
"There are people ... who still think a hearing device is the answer to a deaf person's mental health problems — it's simply not," Mrs Daly said.
"It's the system and the environments that deaf people grow up in that also create their mental health problems."
As a child of deaf adults (CODA), Mrs Daly grew up in a bilingual household, with her family communicating in Auslan and English.
"Being bilingual, my plan was to provide [counselling] services to both the deaf and hearing community. However, since starting my private practice word has gotten out fast and now all of my clients are Deaf and hard of hearing," she said.
"I'm very grateful that my service is being received really well by the deaf community, but it's also been quite challenging because my books are almost full.
"I am now putting people on waiting lists or trying to find other services that can support them. There is an extremely high demand for mental health services for deaf people and simply not enough professionals who use Auslan or who are deaf-aware to meet that demand."
Mrs Daly believes that it is important deaf people can access mental health services that are culturally affirmative.
"Health professionals in the wider community may think Auslan is 'English on the hands', but it's not," she said. "This is where concepts or diagnostic questions can become misunderstood if not translated correctly.
"The medical system needs to ally with [mental health] services and supports that are culturally affirmative to create a bridge and not a barrier."
Ms Dettman also expressed concerns about long waiting lists for deaf-aware mental health services and would encourage other deaf and hard of hearing people to train as counsellors.
"With my work, I am able to develop a rapport with my clients quickly. I have that understanding about the deaf experience," she said.
"My clients often say, 'It's a relief — finally someone who can understand me, I don't need to keep adjusting myself to make myself understood. I can just communicate in my own way.'"