The authors describe their effort to create a Deaf culturally affirmative psychiatric inpatient unit at a state psychiatric hospital in Massachusetts. A culturally affirmative program is defined as one based on Deaf cultural values. Four values are discussed in the context of how they could be translated into programmatic realities. These values are (1) that the least restrictive environment for serving deaf people is a Deaf environment; (2) that communication needs to be appropriate as well as affirming of the Deaf community; (3) that staff have to be recruited, hired and developed with the necessary cultural and clinical skills; and (4) that therapeutic approaches have to be specifically designed for deaf psychiatric patients.

The barriers to developing such a culturally affirmative psychiatric inpatient unit are presented along with some necessary compromises made as these ideas were implemented. Administrative issues pertinent to psychiatric inpatient work with deaf people include finding the balance between program autonomy and integration within the larger institution as well as working with unions, civil service, established hiring policies and affirmative action in order to hire deaf and hearing staff with the needed skills. Clinical issues include developing verbal and non-verbal therapeutic evaluations and interventions, balancing clinical and communication dynamics in grouping patients for treatment, using themes relevant to deaf people's experiences and understanding cross-cultural psychological dynamics between deaf and hearing people.