The author was the director or co-director of a specialty Deaf psychiatric inpatient unit for 17 of its 23 years. This program was established as a culturally affirmative mental health program. The author reflects back on what this has meant and how the unit staff struggled to create a program that was both culturally and clinically competent. In Part 1 of this two-part article, the lessons learned about some unique clinical challenges are discussed. These involved the challenges of working with ASL competent deaf persons and with deaf persons with severe language dysfluency in their best language, sign. The question of whether some of the deaf clients have a unique clinical syndrome involving severe language deprivation and an array of psychosocial deficits and behavioral problems is also discussed.

Part II of the article discusses lessons learned about adaption of best practices in psychiatric rehabilitation for language and learning challenged deaf persons. In Part II, the author also reviews the lessons learned about staff and program development including the need to balance cultural and clinical competence and respond skillfully to Deaf/hearing cross- cultural conflicts.