There is a need for mental health support in audiology and hearing clinics. Audiologists working in this space, DR BEC BENNETT and DR EMMA LAIRD, discuss barriers and facilitators to this care, research and upcoming interventions while Beyond Blue also provides tips.
Hearing loss and mental health are intricately linked, says Dr Bec Bennett, senior research audiologist at the National Acoustic Laboratories. For many adults, the experience of hearing loss is not only about struggling to hear but also about grappling with feelings of frustration, overwhelm, isolation, anxiety, and depression, she adds.
“While audiologists are well-versed in diagnosing and treating hearing loss, referring clients for mental health support remains a significant challenge,” Dr Bennett says. “Our recent study sheds light on this issue, exploring barriers and facilitators to mental health referrals in audiology clinics.
Dr Bennett also has a Graduate Diploma in Counselling. Her research includes social and emotional impacts of hearing loss and leading a program of work developing a digital self-management tool to address these impacts.
“Mental health problems, such as depression and anxiety, are common in individuals with hearing loss,” she adds. “Despite this, audiology professionals often feel ill-equipped to address these issues. The need for a more holistic approach to hearing care is evident.”
Audiologists are frequently the first point of contact for adults with hearing loss and are in a prime position to detect early signs of mental health issues. “Many audiologists report feeling unsure about how to initiate conversations about mental health, what referral pathways to follow, or even whether mental health support falls within their scope of practice,” she says.
Barriers to mental health referrals
The study identified key barriers that prevent audiologists from referring clients for mental health support including:
• Beliefs and awareness: Audiologists are aware that hearing loss can impact mental wellbeing, but some believe that hearing aids alone will resolve mental health problems caused by hearing loss. This belief may lead them to overlook the need for additional psychological support. Some hearing professionals are also unaware that discussing mental health is within their professional scope.
• Lack of training and knowledge: Many audiologists feel unprepared to handle discussions about mental health. They often lack the necessary training to detect signs of anxiety, depression, or other psychological issues and do not know how to refer clients to appropriate mental health services.
• Time constraints and resources: Audiology appointments are often time-limited, and clinicians may feel pressured to focus solely on technical aspects of hearing care. Audiologists may not have access to the necessary tools or resources, such as referral pathways or screening protocols, to address mental health concerns effectively.
• Client receptiveness: Some clients may not recognise the severity of their mental health issues or may be resistant to discussing them with their audiologist. In other cases, clients may not see the connection between their hearing loss and their mental health, making it more difficult for audiologists to broach the subject.
Facilitators for mental health referrals
Despite these barriers, Dr Bennett says there are several factors that can facilitate successful mental health referrals in audiology settings:
• Organisational support and culture: Audiology clinics that foster a supportive culture around mental health are more likely to see successful referrals. Having clear protocols for addressing mental health concerns, along with staff training and support from management, can make a significant difference.
• Collaboration with reception staff: Reception staff can play a crucial role in detecting potential mental health issues. They often have more informal interactions with clients and may be able to identify signs of distress that audiologists might miss during appointments.
• Comfort and confidence in discussing mental health: Audiologists who feel comfortable discussing mental health are more likely to refer clients for support. Building rapport with clients and validating their experiences can help audiologists feel more confident in addressing these issues.
• Training and education: Training audiologists how to detect and discuss mental health concerns can improve referral rates. Education on mental health impacts of hearing loss and support services can empower audiologists to take a more active role in their clients’ overall wellbeing.
“Hearing loss does not exist in isolation — it affects every aspect of a person’s life, including their mental and emotional wellbeing,” Dr Bennett says. “By equipping audiologists with the knowledge, skills, and resources to address mental health concerns, we can improve hearing outcomes and overall quality of life for individuals with hearing loss.
“As audiologists, we have an opportunity — and a responsibility — to take a more holistic approach to hearing care. It’s essential that audiology clinics adopt comprehensive mental health protocols and provide ongoing training for staff.
“Additionally, collaboration with mental health professionals can help bridge the gap between hearing and mental health care. With the right support, audiologists can play a pivotal role in addressing the mental health needs of their clients, ultimately leading to better outcomes for hearing and mental wellbeing.”
Luminear app improves wellbeing
Meanwhile a Melbourne innovation being trialled this year might soon be available to assist audiologists in helping their patients’ improve their wellbeing. Audiologist Dr Emma Laird has been working on a new digital program with Soundfair and The University of Melbourne that aims to improve the mental health and wellbeing of people living with hearing loss.
The Luminear app, developed by the university and Soundfair as part of Soundfair’s Hearing Wellbeing Program, provides mental health support for those with hearing loss through personalised programs.
Its online, self-guided, tailored program addresses wellbeing impacts of hearing loss and includes cognitive behavioural therapy plus acceptance and commitment therapy techniques.
Dr Laird says the NHMRC funded the program transfer from paper to digital. She says there’s potential for the finalised version to be funded through the Hearing Services Program (HSP) or government, with the goal to make it freely available and accessible to everyone with hearing loss.
“We would love audiologists to be able to use this as an additional tool,” Dr Laird says. “If they can’t address clients’ wellbeing concerns in an appointment or they don’t have the time or resources , they can recommend Luminear and the client goes home and does a personalised program.”
A small feasibility study found very good, unexpected results with a significant decrease in symptoms of anxiety, depression and stress. “We were expecting a change in wellbeing, rather than a decrease in psychological symptoms, but the strategies and techniques in the program are informed by psychologists and the program was written by two psychologists,” Dr Laird says.
“They use therapeutic techniques such as cognitive behavioural therapy and acceptance and commitment therapy, so it makes sense that depression, anxiety and stress reduced.”
Participants receive a fact sheet summary of their wellbeing including a graphic and can share this with their audiologist if they want, encouraging discussion and further support.
A clinical trial has now started in 71 people with hearing loss who may or may not have seen an audiologist. Half are randomised to Luminear where they answer a questionnaire, receive an online tailored program and reports of their wellbeing profile, and the rest watch videos that teach about hearing loss.
The trial aims to find out how effective the app is. “We’ll compare program participants with control participants and see what impact it has on wellbeing,” Dr Laird says.
“Participants will have access to the program to use as much as they want for three months. They’ll then do the questionnaire again at three months and six months to see if there’s changes and they are sustained longer term.
“Luminear addresses lots of different areas of where wellbeing might be impacted by hearing loss. There could be sensation of grief, and anxiety about interacting and communicating as well as how to ask people to respect your needs and make accommodations for you.
“There can be identity issues when you’re not quite part of the ‘Deaf with a capital D’ community because you don’t use sign language but you’re also not quite part of the hearing community.”
While useful for people who have brought up concerns emotionally or socially with their hearing loss, Dr Laird says the app also addresses acceptance of hearing loss for people who maybe aren’t talking about anxiety, but feel upset about their hearing. These people may be in denial or not wanting to deal with life with hearing loss, Dr Laird adds.
“People can access it regardless of whether they’ve seen an audiologist. There’s recommendations in the program to suggest seeing an audiologist if they have not seen one,” she says.
Dr Laird says the hope is to continue to provide it free to clients and for it to be funded under the HSP or a government scheme. “We’re still working out implementation but from interviews in the feasibility trial, we found people find a lot of value in it but there’s hesitancy when it comes to asking how much they’d pay for it,” she adds.
“Maybe it could be bundled with a hearing aid and a fraction of that cost goes with the hearing aid, but ideally we want to provide this for free through some kind of funding to keep it sustainable and online.
“We’re looking for additional grants and exploring options to improve and expand the program.”
Dr Laird previously worked at Soundfair and although now a La Trobe University audiology lecturer, she still volunteers for Soundfair’s Hearing Wellbeing Program.
Uncontrollable worry, low mood or social withdrawal
Beyond Blue is another good option. Dr Luke Martin, Beyond Blue clinical spokesperson, also says studies in Australia have shown there is a link between uncorrected hearing loss in older people and social isolation, anxiety and depression.
“Socialising can become difficult for people who have hearing loss. It can be harder to engage in conversation which can lead to worry, embarrassment and feeling cut off from others,” he says.
“It can also cause people to stop doing the activities they enjoy. This can have profound impact on people’s mental health.
“Connection is a basic human need, so it’s hard to experience positive mental health when we’re not feeling connected to friends and family. It is so important for us to find ways to ensure people with hearing issues can connect with others over common interests and to share stories.”
Dr Martin says Beyond Blue research shows that almost one in three Australians feel lonely. “People across all age groups in Australia appear to be having less social contact now than in the past two decades,” he told HPA.
“Hearing practitioners can help by being aware that their patients and clients are at an increased risk for experiencing mental health concerns, and to look out for any signs of concern, such as uncontrollable worry, low mood or social withdrawal.
“There is still stigma surrounding mental health issues so it’s important for health practitioners to openly discuss the topic with patients and clients. It’s helpful to ask how they are feeling and if they require any further support.
“We can let our patients and clients know about the mental health support services that are available. Some might not be ready to take that step yet, but you’ve planted a seed that free and confidential support is available. Beyond Blue is ready to talk when they are.”
Beyond Blue is focusing on early intervention and encouraging people to act early and not wait until their symptoms of anxiety or depression worsen. Its research shows more than half of Australians experiencing a mental health condition don’t seek professional support and those who do, often delay seeking support, often until symptoms are severe.
“The sooner people seek support, the more effective it is,” Dr Martin says.
**Beyond Blue Support Service is free and available 24/7, 365 days a year.
Deaf community assistance: Connect to the National Relay Service and ask to
be put through to Beyond Blue on 1300 22 4636. Call TTY (teletypewriter) on 1800 555 677 and ask for 1300 22 4636. Chat to a counsellor online at beyondblue.org.au/get-support.
Lifeline’s 24/7 Crisis Support is available on 13 11 14 or text 24/7 to 0477 13 11 14.
