Working with interpreters in mental health: Are we lost in translation?

Dear Editors,

When there is a language barrier between patients and clinicians in mental health, interpreters can help ensure that communication is adequate to achieve high-quality care. Working with an interpreter can be an opportunity to broaden clinical perspective and to enrich knowledge (Tribe & Thompson, 2008). However, clinicians and interpreters often receive very little training on how to work together.

Guidelines recommend that prior to a patient consultation a clinician should meet the interpreter to explain the purpose of the consultation (Mental Welfare Commission for Scotland, 2013). The interpreter can be asked about cultural issues which may be of relevance (Tribe & Morrissey, 2004). The clinician should check that the interpreter and the patient do not know each other socially (Tribe & Thompson, 2008). During the consultation, confidentiality should be discussed with the interpreter present (Miletic et al., 2006). The clinician should speak to the patient directly instead of addressing the interpreter (Farooq & Fear, 2003). Speaking clearly and in short segments enables the interpreter to translate accurately (Tribe & Lane, 2009). After the consultation, the interpreter’s views should be explored without the patient being present (Farooq & Fear, 2003). The interpreter can raise linguistic or cultural issues and comment on the session (Mental Welfare Commission for Scotland, 2013). The clinician should explore the interpreter’s emotional response and offer support where needed (Tribe & Qureshi, 2013).

We aimed to evaluate if clinicians at Barnet, Enfield and Haringey Mental Health NHS Trust follow these guidelines and asked interpreters for their feedback. A total of 254 interpreters attending consultations were invited to complete a questionnaire following two monitoring periods (24 March–6 April 2014 and 7 April–20 April 2014). 46 responses were received.

In 33% of all consultations, the clinician met the interpreter before the patient consultation. If such a meeting took place, 73% of clinicians explained the purpose of speaking with the patient. 18% asked about cultural issues and 27% checked if the interpreter knew the patient socially. Confidentiality was discussed in 33% of all consultations. 85% of clinicians addressed the patient rather than the interpreter. 94% spoke in short segments, slowly and clearly. 36% of clinicians met the interpreter after the consultation, out of which 42% asked the interpreter to share their views on the consultation. 17% of clinicians explored the interpreter’s emotional response and offered support where needed.

Some interpreters made insightful comments using the free text box of the questionnaire, highlighting the importance of cultural issues when considering the presence and influence of spirits or apparitions or a lack of adaptation of memory tests which do not take into consideration the patients’ background, culture and education.

We believe that meeting an interpreter before and after a patient consultation can help gain a better understanding of the patient’s presenting issues. We encourage clinicians to make use of interpreters as a resource to gain a better understanding of the patient and to regard interpreters as members of the multidisciplinary team. Joint training sessions can help develop the working relationship, to improve communication with patients and to ensure high quality of mental health care.