Basic Competencies for Mental Health Interpreters

Basic Competencies for Mental Health Interpreters

Full-text article: " by Hans Buwalda Introduction Must be fluent in two languages, one of them English. The interpreter should be able to speak, understand, and write both languages. Must be culturally competent in all cultures he or she interprets for. Must understand the medical and ethical dilemmas in mental health services. Must be able to apply the ethics and professional rules to mental health care interpreting situations. Must be skilled in facilitating communication between patient and provider without becoming a barrier to building a treatment relationship. Must be assertive when needed to prevent communication breakdown. Must be familiar with the mental health setting and the mental health system. Must be familiar with the vocabulary specific to mental health services. Must be familiar with the terminology of interpretation. Must be skilled in sight translation. Must have extensive general knowledge. Conclusion Introduction By law, every person in Illinois has the right to access and receive quality mental health care regardless of the person’s fluency in English. The Center for Multicultural and Multilingual Mental Health Services is a program of Heartland Alliance for Human Needs & Human Rights, and is a contracted project of the Illinois Department of Human Services, Office of Mental Health. The Center’s goal is to ensure this access exists in reality. We realize that, while it is desirable that each mental health provider serve all clients in the client’s first language, this is not always possible. Very few mental health providers are bilingual, much less multilingual, and mental health professionals are seldom fluent in all the languages of all of their clients. The next best thing to a mental health provider skilled in the client’s first language is a skilled professional interpreter. A professional mental health interpreter is not just a bilingual person, but has knowledge and skills specific to the task of facilitating communication between clients and providers in the field of mental health. This paper describes the major competencies we believe that an interpreter in mental health care should possess. It is written from the perspective that poor or inadequate interpreters can seriously harm the quality of mental health services provided. Unlike sign language or Federal Court interpreters, there is no certification for health care interpreters or community interpreters in the State of Illinois. Currently, anyone considering him or herself bilingual can offer to interpret in health care settings. This is a major liability as it makes it impossible to monitor the quality of the interpreting services delivered. Heartland Alliance has developed special training to ensure quality interpreting services. Its Health Care Interpreting Services (HCIS) has developed a comprehensive 40-hour basic training program for health care interpreters. Mental health interpreters utilized by the Center for Multicultural and Multilingual Mental Health Services (hereafter, "the Center") must not only complete HCIS’ basic program, but must also complete an additional six-hour program designed by the Center specifically for those working in the area of mental health. Additionally, to facilitate proper interpreting by bilingual staff already employed by state mental health agencies, the Center has developed a 40-hour training program to ensure the quality of interpreting of mental health agencies’ bilingual staff. These trainings are designed to enhance the quality of interpreting services available to limited-English-speaking persons in need of mental health services. In addition to providing a wide range of information concerning interpreting practice and liability issues, trainers provide numerous exercises to help students practice techniques and define their role as interpreters throughout each training. In addition, cultural issues and dilemmas are extensively discussed. Trainers observe participants closely to monitor their progress. From this extensive experience in training skilled interpreters, we believe that each interpreter needs to have a set of basic competencies. These competencies are described below, and examples are provided to help illuminate each competency. Each mental health interpreter: 1. Must be fluent in two languages, one of them English. The interpreter should be able to speak, understand, and write both languages. Not every bilingual person can be an interpreter. A bilingual person is somebody who speaks two languages. However, in the United States, "bilingual" is a broad classification. The label "bilingual" does not distinguish between a person who took Spanish 101 or a person who was raised bilingual. It also does not specify whether the person is fluent in comprehension, speaking and writing, or in only one or two of these aspects of the language. The interpreters used by the Center through Health Care Interpreting Services (HCIS) have been assessed for their competency in speaking, understanding, and writing in both English and non-English languages before they can attend the training program for interpreters. The section for the foreign language is evaluated by a qualified speaker of that language. The results of this assessment indicate the extent to which a candidate is bilingual. Only candidates who demonstrate true bilingualism in all three areas --comprehension, speaking and writing– are allowed to enter the training program. Only persons who have completed the training program are utilized as interpreters by the Center. In some instances exceptions are being made to the rule of requiring written fluency in a language in order to qualify for the interpreter training. There are languages that do not have a written form such as Navajo. There are also certain immigrant and refugee groups in the Chicago area whose members are rarely literate in their dominant language, such as the Cambodians. In these situations, written fluency can not be required. 2. Must be culturally competent in all cultures in which he or she interprets. A competent interpreter in mental health is not only a language broker but also a cultural broker. This is extremely important. As the task of the interpreter is to facilitate communication, the interpreter must know not only the meaning of words in another language, but he/she must also understand the meaning of concepts in both cultures. Example: When a Guatemalan Mayan woman explains that she is listening to her ancestors who are giving her advice on how to solve her problems, the provider suggests that she is hearing voices. The interpreter must be knowledgeable about the culture of Guatemalan Mayans to explain to the provider that she may have to explore this more closely before concluding that the Guatemalan woman is hearing voices. In Guatemalan Mayan culture, it is common practice to ask wise ancestors for advice; it is not necessarily a sign of psychosis. It is important to note that although the same language may be spoken in different countries, words may have different meanings. An interpreter needs to educate him or herself on the meanings of different words in different countries to help avoid a breakdown in communication. Example: Spanish is spoken in most Latin American countries. This does not mean that a Mexican interpreter will be a suitable choice to interpret for a Peruvian as the Spanish spoken in the two countries differs. Another example comes from the Philippines. Tagalog speakers frequently use the Spanish word "siguru." In Spanish, it means "for sure;" in Tagalog, the same word means "maybe." In addition, when a Filipino says "siguru," he may actually mean "no," but is too polite to hurt the other person’s feelings by rejecting the suggestion directly. In Filipino culture it is thought rude to tell somebody "no," therefore many Filipinos will say "maybe" when they actually mean "no". 3. Must understand the medical and ethical dilemmas in mental health services. Interpreters may be met with ethical and medical dilemmas while on assignment in a mental health center. For example: When a doctor enters the room with a smile on his face and congratulates the young, unmarried Ethiopian woman with her pregnancy, the interpreter is shocked. Although he knows that everything said should be interpreted as closely to the meaning as possible, he decides that it would be unethical to interpret the doctor’s message. Instead, he stops the conversation and explains that, in Ethiopian culture, being pregnant while not married is cause for committing suicide to avoid shaming her family. Although the woman may not be clinically suicidal, there is a chance that she becomes suicidal when the issue of her pregnancy is not dealt with in a culturally appropriate manner. 4. Must be able to apply the ethics and professional rules to mental health care interpreting situations. Similar to other professions in the health care setting, interpreters have to abide by certain ethical standards and professional rules. Despite the fact that there is no official certification for medical interpreters--whether focused on health care in general, mental health, or working in the community-- there are certain standards agreed upon by trainers of interpreters. These standards are very similar to those of sign language interpreters: Interpreters must maintain confidentiality at all times. Example: Many of the immigrant and refugee communities are very small and it is likely that interpreters know the clients or their families. Interpreters have the same responsibility as providers regarding confidentiality and cannot give any information about the assignment. In fact, the interpreter cannot even disclose that the service was performed. An interpreter must interpret accurately. No information may be added or omitted. In addition, a professional interpreter will also convey the spirit of the message, and interpret in a way so that the listener will understand. Example: A client uses foul language and expresses her dislike for the provider. Even though the interpreter may feel uncomfortable about possibly offending the provider, s/he has to interpret as accurately as possible so that the provider gets all the information and can make an accurate assessment. Interpreters must not provide advice or give their own opinions. The interpreter facilitates communication only, and does not accept responsibility for the treatment outcome. The treatment remains the provider’s responsibility. Example: When the provider escorts the interpreter to the front door of the hospital after an assessment session, s/he asks the interpreter if s/he thinks the client spoke truthfully. The interpreter should decline to answer as it is not his responsibility to assess the client. Another example: The client wonders if the medication the doctor prescribed is good medication and asks the interpreter for advice. The interpreter explains that s/he is not able to answer those questions, but that s/he is willing to interpret for the client when the client requests an appointment with this doctor or any other doctor. 5. Must be skilled in facilitating communication between patient and provider without becoming a barrier to building a treatment relationship. Although interpreters attend an encounter to facilitate communication between the provider and the client, if they are not properly trained, the interpreter is likely to become a communication barrier. Trained interpreters know how to make sure the provider and client can build a solid treatment relationship despite the fact that they do not speak the same language. The major way of accomplishing this is by instructing the provider and client to address each other directly. The interpreter will then use the same form of speech as the speaker --first person. For example: Client: Ik kon vannacht helemaal niet slapen. Interpreter: I couldn’t sleep at all last night. Provider: Do you know the reason for that? Interpreter: Weet u waarom niet? Client: Er bleven maar gedachten door mijn hoofd spoken. Interpreter: I continuously had thoughts going through my head. As opposed to: Client: Vertel hem dat ik vannacht helemaal niet kon slapen Interpreter: He asks me to tell you that he couldn’t sleep at all last night. Provider: Can you ask him if he can tell me the reason for that? Interpreter: De doktor vraagt of uw weet waarom u niet kan slapen. Client: Zeg tegen de doktor dat er maar gedachten door mijn hoofd bleven spoken. Interpreter: He asks me to tell you that he continuously had thoughts going through his head. 6. Must be assertive when needed to prevent communication breakdown. When the interpreter notices that the provider and client are not understanding one another despite the fact that he/she is interpreting correctly, he/she needs to be assertive in asking to stop the communication to give him/her time to explain the cultural concept. In some cultures, it is uncommon to be assertive and interrupt a provider, but this is sometimes needed to facilitate communication. Example: A Cambodian client related that she "coined" her son when he had a fever. As the provider was not familiar with the cultural practice of "coining", the communication between the provider and client broke down despite the interpreter interpreting the information accurately. The interpreter stopped the interview, telling the client that she needed to explain the concept of "coining" to the provider. After the explaining the practice of "coining", and after confirming that the provider understood the concept, the provider and client were able to resume communication. (People who practice "coining" vigorously rub a coin on the affected area. "Coining" frequently leaves bruises that should not be confused with signs of abuse. In southeast Asian cultures, a parent who "coins" a child for minor aches or pains acts responsibly, just like an American parent who gives a child Tylenol.) 7. Must be familiar with the mental health setting and the mental health system. An interpreter who knows what to expect when going on an assignment can prepare him or herself for the encounter, improving the quality of the interpretation. Therefore, interpreters in mental health should be familiar with the titles and roles of the different mental health providers such as intake workers, psychologists, social workers, therapists, laboratory technicians, nurses, nurses aides, etc., and with the different types of organizations such as community mental health centers, private hospitals, state operated mental hospitals, etc. Many of these professions and institutions do not exist or perform different tasks in other countries and cultures. The interpreter should also be familiar with the different processes and practices in the mental health system such as intake, admission, treatment, etc. 8. Must be familiar with the vocabulary specific to mental health services. Mental health Services has its own vocabulary and jargon. In order to correctly interpret terminology used in mental health, interpreters should be familiar with the terminology in both English and the non-English language. Many concepts of U.S. mental health are not familiar in other cultures, and interpreters should be able to interpret them in a meaningful way to the client. Interpreters must therefore be knowledgeable about major diagnoses and symptoms, medications and their side effects, and the terminology used on the different forms that a client is required to complete and/or sign. Interpreters show professionalism when they ask the provider to describe a concept in different words when they not know the exact meaning. For example, in Vietnamese, there is no word for ‘depression’. The interpreter must know the symptoms of depression to interpret a question about depression. 9. Must be familiar with the terminology of interpretation. Professional interpreting is a profession with its own jargon, techniques, and underlying theories. The interpreter must be familiar with this terminology and especially with the following concepts, among others: References to interpreter’s languages: The A-language is the language that the interpreter is most comfortable with. Most often, this is the first language of the person or the language the person was raised with. The B-language is the interpreter’s second language. Example: For a woman who was born and raised in Germany and immigrated to the United States as an adult, German is her A-language and English her B-language. References to the languages used in interpreting situations: The target language is the language the interpreter interprets to. The source language is the language the interpreter interprets from. Example: A conference presentation is done in Spanish for a non-Spanish speaking audience in the United States. Spanish is the source language. The interpreter interprets the presentation into English for the listeners; English is the target language. In health care encounters, the source and target languages change all the time. If the client asks the provider a question in Spanish, the source language is Spanish. Then the interpreter interprets what was said into English, the target language. When the provider answers the question in English, English becomes the source language, Spanish becomes the target language. Interpreter Styles: Consecutive interpreting When using consecutive interpreting, one person speaks at a time. The speaker speaks in short sentences. When the speaker is finished, the interpreter interprets from the source language into the target language. This technique is the most commonly used form of interpreting in mental health services because it is the least confusing. It is more accurate than simultaneous interpreting for interpreters who do not have years of training, as do sign language interpreters, because when using the consecutive method, the interpreter does not have to listen and speak at the same time. Consecutive interpreting is also the least confusing technique for clients with mental illness who are often already confused and/or hear voices. There are a few times in mental health situations when simultaneous interpreting is used. Simultaneous interpreting means that the interpreter follows just a few words behind the speaker --both the speaker and the interpreter are speaking at the same time-- simultaneously. The technique is used when, in addition to the interpreter, there are more people in the room than just the provider and the client, or when the client is not able to speak in short sentences and cannot be stopped to give the interpreter time to interpret what was said. Example: A client is being interviewed by two persons, a psychologist and a social worker, and the two providers are discussing the situation among themselves. To assure that the patient understands everything, the interpreter will simultaneously interpret the provider’s discussion. The other way around is done as well. For example, the client is accompanied by his wife and, before answering a question, husband and wife discuss between themselves. While this discussion is going on, the interpreter will interpret simultaneously to the providers. Another example: The client is very emotional and speaks in a disjointed fashion and changes subjects quickly. It would be inappropriate to interrupt the client to give the interpreter time to interpret what was said. Instead, the interpreter interprets simultaneously. Relay interpreting is a technique that is seldom used and is very vulnerable to communication errors, but is sometimes the only way to communicate between clients and providers. Relay interpreting is used when the client speaks a language in which no bilingual person can be found who also speaks English in addition to the foreign language. In this case, two interpreters are needed to facilitate communication. For example, a Nigerian client speaks only Hausa, but no person can be identified who speaks Hausa and English. There is one person who speaks Hausa and Ibo, and there is one person who speaks Ibo and English. The question is asked by the client in Hausa, and is interpreted by interpreter 1 into Ibo. Interpreter 2 interprets the message from Ibo into English so that the provider can understand the question. And, of course, the reverse process takes place when the provider communicates with the client. 10. Must be skilled in sight translation. Although it is clearly preferable that all documents and information pamphlets are translated into the client’s language, this does not always happen. In these situations, the interpreter may have to do a sight translation of a document, which means that the interpreter translates a document from written to spoken language. It is essential that interpreters familiarize themselves with these documents prior to interpreting, as the language is frequently very technical, as in the case of patient consent forms. 11. Must have extensive general knowledge. Any topic can come up in an encounter between a provider and a client. It is very difficult to interpret what you don’t understand, therefore interpreters must be well-read and familiar with many issues and topics. Conclusion This paper highlighted competencies essential to providing skilled mental health interpreting ensuring access to quality mental health services for immigrants and refugees who do not fully understand the words and the culture of the mental health provider. For too long, untrained bilingual relatives and/or staff have been used to provide interpreting services for immigrants and refugees. This is inadequate in and of itself, and it can lead to retraumatization. The Center for Multicultural and Multilingual Mental Health Services in partnership with Health Care Interpreting Services providers quarterly interpreter trainings to provide high quality services in mental health settings in Illinois. By law, immigrants and refugees have the right to access and receive quality mental health care regardless of their fluency in English. Ensuring that interpreters have these basic competencies is a major step forward in providing high quality mental health service. Utilizing untrained personnel, volunteers, and family members can lead to misdiagnosis and inappropriate treatments. "

http://www.mc-mlmhs.org/

by Hans Buwalda

Each mental health interpreter: