Language, culture, and task shifting – an emerging challenge for global mental health

Abstract

Language is at the heart of mental health care. Many high-income countries have sophisticated interpreter services, but in low- and middle-income countries there are not sufficient professional services, let alone interpreter services, and task shifting is used. In this article, we discuss this neglected issue in the context of low- and middle-income countries, where task shifting has been suggested as a solution to the problem of scarce mental health resources. The large diversity of languages in low- and middle-income countries, exacerbated by wide-scale migration, has implications for the scale-up of services. We suggest that it would be useful for those who are working innovatively to develop locally delivered mental health programmes in low- and middle-income countries to explore and report on issues of language and how these have been addressed. We need to know more about local challenges, but also about local solutions which seem to work, and for this we need more information from the field than is currently available.

Ad hoc interpreters in South African psychiatric services: service provider perspectives

“…One example of this problem is that there is currently no standard of care for work through and interpreter in the South African context [3]. It is also important to consider the ways in which the practice of psychiatry in a postcolonial context needs to be understood in terms of global economies of wealth and power [3,4,47]. This said, it is important if change is to occur to understand the everyday context of the work from the position of those doing the work [48].…”

“…Language and communication lie at the heart of good quality mental health care and are a vital, yet complex, part of the diagnostic and treatment process [1][2][3][4]. Words and the relationship between clinician and patient are two of the main components of mental health care [5].…”

“…Words and the relationship between clinician and patient are two of the main components of mental health care [5]. It is of central importance that mental health workers and patients understand what each other are saying [4,6]. Good quality health care relies on effective communication.…”

“…Communication generally happens through the medium of language. This enables patients to report symptoms to clinicians [4,7]. Language barriers pose a significant threat to delivering good quality health care, but also to the access of treatment, patient satisfaction, clinician-patient relationship, treatment adherence and health outcomes [8,9].…”

Reducing neurodevelopmental disorders and disability through research and interventions

“…Such intergenerational epigenetic mechanisms of psychiatric disorders necessitate evidence-based and sustainable community-wide treatment strategies to address these disorders within the foundational mother-child caring fabric of that society 29 . Task shifting will be a crucial strategy in addressing such community mental health support services 30,31 . There is evidence to support the effectiveness of a yearlong maternal carer training programme for children who are affected by HIV in rural Uganda to facilitate child development in low-resource settings, while remediating maternal depression and enhancing carer functionality 8,11 .…”