Language Discordance in Mental Health Services: An Exploratory Survey of Mental Health Providers and Interpreters

Abstract

Global migration has contributed to greater language diversity in many parts of the world. Many migrants experience language barriers in their adopted countries. Language barriers hinder access to healthcare, including mental health. There exists little research on the extent of communication difficulties during language discordant mental health services. A cross-sectional observational study design was used to examine prevalence of communication challenges, use of communication best practices, and training needs among mental health providers and interpreters working with immigrants with Limited English Proficiency (LEP) in the United States. Using snowball sampling methods, 38 providers and 34 interpreters were recruited to complete online surveys. Challenges reported by interpreters pertained to technicalities of communication, while those reported by providers pertained to content of communication. Communication best practices such as pre-session briefings and post-session debriefings were used infrequently by providers in the sample. Providers with higher education levels were more likely to endorse some best practices. Fifty-four percent of the providers and 84% of the interpreters were interested in additional training in working with patients with LEP. Findings suggest the need for customized trainings for providers and interpreters to improve the quality of mental healthcare for patients with LEP.

Navigating language discordance in public health care in rural South Africa: a qualitative descriptive study of occupational therapists’ perspectives

“…The findings illustrated the pragmatic and innovative approaches that the occupational therapists in a low resource context used to navigate a complex issue such as language discordance. There is evidence that other health professions use similar strategies to those identified in this study, for example, the use of interpreters and digital translation tools [ 8 , 10 , 12 , 60 ]. In addition, the participants used: videos to demonstrate instructions; non-verbal communication including gestures and demonstrating; doing action-based therapy; collateral information from patient files; visual aids; and short phrases or words in the service user’s language.…”

“…Using a trained interpreter or if not available, an informal one, has been reported as the preferred and often the only strategy that health professionals used to navigate language discordance [ 10 , 12 ]. However, in this study, participants did not have access to trained interpreters.…”

“…Language discordance has been reported to result in; difficulties in gaining informed consent [ 8 , 9 ], incomplete assessments [ 10 , 11 ], diminished rapport building [ 12 , 13 ], and safety risks [ 8 , 14 ]. Studies from South Africa show that poor communication between health professionals and service users stunted the appropriateness and acceptability of health care [ 15 ], especially in rural areas [ 16 ].…”

“…Several strategies used to mitigate the effects of language discordance have been reported. These include use of formal (telephonic included) [ 11 , 12 ] and informal interpreters [ 8 , 11 , 25 ], staff attending short-term language courses [ 26 ], professionals communicating using basic language and non-verbals [ 3 , 27 ], hiring more linguistically diverse staff [ 3 , 11 , 12 ], and translation [ 28 ]. However, these strategies have varying levels of effectiveness, ethical implications, and different logistical requirements across both well-resourced and under-resourced contexts.…”