Chance interpreters

As mentioned above, it is not rare for hospitals, even ones located in large multicultural cities, to be unable to provide professional interpreting services (Mirdal, Ryding & Essendrop Sondej, 2012).

Patients and providers may instead have to rely on a bilingual or multilingual bystander, or a member of staff of the hospital. Such individuals usually carry out tasks that have little or nothing to do with the activity of professional interpreters; they may work as a cleaner, janitor, household aid, security guard, member of the administrative staff, receptionist or technician. In her updated 2016 study, Hsieh calls individuals belonging to this category “chance interpreters”. The most notable difference between chance interpreters and family interpreters is that the former share no bond with the patient (they are not family members or close friends chosen or who volunteered to help the patient communicate with the provider).

Like family interpreters, chance interpreters typically have no formal training in interpreting, let alone language interpreting in a mental health encounter. In addition, they are often not fully proficient in the two languages (Kilian, Swartz, Dowling, Dlali, & Chiliza, 2014). The quality and accuracy of their renditions can therefore not be guaranteed (Giacco & Priebe, 2018).

Like other aforementioned groups, the use of this category of interpreter brings its own challenges.

A previous study (Messias, McDowell, & Estrada, 2009) suggests that in general, untrained interpreters (also dubbed “informal interpreters”) tend to see their role as that of someone involved in the life of the patient for whom they are interpreting. According to Messias et al., this creates a

“dissonance” (p. 131) in their interpreting roles. This means that the interpreter’s actions may switch from simply providing a linguistic service to actively siding with the patient and playing a more active role as the patient’s advocate. Untrained interpreters may understand their position as transcending the “technical provision of language interpreting”, to become more of a friend, helper or extended family member (Messias et al., p. 135; Flores, Laws, Mayo, Zuckerman, Abreu, Medina, & Hardt, 2003; Laws et al., 2004). Messias et al.’s study further suggests that this is also encouraged by the patients, who expect the unknown same-language speaker (who they often meet for the first time during the consultation) to become their ally or even their advocate. Studies have also suggested that untrained interpreters tend to speak “on behalf” of the allophone patient, thus playing a more active role in the consultation (Messias et al., 2009)

The “significant role dissonance” (Messias et al., 2009, p. 140) noted in the case of chance interpreters can be in part attributed to their insufficient knowledge of the profession and lack of training. While it is true that professional interpreters may too feel inclined to show solidarity for a particular group, they would likely be better prepared to bracket these feelings to remain fully professional. Indeed, professional interpreters are often faced with role dissonance dilemmas, but still perceive their role as one of “information transfer while maintaining professional boundaries” (Messias et al., p. 140).

Trained interpreters are more aware of these almost inevitable role dissonances, and seem to be therefore better equipped to deal with them in respect of the boundaries of the profession and its code of ethics. One could argue that health care providers should be aware of the role that a “stranger” may play in a consultation; whilst not inherently negative, their different attitudes and goals (e.g. acting not only as language broker role but also as active patient advocate) can indeed affect a consultation.

In a mental health encounter, the switch from an interpreting role to a more active advocating role may (even unconsciously) disrupt group loyalties and allegiances, therefore hindering the creation of a stable triadic relationship between the participants of a session (Bot, 2005a).

Unsurprisingly, the proficiency of an interpreter is essential in mental health encounters. The use of chance interpreters in this setting is cautioned against by Vasquez and Javier (1991), who highlight that untrained interpreters may make significant errors and gather inaccurate and misleading information. Again, these errors are not limited to their potential linguistic shortfalls. For example, an untrained interpreter may over or understate a psychopathology, and minimize or exaggerate a patient’s suicidality. The occurrence of distortions and errors of greater clinical significance made by untrained interpreters in mental health has also been observed in other early studies on the topic (Marcos, 1979; Price, 1975). In addition, it has been shown that even untrained interpreters with years of experience interpreting in mental health do not always provide quality interpretation services (Marcos; Price).

In mental health care, one could argue that the use of a chance interpreter does indeed jeopardize the successful construction of a relationship of trust between patient and provider; Bauer and Alegría’s systematic review (2010) reports that the use of non-professional interpreters may “impede disclosure of sensitive material” (p. 768) where the use of professional interpreters may instead facilitate it. A patient being reluctant to reveal sensitive information is not without consequences: this may leave them less likely to be referred for further care, and their diagnosis may not be accurate (Bischoff et al., 2003). In the same review, Bauer and Alegría add that the disclosure of psychological symptoms (as opposed to the disclosure of physical symptoms) may be more easily hindered by language barriers. This demonstrates how crucial communication, and therefore good interpreting, are in mental health encounters.