This section aims to answer the research question of this MA thesis:
How do different kinds of interpreter affect a mental health encounter between a health care provider and an allophone patient?
Elements of response to this question are presented below, dividing according to the main macro-factors affecting a mental health care encounter.
How do communication skills affect the encounter?
It was previously highlighted that language skills and the ability to navigate across cultures are elements that affect a bilingual mental health care encounter. Individuals acting as interpreters may tackle these barriers in different ways. The literature analyzed shows that while some untrained interpreters may have the necessary language skills (which affect the quality and accuracy of their renditions), this does not directly translate into a satisfactory level of multicultural skills to make them competent culture brokers. This was identified as a possible issue for every kind of untrained interpreter explored in this study: family interpreters, chance interpreters and bilingual medical staff.
The findings regarding skilled bilingual health care professionals are of particular interest. These individuals are usually perceived as being the best solution in a bilingual medical encounter.
However, it has been shown that they too are not immune to the risks of overestimating their language and cultural skills, to the detriment of cultural and linguistic mediation. Professional interpreters, on the other hand, were found to be more aware of possible cultural and social barriers. Specifically regarding cultural barriers, face-to-face professional interpreters are able to share useful information with providers during briefings scheduled before and after the mental health encounter. In addition to fluency, other skills necessary for a good communication flow include health literacy, multicultural
sensitivity, understanding the importance of cultural differences and the ability to recognize different explanatory models.
How does the interpreter's perception of their role(s) affect the encounter?
The literature shows that different kinds of interpreter (for example family interpreters, chance interpreters or professional interpreters) tend to perceive their roles differently. Moreover, the other participants can also have different expectations of an interpreter according to the category they fall into. Participants may expect the interpreter to provide a purely linguistic service, or rather to help them in a more active way - for example to defend them or advocate for them. Moreover, an occurrence during the encounter may make the interpreter “switch” roles.
Since different kinds of interpreter have different goals in an encounter, it follows logically that they approach their work with differing strategies. The literature seems to support this; it was found that sticking purely to the role of a “language facilitator” is more difficult for chance interpreters and family interpreters. As professionals, trained interpreters are usually more aware of the possibility of role dissonance between that of a language facilitator and a more involved role. They are therefore able to tackle this issue more professionally, maintaining a more balanced approach to ensure successful communication. As the literature shows, this is mainly thanks to their training, their awareness of their professional role(s), their adherence to a professional code of ethics, and the importance with which they view (at least apparent) interpreter neutrality.
While this thesis does not take as its main focus a typology of the roles adopted by an interpreter, nor does it attempt to identify the best role for a health care interpreter to adopt2, one could argue that
2 For a better insight on the variety of roles assumed by interpreters, please refer to the studies of Hsieh Bilingual health communication: Medical interpreters' construction of a mediator role (2005)
both patient and provider should be made aware that different kinds of interpreter tend to adopt different approaches when interpreting. A better understanding of the activity of a professional interpreter, and the importance that professionals give to privacy and confidentiality, could help avoid uncomfortable situations that can arise during a mediated exchange. It could also help to avoid misunderstandings that arise due to the patient’s and provider’s potentially incompatible expectations of the interpreter.
How does interpreter availability affect the encounter?
The studies examined for this project highlight the fact that, often, the demand for professional interpreters is greater than their availability. Even when professional interpreters could be hired for a consultation, untrained interpreters may by preferred instead because of their more immediate availability. This preference may arise, for example, if a professional interpreter were to arrive late to an encounter or become suddenly unavailable; the inconvenience creates a snowball effect in the hospital, and this negative experience could deter the hospital from employing a professional interpreter in the future. Moreover, the limited availability of professional interpreters can affect and, in some instances, disrupt bilingual encounters. Encounters with professional interpreters risk being rushed or not properly conducted (it is worth mentioning once again the importance of briefing sessions for the mental health provider and interpreter), with serious effects on the outcome. It has been demonstrated that the rise in availability of remote interpreting services could contribute to tackling this problem. However, it is also important to ensure that no technical problems arise during the call. Moreover, it has been shown that often, the physical unavailability of these interpreters has a negative impact on the encounter, with interpreters being less involved and more distracted. It is worth noting that in the field of mental health, these issues were often found to be quite present.
Another related issue is the fact that often the same interpreter cannot follow the same patient throughout all of their mental health encounters. This hinders the development of a relationship of trust between the three main participants. In mental health care encounters, the relationship between the three participants is of paramount importance and can greatly impact the health outcome of the patient, as explained in the section below. One could argue that this is an issue found both in face-to-face interpreting and telephone interpreting settings (Hadziabdic, Heikkilä & Hjelm, 2009).
That being said, one could argue that availability should not be the sole reason for choosing one kind of interpreter rather than another, but health care providers may benefit from a greater level of awareness of the possible repercussions of the (lack of) availability of each kind of interpreter on the actual encounter.
How does the creation of trust between the participants affect the encounter?
Trust underpins every medical setting, and, unsurprisingly, mental health care encounters add yet another layer of complexity to the issue. The main elements that were identified as influencing the construction of trust were the relationship between patient and interpreter, working conditions (in person or remote), adherence to a code of ethics, and the interpreter’s perception of their role. It is once more important to stress that the trust-building process between the three participants of an interpreted encounter depends heavily on what is discussed during the encounter. The importance and peculiarity of trust in mental health care is further highlighted by the fact that trust-related issues may arise even with professional interpreters who abide by professional standards (which, as already explained in Chapter three, include the ethical concepts of impartiality and confidentiality): patients may still feel uncomfortable with professional interpreters, and may therefore refuse their assistance.
It is therefore essential to ensure that both provider and patient are aware of the potential risks and
implications on the trust-building process of each different kind of interpreter, especially in a setting as sensitive as a mental health care encounter.