Face-to-face (or in-person) professional interpreters

According to the existing literature, employing a professional interpreter is one of the best ways of overcoming linguistic and cultural barriers in health care (along with the availability of a bilingual provider.) Flores (2005) and Karliner, Jacobs, Chen and Mutha (2007) add that employing professional interpreters rather than non-professional interpreters has a positive impact on a bilingual

health care consultation. The same researchers also conclude that providing professional interpreter services can improve patients’ quality of care, the treatment process, health outcomes, patient satisfaction, and adherence to follow-up appointments (Flores, 2005; Karliner et al., 2007). In some studies, researchers have found that the overall experience of allophone patients benefiting from face-to-face interpreting services is no worse than – and may even prove better than – that of patients who speak the provider’s language (Andrulis, Goodman, & Pryor, 2002; Tocher & Larson, 1996 in Hsieh, 2015a). The importance of a good-quality language service is also highlighted by health care professionals. Priebe et al.'s 2011 study, based on structured interviews with European health care professionals on good practice in migrant health care, shows that 91% of interviewees identified good interpreting services as components of good practice. Only one other element was more widely identified (by 98% of interviewees) as being part and parcel of good practice: “organisational flexibility with sufficient time and resources”, itself encompassing the availability of face-to-face interpreters (Priebe et al., 2011, p. 7).

Despite the arguable advantages of using in-person professional interpreters, this practice does have drawbacks: namely administrative procedures and time constraints (Hsieh, 2015b). The latter is a noticeable problem voiced by members of hospital staff such as nurses and doctors. Indeed, the availability of professional medical interpreters is rather low (Brisset et al., 2014), and the unavailability of on-site professional interpreters can disrupt providers’ schedules. The delay caused by waiting for an interpreter risks creating a snowball effect on the hospital as a whole. Even in mental health care, for example in psychiatric hospitals, it is not uncommon for providers to find themselves in situations that require health care professionals to intervene immediately. This leads many providers to prefer using bilingual staff or family interpreters, even when they are aware of the potential issues surrounding their use (Giacco, Matanov, & Priebe, 2014; Meyer et al., 2010).

From an ethical point of view, the use of professional interpreters is preferable compared to the use of family interpreters. As professional interpreters abide by a code of ethics, providers feel that they can trust them more than they could trust family members or friends of the patient. An oncologist interviewed by Hsieh (2016) is reported as saying that this adds an “extra level of protection” (p. 206) during an encounter, thus mitigating the risk of malpractice and subsequent litigation. It is unlikely, for example, that a professional interpreter would lie about what was previously said between the patient and the provider. Other types of interpreter who are not bound by rules of conduct, on the other hand, could lie about information exchanged and then deny that such misinformation had ever occurred (Brisset et al., 2014).

However, the issue of trust is still present. Several studies have highlighted the fact that some clients refused to have an interpreter present because they knew that said professional interpreter belonged to their own minority community (Foundation House, 2012; Fidan, 2017). This occurred when both interpreter and client were from relatively small immigrant communities, and proved common amongst refugees and asylum seekers (Foundation House, 2012; Fang, Sixsmith, Lawthom, Mountian, Shahrin, 2015; WHO, 2018). A possible reason for this is that such individuals may be less trustful towards their own established communities in the host country; in several cases, clients explained their refusal by saying that they were afraid the interpreter would disclose the content of the session to their community, or that the interpreter would judge or not understand them (Zendedel et al., 2018). For this reason, refugees may prefer to avoid interacting with an interpreter from their own community, and instead be interpreted by a more distant, neutral professional who is not from their community. Conversely, in some cases it has been observed that patients and family members identify the professional interpreter as an “ally” or an advocate rather than a neutral professional, creating an expectation that cannot be fulfilled by the professional interpreter, as already discussed in previous chapters (Delizée, 2018; Zimányi, 2013).

As far as the researcher is aware, few studies have been conducted to define the practice of professional interpreters in mental health care (Hsieh 2015b; Delizée 2018). One of the most comprehensive works is Bot’s 2005a study. Other studies show that well-trained and professional interpreters are considered the best option since they can have a positive impact on a session, increasing accessibility and quality of care (Hsieh, 2015b). Indeed, Leanza (2005) states that “if the goal is the best care possible, it is an ethical imperative to hire such professionals in medical settings”, and deems professionally-interpreted consultations “a must for culturally sensitive healthcare” (pp.

167-168). Since professional interpreters are aware of possible cultural differences between patient and provider, they are also able to identify such differences and explain them to the provider, paving the way for greater mutual understanding and more culturally-sensitive care. These explanations, as well as other important issues regarding the encounter, can be discussed by the interpreter and the mental health care provider in pre- and post-session briefings. Pre-sessions can be used to discuss the goals and topics of the session, as well as any sensitive issues that may be explored during the session.

Subsequently, a de-briefing “with the interpreter is essential to clarify the interview material and the dynamics of the interaction” (Farooq, Kingston, & Regan, 2015, p. 18). While it is true that such briefings can also be done with non-professional interpreters, this may be rare since non-professional interpreters may be less aware of their clinical importance.

The literature suggests that mental health care providers also tend to be more satisfied when working with professional interpreters. In their qualitative content analysis based on interviews with health care professionals, Lundin et al. (2018) report that some respondents stressed the importance of the presence of a professional interpreter for psychiatric emergency care, and in psychiatric care in general. One professional working in psychiatric care stated that the patient’s words “should not be colored by relatives” while another added that “there are no caring situations where you think ‘we need to try to manage this without an interpreter.’ It doesn’t work.” (pp. 6-7). In a comparative study of the clinical outcomes of patients suffering from PTSD, refugee patients assisted by professional

interpreters showed more improvement than those who did not benefit from interpreting services (Karliner, et al., 2007; Lundin et al., 2018).

The knowledge of a trained interpreter should, of course, not be limited to the languages used in an interaction; quality interpreting also presupposes knowledge of mental health care. For psychotherapist and bilingual communication specialist Hanneke Bot (2015), this includes

“knowledge of diagnoses, terminology, treatment practices and objectives” (n.p.). Professional interpreters are preferred by providers not only because of their guaranteed linguistic knowledge, but also because it is possible to hire the same professional interpreter for all of a patient’s visits, giving greater continuity (Brisset et al., 2014).

It has also been observed that providers feel more comfortable working with interpreters who are familiar with mental health and with the provider’s procedures. This last factor is particularly relevant in a mental health setting, where the trust-building process and the creation of a safe and comfortable space for the three parties (interpreter, patient and provider) is essential.