Technology-based Interpreters

Technology-based interpreters, also known as remote interpreters, are trained interpreters who are not physically present during a medical consultation. This type of over-the-phone (or device) interpretation makes it easier for a provider to access a wide array of languages, making interpretation services more immediately available.

As voiced by Hsieh in her 2016 typology, it is now preferable to use the term “technology-based”

interpreters rather than only “telephone” interpreters to include new forms of remote interpreting, such as Video Remote Interpreting (VRI). This latest development, which includes the use of a screen,

allows better communication between the participants since they can see each other and thus make use of non-verbal communication. This relatively new type of interpretation is, in several ways, more feasible than face-to-face interpreting. Unsurprisingly, one of the reasons for this is that technology-based interpreters do not spend time or money commuting or waiting. The cost-effectiveness of VRI compared to face-to-face interpreting is a significant advantage, and has been described as providing

“monetary savings as an unprecedented, but not unanticipated bonus” (Formolo & Fetterolf, 2017, para. 6). Moreover, a consultation does not have to be scheduled in advance with a technology-based interpreter. In emergency cases, the immediate availability of VRI can be, quite literally, of vital importance. The wide range of languages made accessible by VRI makes this mode of interpreting particularly helpful for new, emerging minority communities building a new life in a host country.

For them, it is unlikely that on-site trained interpreters will be readily available. For the above reasons, this type of interpreting service is increasingly popular (Bauer & Alegría, 2010).

Telephone interpreting (as a sub-category of VRI) still presents some challenges that are mainly technical in nature. Poor sound quality, unreliable reception and the presence of echo may hamper communication, and the physical absence of the interpreter may be viewed as a hindrance by providers. For example, providers interviewed in some studies reported that passing the handset back and forth between provider and patient (especially when there is a lot of echo and using speaker-phone is not an option) can be awkward (Saint-Louis, Friedman, Chiasson, Quessa, & Novaes, 2003), and having the interpreter in the room leads to a “much smoother conversation” (Hsieh, 2015b, p.

77). Furthermore, other studies have indicated that providers find this method to be more distracting for all participants, while others point out that the interpreters specifically seem less involved and more distracted during the encounter when interpreting by telephone, as compared to interpreting on-site (Locatis et al., 2010; Kuay, Chopra, Kaplan, & Szwarc, 2015; Hsieh, 2015b).

In some instances, providers have stated that the use of telephone interpreters is simply inappropriate.

Some have voiced the view that when emotional support is needed, for example when discussing an unfavourable prognosis or end-of-life care, telephone interpreting is not the right choice. This is also due to the fact that according to Saint-Louis, Friedman, Chiasson, Quessa and Novaes (2003), telephone-interpreted encounters tend to focus more on succinct medical issues, with “no chances for chatting” (p. 40) and no time for briefings between interpreter and provider before and after the encounter (Kuay, Chopra, Kaplan, & Szwarc, 2015; Saint-Louis, Friedman, Chiasson, Quessa, &

Novaes, 2003).

The inherent lack of personal closeness that comes with telephone interpreting is viewed as a problem by many providers of mental health care, notably because it deprives participants of visual cues that may aid communication (Hsieh & Hong, 2010).

On the other hand, a great advantage presented by remote interpreting is the high level of anonymity and privacy that it can offer. In consultations in which personal and sensitive information is being discussed, telephone interpreting can be a good solution as it can more easily guarantee the patient’s anonymity. This tends to be especially important for patients from smaller migrant communities (Hsieh, 2015b); the presence of an interpreter from the same tight-knit local community can be perceived as a threat by patients, especially those suffering from acute mental disorders. One study (Kuay et al., 2015) highlighted how hospitals can even source telephone interpreters from different regions or countries, thus further reducing the risk of privacy concerns amongst members of small migrant communities. Kuay et al. further report that when telephone interpreters are used, there are fewer cases of a patient refusing their services because of concerns relating to confidentiality, trust and the interpreter’s background. Nevertheless, interpreter anonymity has its own downsides that should be carefully considered, especially in mental health care. As already discussed, trust is one of the most important issues for consideration in a mediated mental health encounter, and anonymity

can be perceived negatively by paranoid or distrustful mental health patients, and in psychiatric care in general (Foundation House, 2012; Hsieh & Hong, 2010). In their extensive study on new technologies and interpretation, Lundin et al. (2018), report that remote interpreting may not be a suitable solution for psychotic patients who believe that they are hearing voices. Despite its potential advantages, the possible issues emerging from over-the-phone mental health interpreting cannot be disregarded.

In her extensive work on conducting psychotherapy with migrants and refugees, Bot (2005a) notes that the means available to a telephone interpreter are more limited, as non-verbal cues are more difficult (or impossible) to discern. The use of gaze and gestures, for example, is not available to the interpreter, making it more difficult to grasp every nuance of what the participants are saying, and when they have finished speaking. The participants must be aware of the fact that non-verbal cues need to be replaced in some way by verbal ones, but Bot does not give any insight on how this replacement could be done. She also states that in mental health care it is better to work with interpreters in person because therapy sessions are likely to last up to an hour. Psychologists Raval and Tribe (2003) agree with Bot, adding that telephone interpreting in mental health care “is at times as inappropriate as making a proposal of marriage over the phone” (p. 82). They also state that the lack of briefing and de-briefing sessions, during which the interpreter can talk directly to the provider about sensitive issues, is yet another problem of this type of interpretation. While briefing and de-briefing sessions usually take place between on-site professional interpreters and providers, the same cannot be said for technology-based interpreters. This is particularly problematic since pre- and post-session briefings are deemed to be of great importance for a psychiatric assessment.

In sum, the existing literature suggests that in mental health care, telephone interpreting should only be used to make appointments, or in emergency cases where there is no better option, and that the mental health needs of a patient should be considered before settling on this type of service.