The Linguist

@CIOL_Linguists WINTER 2023 The Linguist 23 FEATURES by the training, included cultural and religious beliefs; working with interpreters; working with refugees, Travellers and immigrants, and related stereotypes and prejudices; and how racism and bias have affected people's life and may impact attitudes towards mental health services in different communities. Based on these findings, a taster training session was developed and delivered in the Sheffield area. Case studies focusing on understanding different cultures and religions, working with interpreters, and racism provided a basis for discussions about different aspects of participants' work and enabled them to gain insights into issues and practices in other areas of mental health. In a case study about working in therapeutic sessions, the interpreter adapted a question to be more culturally sensitive to the patient but the therapist was not happy about this, as she had asked the question in that way to elicit a particular response. Additionally, the therapist used idioms that the interpreter was unfamiliar with and found difficult to understand. The case study highlighted the need for both therapists and interpreters to understand their roles and establish communication rules, such as interpreters asking therapists to rephrase and/or clarify questions, and therapists briefing and debriefing interpreters. This pilot led to 12 training workshops which included scenarios around understanding different cultures and beliefs, respecting patients' views/opinions and avoiding anti-racist practices. One case study examined how Black patients may be treated differently when detained and admitted to wards because of stereotypes and prejudices, and offered possible ways to address this. Working with interpreters One of the most discussed topics was the role of interpreters in mental health settings. There were concerns about family members being used as interpreters due to fears around confidentiality, difficulties in finding the right dialect, and interpreters not showing up. This can lead to serious miscommunications, which may adversely affect the entire interaction. When professional interpreters are aware of – and briefed about – the context of certain utterances, they can play a crucial role as cultural mediators. This is particularly important as mental health concepts can have different meanings in different cultures, and certain expressions may need to be phrased in a culturally sensitive manner. Depression, for instance, has no equivalent in Urdu or Somali, so many patients may find the label shameful. Therefore it is better to use patients' own words and terms of reference in describing their lived experience in its cultural context. There was a lot of discussion about briefing and debriefing interpreters. Participants found it interesting to think about interpreters' perspectives and how vulnerable they might feel in certain situations, since agencies rarely provide them with adequate support. In one scenario, an interpreter felt unsafe because the patient was very agitated and moving around. Participants concluded that for a better process and outcome, communicating with interpreters, and being aware of their knowledge and experiences, was crucial. They also considered the implications of the different modes of interpreting (mainly face to face and telephone) currently used in Sheffield Health and Social Care Trust, and how these need to be taken into account in order to ensure effective communication between patients, HSC professionals and interpreters. This includes offering the option to use LanguageLine (a telephone interpreting company) to protect the identity and confidentiality of patients, and forwarding information related to Mental Health Act assessments to interpreters so they can provide appropriate information to patients. Difficulties related to working with interpreters were also shared, for example when they spend a long time talking to patients but come back with just a few words as an answer. Participants acknowledged that it can be difficult to convey meaning in the other language, but stressed that the interpreter must explain what has been said so the HSC professional is fully informed and can do their job properly. It was noted that some interpreters fail to relay important information, which could put patients' lives in danger or have a knock-on effect. In one scenario, the patient displayed behaviour to the interpreter that was not considered to be 'normal'. The interpreter noted this non-verbal behaviour to the psychiatrist and it was discovered that the patient had a learning disability. It had taken almost a year for the patient to get the right treatment. Interpreters can benefit from being informed about the importance of reporting any observed body language, while HSC professionals should provide agencies with feedback to ensure interpreters have the right skills and training. More work to do Interpreting mental health diagnoses requires specialist knowledge since many cultures lack easy equivalents for English mental health terminology. In one scenario, the patient used a proverb from her culture to give depth to her distress: 'When the washing line is full, you can't add more.' If the interpreter translates this literally, it might mean nothing to the therapist. Moreover, mental health involves complex interpersonal communication with individuals who may act, speak or think in unusual ways. Interpreters need to undergo specialist training in order to improve their skills and understand trauma triggers. The training highlighted the importance of this kind of learning. As a result, a number of cultural awareness training workshops are planned for the coming months. We have identified a number of key takeaways, including the need for HSC professionals to consult interpreters regarding differences in cultural and religious beliefs and how best to approach these topics; interpreter training materials to ensure they fully understand mental health concepts; and briefing and debriefing for interpreters. Developing training that involves both interpreters and HSC professionals would be valuable, as this would allow them to gain insights into best practice and learn from one another. Most importantly, there should be guidance and clear protocols for interpreters with regard to neutrality and ethical concerns, and when they should or shouldn't inject their opinions. Notes 1 Arafat, N (2018) 'The Influence of Language and Culture on Improving Access to Psychological Therapy (IAPT) for Pakistani, Somali and Yemeni Patients in Sheffield: Spiritual beliefs and emotions.' PhD Dissertation, University of Sheffield

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