Lost in Interpretation: Providing Mental Health Services to Patients with Limited English Proficiency and Culturally Distinct Syndromes

INTRODUCTIONAt present, approximately one-fifth of the U.S. population speaks a language other than English at home. In addition, many recent immigrants to the United States have mental health issues. As a result, many mental health professionals are interviewing and treating patients with the assistance of an interpreter. While research on medical interpreters indicate a high rate of clinically significant errors, these mistakes are particularly high among untrained interpreters. There are several established educational programs for medical interpreters. However, there has been relatively little attention devoted to the unique demands of interpreting in mental health settings. Suggested guidelines for both mental health interpreters and clinicians are provided. A particularly challenging issue in this context is that psychological distress is often experienced and expressed differently in other cultures. As a result, professionally accepted diagnostic criteria such as those from the Diagnostic and Statistical Manual of Mental Disorders, may not apply to patients from many ethnic backgrounds. Clinicians who are able to work successfully with interpreters, while respectfully inquiring into patients' beliefs about their symptoms, are likely be more successful in providing high quality care in cross-cultural encounters.Language is the medium through which we categorize and attribute meaning to experience. This becomes particularly noteworthy in clinical encounters involving more than one language. Linguistic diversity has become an important civil rights issue (Searight and Searight, 2009) as well as an important dimension in both medical and mental health encounters. Currently 18% of Americans speak a language other than English at home and 8% demonstrate limited English proficiency (Flores, 2005; Searight and Searight, 2009). Federal law in the United States guarantees that medical, legal, and governmental proceedings are carried out in one's native language or with interpreter services (Flores, 2005; Searight and Searight, 2009). While there are bilingual health care providers, many of them are not clinically fluent in a second language. A recent study found that when physicians who had previously indicated that they were able to provide clinical care in (an)other language(s) were asked to systematically assess their ability in a second language, they frequently "downgraded" their linguistic knowledge (Diamond, Luft, Chung, and Jacobs, 2011)In addition, while languages such as Spanish, French, and German are commonly taught in U.S. secondary schools and universities, many recent immigrants to the United States speak languages such as Dari Cambodian, Farsi, and Bosnian in which few Americans are formally educated. As a result of these factors, foreign language interpreters are becoming much more common in health care settings.While there are training and educational programs in medical interpretation, there are few programs specifically oriented towards mental health care. While some of the principles for effective interpretation in outpatient medical encounters are similar to those for mental health, there are some unique aspects of psychiatric treatment that differ from general medicine. In particular, psychiatric disorders have distinct symptomatology and phenomenology-often constructed through culturally specific language (Kitanaka, 2012). Additionally, the concept of mental health as a field with its own diagnoses and a distinct category of professionals treating these conditions is also at variance with cultures viewing these conditions as manifestations of spiritual conflicts, imbalances in bodily humors, or moral defects that should be treated by indigenous healers and/or religious leaders.Many studies have found that immigrants report higher levels of psychiatric distress. However, the prevalence of psychiatric conditions is likely to be higher in many immigrant groups-particularly those from war-torn countries. …