Where conversation is part of the therapy

Greater awareness of psychological health and an increasingly ageing population have led to higher demands on the NHS for psychiatric help. For patients who do not have English as a first language delivering effective treatments can be more complex and, are highly dependent on the intervention of professional language services.
    
With over 300 languages spoken in the UK, communication in the NHS between clinicians and patients can often be compromised as a result – especially for older people who are less likely to speak and understand English, having previously always relied on friends and family.
    
Strong, respectful therapeutic relationships and compassionate patient care is something that is at the forefront of the health sector’s mental health aims. The clinician’s ability to explain, listen and empathise can have a significant effect on functional health outcomes of the patient, as well as patient satisfaction and experience of care.

Supporting standards
Dr Valerie Curran, Consultant Psychiatrist for Older Adults, at Black Country Partnership NHS Foundation Trust in West Bromwich outlines how translation and interpreting services can support these standards of mental health care. She argues the need for good quality interpreting and translation services within her area of work, facilitate a good therapeutic relationship between the service user and the doctor.
    
She said: “In order to interact with patients effectively and compassionately, and to keep patients engaged in their therapy, good quality communication is very important.
    
“Mental health problems can affect people from all backgrounds and cultures, and effective information sharing is a key factor in supporting good communication. Mental health workers understand that the therapeutic conversation that takes place is often the key intervention in itself.
    
“The Equality Act of 2010 mentions 9 personal protected characteristics which should not in themselves reduce or impact on an individual’s right and ability to access the services they may need, including healthcare.”
    
Dr Curran also describes her views on what constitutes good quality interpreting services. She commented: “Services should be easily accessible and available, the providers to be appropriately qualified and experience to act as the intermediary between the clinical staff and the patient. Empathy, respect and compassion are required to ensure understanding of the patient’s perspective and to accurately communicate.

There needs to be appropriate knowledge about maintaining confidentiality and information sharing. Interpreters should have no prior personal relationship with the service user. An interpreter needs to have a clear understanding of their role when participating between the patient and the clinician – their role is to translate information, but not to interject with any personal queries or opinions.”

“In the locality in which I work, we have a large Asian community, so we work with languages such as Gujarati, Mirpuri, Punjabi. There is also a growing Polish community. It’s important that interpreters know how to interact with the service users in a culturally appropriate way.”

Legal frameworks
The Mental Capacity Act and other legal frameworks highlight the importance of the optimising and enabling an individual’s capacity to make decisions and communicate about their care where possible. Providing people with the resources to directly express themselves and communicate about their views and needs, rather than having family members speak on their behalf, is an important means of supporting this principle. I have worked with a large variety of interpreting services, including The Association of Translation Company (ATC) member Absolute Interpreting and Translations, and it is my impression that more consistency in skill and knowledge is required across interpreting service providers”.
    
Communicating with the patient’s members is an important part of Dr Curran’s everyday work, which can bring challenges. Good quality communication is also important in respect of families and carers. Sometimes it is not just the patient who doesn’t have English as their first language but family members and carers too, and if, for example, carers are not able to effectively communicate the patient’s clinical or collateral history or understand the treatment plan agreed, this could negatively impact on the clinical outcome.”

As a Psychiatrist working predominantly but not exclusively with older adults, Dr Curran treats people with a range of mental health issues including dementia, functional mental health problems such as psychosis, depression, and anxiety in old age. She said: “What we tend to find is that younger people (under 65 years old) from ethnic minority groups who have grown up in the UK are likely to have good English language skills especially those who have participated in the education system here. However, older people from BME communities who have grown up abroad may have varied levels of English literacy and language skills linked to their earlier educational opportunities and this group of people will often benefit from specialist language services.”
    
Furthermore, Dr Curran explains why language barriers can interfere with the therapeutic relationship. She said: “Linguistic barriers can impact negatively on the relationship if patients don’t feel like they are being listened to or are being treated in a manner that they feel is not adequately respectful. Patients can disengage if they don’t feel that clinicians are interested in finding out their perspective, and if people disengage, this can impact on treatment outcomes and access to care.”

Language services
Explaining the necessity for accuracy in the language services procured, Geoffrey Bowden, general secretary of the ATC explains: “Language services bridge the gap between healthcare professionals and patients whose first language is not English. It ensures that patients understand the treatments that are being offered, and helps make sure they are confident on the issues they face and the options available to them. It is essential for both parties involved that mental health services in the NHS have access to translation and interpreting services to deliver safe and effective healthcare.
    
“As well as ensuring the availability of language services, the health sector needs to be confident it is accessing services that are of the highest quality, to be certain that all languages are delivered professionally and with full regard to patient sensitivity and confidentiality.
    
Geoffrey continues: “The NHS has to be confident that only appropriately qualified interpreters are being supplied through translation companies belonging to professional bodies such as the ATC. ATC members will have put in place rigorous screening processes to ensure that only the best linguists are assigned to work in NHS settings. Patients and clinicians must be confident that interpreters understand the boundaries within which they are working.
    
“Some ATC members specialise in telephone interpreting services which are accessed during consultant and patient assessments. The interpreter acts as the essential intermediary, ensuring everyone understands each other and that no element of the consultation is open to misinterpretation. Working without such high standards not only risks the reputation of the NHS service and the language service industry, but can also be highly detrimental to the patient.”
    
Ameet Gauher at Five Star Interpreting & Translations, another member of the ATC, comments: “There isn’t one area of the public sector where limited or inaccurate language services would not cause detriment, but especially so in healthcare.
    
“Whenever an individual is involved with a life changing decision it is essential that there is clarity of information. Clear language and communication skills are at the centre of good medical practice.
     
Ameet concludes: “When it comes to the reputation of the health sector, there are always potential risks when there is a lack of or limited communication. Language services should, for this reason, never be considered a luxury, but a necessity for the NHS to maintain and improve upon its reputation.”

Further information
www.atc.org.uk