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Use of Language Services in Area Mental Health Services (October 2006) (Revised 2010)

Key message

Government policy and legislation requires area mental health services (AMHS) to ensure that people who cannot speak English, or who speak limited English, can access professional interpreting and translating services where significant decisions are concerned and where essential information is being communicated.

Background

Effective mental health care depends on good communication with consumers and families/carers. Inadequate communication with people who have limited English proficiency restricts their access to and understanding of mental health services, and also has a profound impact on the quality of their assessment, treatment and care when they do gain access. Access to culturally and linguistically appropriate information is also vital in educating consumers' families and carers, and supporting them in the caring role.

Inadequate communication increases the risk of diagnostic or treatment errors, and may hamper mental health staff in monitoring mental illness symptoms and the person's medication. It may also affect the consumer's compliance with treatment.

It is the responsibility of the area mental health service (AMHS) provider to deliver services in a manner that is understood by the consumer. The Department of Human Services (DHS) Language Services Policy outlines the legal requirements of services. Further to the broader legislative and policy context described in this document, the Mental Health Act 1986 (s5) requires that mental health services:

• take into account the various religious, cultural and language needs of people who are mentally ill.
• ensure that clients are informed of their legal rights under the Act.
• ensure that the relevant provisions of the Act are explained in a language, mode of communication or terms that clients are most likely to understand.

The National Standards for Mental Health Services require services to be responsive to the cultural and linguistic needs of consumers and their carers/families. They include the requirement for services to 'uphold the right of consumers and their carers to have access to accredited interpreters' (Standard 1.7) and the requirement that services provide written and verbal information on the consumer's rights and responsibilities in a way that is understandable to consumers and their carers/families (Standard 1.3).

Interpreting

An accredited interpreter (see below) should be used when:

• a consumer, carer or family member requests an interpreter.
• where a staff member cannot understand the information being conveyed by a consumer, carer or family member.
• when a consumer, carer or family member does not fully understand what is being told to him or her because of difficulty in communicating in English.

The use of families and carers - and particularly children under 18 years - as interpreters should be avoided.

Critical points for the provision of interpreter services

Staff should inform consumers and their families/carers of their right to use interpreting services if and when needed. The need for an interpreter should be assessed at service entry (i.e. by the triage/intake worker in clinical services) and should be reviewed at key points in the service delivery process, including:

• whenever critical information is being imparted (for example, information about the client's rights, treatment options, proposed interventions, and medication).
• during assessment (for example, the mental state examination).
• when obtaining consent to treatment or release of information.
• on admission to and discharge from an inpatient facility, and at key assessment, decision-making and information provision points during an inpatient stay.
• on discharge from community based care.
• in crisis situations and/or where the consumer's mental health has deteriorated.
• where carers or family members with difficulty in English communication are present or become involved in the consumer's care.

Requirements and standards for the use of interpreters

It is expected that area mental health services will have processes in place to access interpreters 24 hours a day, seven days a week.

All AMHS must establish procedures for using telephone interpreter services.

The AMHS must use accredited interpreters who provide a responsive service. Interpreters used in public mental health services must be selected from the following categories in descending order of priority:

• Interpreters accredited by the NAATI (the National Australian Association of Translators and Interpreters) as Professional Interpreters (level 3) who have undertaken training in mental health issues.
• Interpreters accredited by NAATI as professional interpreters (level 3).
• Interpreters accredited by NAATI as level 2 or less if interpreters of the above criteria cannot be met for the required language.

The following additional requirements apply:

• All urgent requests for interpreters from staff of Crisis Assessment and Treatment Services must be met.
• All requests for interpreters made in connection with the 24-hour statutory review process for involuntary patients must be met.
• In all other cases, interpreters must be made available within 24-hours of the initially desired booking time.
• Interpreters are to be told that Section 18 of the Mental Health Act requires that patients be informed of their rights.
• The AMHS must ensure that interpreters are informed about:
  • The process surrounding involuntary treatment and care.
  • The role and function of the Mental Health Review Board.
  • Basic psychiatric terminology.

While the agency employing the interpreter is ultimately responsible for his or her welfare, it is good practice to include interpreters in any staff debriefing following distressing events or incidents that they are involved in.

Translations of written material

The Mental Health Branch produces a range of translated information for non-English speaking consumers and carers. Other sources of translated information on mental health topics include:

• Victorian Transcultural Psychiatry Unit
• Action on Disabilities in Ethnic Communities: telephone 03 9480-1666 to access audio tapes on mental illness in a range of community languages
• Multicultural Mental Health Australia

Where a mental health service wishes to produce service-specific written consumer/carer information that is not available from existing sources, this should-where possible-be translated into main community languages applicable to the local area.

Further information about about language services

The Mental Health Branch funds the Victorian Transcultural Psychiatry Unit (VTPU) to provide information and training to mental health services on the needs of people from culturally and linguistically diverse groups.

Action on Disabilities in Ethnic Communities (ADEC) also provides training on the use of interpreting services, and other aspects of service provision to multicultural communities.

The VTPU publication, Working with Interpreters: Guidelines for Mental Health Professionals provides further information about the use of interpreters in mental health services. The document is available online at www.vtpu.org.au . A training DVD for working with interpreters in a mental health setting has also been developed by the VPTU.

The AMHS should ensure that staff have access to these guidelines, and are aware of the service's specific arrangements for organising interpreter services. Attachment 1 below summarises the key 'good practice' principles from the VTPU guidelines.

For advice and guidance on working with Auslan interpreters, consult the Working With An Auslan (Australian Sign Language) Interpreter Fact Sheet, available from the VicDeaf website.

Interpreting symbols and cards for consumers to identify their language and need for interpreting assistance are available from the Victorian Multicultural Commission - phone 9651 0651.

To assist a consumer to identify the language they speak services can develop a poster from the tool Find your language available at www.healthtranslations.vic.gov.au

Attachment 1: Good practice in working with interpreters in mental health settings

• Ensure that you know which language (and dialect) the consumer speaks: do not assume the language spoken from the consumer's country of birth
• Check whether there may be an ethno-political divide between consumer and interpreter
• Check whether the gender of the interpreter is important to the interview
• Ensure that the interpreter knows the purpose of the interview
• Be aware of the needs of the interpreter (particularly in stressful and difficult circumstances) and keep in mind the complexity of the interpreter's task
• Introduce all people present to one another and explain the role of each person
• Explain to the consumer and carers/family members that the interpreter is bound by a code of ethics and is required to observe confidentiality
• Speak to the consumer directly: do not say to the interpreter "Ask her if..."
• Use short simple sentences and speak in plain English, avoiding the use of jargon, slang, and colloquialisms
• Allow enough time for questions and answers to be interpreted - this may extend the time needed for the interview
• Do not ask for a 'literal translation' as mental health terms may not have a direct translation in the consumer's language. The interpreter's role is to convey an equivalent meaning.
• Be aware that the interpreter is not a mental health expert and should not be asked about the mental state of the consumer
• Although the interpreter may be asked about cultural background issues, he/she is not a cultural consultant, and may be from a different class or culture to the consumer
• Review the session with the interpreter after the interview, and ask whether there were any interpreting difficulties
• Include the interpreter in any debriefings necessitated by incidents or occurrences that he or she was party to.