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Medical Interpreting for Behavioral Health

Behavioral health interpreting, sometimes referred to as mental health interpreting, requires specialized training in terminology and extensive knowledge of best practices for navigating different behavioral health encounters. Due to the complexities of behavioral health diagnosis and treatment, interpreters pursuing the field are held to particularly high standards.

The National Consortium of Interpreter Education Centers recommends medical interpreters complete a minimum of 40 contact hours through an educational program at an accredited institution or organization and at least 100 hours of field experience before entering the realm of behavioral health.

Several elements set behavioral health interpretation apart from other forms of interpretation. Pre-sessions are often necessary to both inform the interpreter of the type of healthcare encounter that will take place and prepare the provider for the interpretation process. Details, like whether the LEP patient is attending an individual, couples or group therapy session, are helpful in the interpreter’s preparation for the session.

Cultural competence is another essential element of behavioral health interpretation. The National Center for Cultural Competence defines cultural competency as “the capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing”. Behavioral health programs and terminology from one country may function differently than in the United States and therefore require further explanation than a literal interpretation. Interpreters who are medically qualified can quickly determine when a cultural difference is impacting patient-provider communication and act accordingly.

Behavioral health interpreters must be particularly savvy at discerning the subtleties of vocal inflections and nonverbal communication. Gestures and facial expressions carry significant meaning, making up a considerable percentage of the overall message. For effective communication to take place, it is important to observe the manner in which something is said in addition to what is being said. In behavioral health, this is essential. Post sessions are also common with these encounters to address any therapeutic concerns or communication issues that may have surfaced during the encounter.

Tips for Behavioral Health Providers When Working with an Interpreter:

  • Inform the interpreter of the goals of the behavioral health encounter in the pre-session.

  • Consider the physical location of each person and/or VRI device in the room for optimal communication effectiveness.

  • Address questions and comments directly to the patient, not the interpreter.

  • If you feel that a cultural nuance is impacting patient understanding, ask the interpreter to clarify.

  • Be aware, the interpreter will convey everything that is said by all parties in the room.

  • Hold a post session to address any therapeutic concerns or communication issues that have surfaced during the encounter.

In behavioral health encounters, it is important to remember that ad hoc interpreters, i.e., family, staff and other bilingual individuals who are not extensively trained in medical interpretation are not qualified to interpret. Ad hoc interpreters do not typically possess the medical terminology or cultural competency that is required. Relatives or friends are often compelled to omit or alter sensitive information that may be disturbing or embarrassing to the patient, particularly when children are used to interpret for their parents. They also compromise the patient’s privacy, causing the patient to withhold key information for proper diagnosis and treatment. In behavioral health, this can be highly problematic.

A study by the Medical Effectiveness Research Center for Diverse Populations shows that when family members, friends or other untrained individuals interpret in medical situations, a substantially higher number of interpretation errors occur. Interpretation errors are correlated with a decrease in the level of patient care and patient outcomes.

VRI in Behavioral Health Care Encounters

The need for behavioral health services is widespread.  Many patients delay seeking treatment due to a shortage in specialists and/or the stigma that is associated with behavioral health care. When you add in language as a barrier, it presents an additional hurdle for patients to receive care. Video remote interpretation (VRI) simplifies the process, greatly expanding LEP patient access to qualified medical interpreters.

With VRI, providers can connect non-English speaking patients with a wide range of spoken and sign language interpreters over HIPAA compliant video. For behavioral health encounters, VRI can be an effective solution, particularly with individual patient sessions.

In tight knit LEP communities, e.g. the Deaf and Hard of Hearing (HoH) community and communities who speak languages of lesser diffusion, patients often know the interpreters first hand. This can be problematic when it comes to maintaining patient privacy. VRI interpreters, on the other hand, will be less likely to have community ties with patients and work from remote locations. The unbiased atmosphere that VRI provides enables patients to share symptoms and therapeutic concerns that otherwise might be withheld from the provider.

At AMN Language Services, our interpreters are extensively trained in medical terminology and cultural competency. When one of our interpreters is called to facilitate communication in a behavioral health encounter, they become a part of that medical team. View a list of our spoken and sign language interpreter qualifications here.

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