As preparation for the mental health training series I produced for Americans Against Language Barriers, in October of 2020 I conducted an informal survey of medical interpreters about their experiences and training as it relates to mental health interpretation. I’m excited to share the results of this survey here, but once again I have to emphasize that this is of course a very small sample size and may not be representative of the experiences of all medical interpreters.
For ease of navigation, you can click on any of the links below to jump to different parts of the survey.
Background Information
Demographics
I shared the link for the survey on various professional interpreting groups on Facebook, the social media network where I tend to find the most medical interpreter activity (fun fact: RSI terps tend to hang out on Instagram!). All in all, I had 118 respondents, a few of whom expressed that they do engage in medical interpretation, so I excluded them from the pool since their experiences are outside the scope of this survey.
When it comes to the target languages of the interpreters surveyed, there are two ways to look at the data because multiple interpreters listed multiple languages. First, in the pie chart above, you’ll see what percentage of languages listed are Spanish, Portuguese, Arabic, French, Russian, etc. In the table below, you’ll see what percentage of interpreters listed each language, hence the difference in percentages. Because the percentages in the table would exceed 100% if added together, I wouldn’t be able to use a pie chart to visualize it!
| Language | # of Respondents | % of Respondents |
|---|---|---|
| Spanish | 98 | 83.8% |
| Portuguese | 6 | 5.1% |
| Arabic | 5 | 4.3% |
| French | 5 | 4.3% |
| Russian | 4 | 3.4% |
| Vietnamese | 3 | 2.6% |
| Ukrainian | 2 | 1.7% |
| Bengali | 1 | 0.9% |
| Bosnian | 1 | 0.9% |
| Croatian | 1 | 0.9% |
| German | 1 | 0.9% |
| Italian | 1 | 0.9% |
| Japanese | 1 | 0.9% |
| Mixtec | 1 | 0.9% |
| Polish | 1 | 0.9% |
| Serbian | 1 | 0.9% |
| Haitian Creole | 1 | 0.9% |
Qualifications
The majority of the interpreters surveyed were certified. Only 26% of respondents did not list any qualifications or stated that they had none aside from their 40-hour training course in medical interpretation. It seems CCHI (including CoreCHI) had a slight edge over NBCMI (the organization I’m certified with!). We also had a few Washington State DSHS certified interpreters, as well as a small percentage of interpreters with other certifications (i.e. national certifications outside the U.S.), and a few respondents who had multiple certifications. 3% of respondents were awaiting the results of their certification tests, and 2% of respondents had degrees in interpretation/translation or some other linguistics-related field.
Employment Status & Years Interpreting
I was surprised to find that if we lumped together all interpreter employees (full-time, part-time, PRN) they’d surpass independent contractors! Some respondents listed multiple employment classifications. Independent contractors/freelancers made up the bulk of our responses on their own, followed closely by full-time employees.
Part-time employees and volunteers were nearly tied, and some interpreters only reported back that they were volunteers. This is likely due to the fact that 1) this is a common way interpreters gain experience before seeking contracts/employment and/or 2) this is a strategy some interpreters use to keep their skills “fresh” in-between employment or while they are unemployed.
Only 4 respondents indicated that they were PRN employees, and 4 other respondents fell into the “other” category, which includes unemployed folks and interpreting agency owners.
| Least Years Interpreting | Most Years Interpreting | Average Years Interpreting |
|---|---|---|
| 0 | 30 | 8.9 |
All in all, years of experience ranged from 0 to 30 years, with the average years of interpreting experience being 8.9.
Main Survey Data
Mental Health Training
Perhaps one of the most important questions I wanted to ask in this survey was whether or not interpreters received any form of training in mental health interpretation. Remember: these are medical interpreters, or at the very least interpreters whose duties include medical interpretation.
Have you received training in mental health interpretation?
Please note that this does not include mental health training, but specifically training in interpretation as it occurs in mental and behavioral health settings, or for patients with mental/behavioral health issues.
I included the phrasing of the original question as I believe it outlines some important distinctions and instructions that may have influenced responses. The results are striking.
A whopping 54% of respondents reported that they had not received any mental health interpretation training. Furthermore, 2% of respondents were unsure. The remaining 44% either had mental health interpretation training OR some form of training as a mental health professional/provider, which I felt was important to include.
I asked the following three questions as well:
- How many hours of mental health interpretation training have you completed in the past year?
- How many hours of mental health interpretation training have you completed in the past 5 years?
- How many hours of mental health interpretation training have you completed in the past 10 years?
I realize now that this may have confused some respondents, because a few folks gave higher numbers for 1 year than for 10 years, the number of hours at 5 years was drastically larger than the quantities given at 1 year or 10 years, so I had to exclude these obvious outliers from the pool.
We would expect these hours to increase over time, which they do, but not by very much. Over a very long timeline, we’re looking at an average of less than one hour of training per 10 years. This makes sense given that mental health care is being taken more seriously, and generally becoming less stigmatized as time goes on. The bulk of the average interpreter’s mental health training in this survey appears to have occurred more recently, which is a positive trend!
Remember: the average number of years of experience of medical interpreters surveyed is 8.9, so nearly half of respondents have been interpreting for nearly 10 years!
I also asked folks how many hours of mental health training excluding mental health interpretation training they’ve had. As opposed to mental health interpretation training, mental health training would be any type of training or formal education related to mental health, but not relating to interpretation. For instance, taking classes to become a peer recovery specialist, training to become a licensed clinical social worker (LCSW), and even undergraduate PSYCH classes would all count as mental health training.
The average I came up with was around 41 hours (total) but seeing the raw data, most folks reported zero, whereas a few people responded with hundreds or even thousands of hours, which makes sense because elsewhere they mentioned they were mental health professionals (therapists, psychologists, etc.). I believe the trained mental health providers drastically skewed these data.
High Levels of Training Skewing Results
In an effort to account for the high levels of training of some interpreters skewing results, I went ahead and calculated different averages excluding those that responded with zero hours of training at all levels. This would paint us a picture of just how much training those with training actually had, instead of being depressed by the responses of those with no training.
When looking at hours of training at the 1, 5, and 10-year marks, this is how the data stacks up between all interpreters surveyed (previously shown) and only interpreters who expressed some level of mental health interpretation training.
| Average Hours of Mental Health Interpretation Training | ||
|---|---|---|
| All Respondents | Only Those With Mental Health Training | |
| Past year | 6.2 | 15.3 |
| Past 5 years | 7.2 | 15.3 |
| Past 10 years | 9.9 | 20.3 |
So it’s clear that the more than half of interpreters surveyed that expressed that they had zero training is more halving these averages in most cases.
When it comes to how many hours of mental health training excluding mental health interpretation training they’ve had, the previous average was 41 hours, whereas the average excluding those with zero training jumps to 96 hours.
Free Responses About Mental Health Training
After asking about mental health training, respondents were given an opportunity to explain in more detail anything they believed to be relevant to their mental health interpreting training.
Furthermore, many respondents expressed that they simply learned “on the job” and/or did their own research based on issues that came up during sessions. Some other interpreters admitted that their training was minimal and only touched upon mental health vocabulary, or that they only took optional 1-hour CEU courses on mental health topics that only skimmed the surface.
Many respondents expressed that they know they need more mental health interpretation training, some even encouraging me to offer such trainings since it is so sorely needed. One respondent expressed, “I sincerely believe it’s not for everybody and a heads up on what to expect would make a huge difference.”
A few ASL interpreters (who also interpret for spoken languages) took the survey, and expressed that their mental health interpretation training comes from their ASL interpretation training, which is standard for ASL interpreters.
Three respondents quoted their own experiences with mental health issues as background knowledge that assists them with mental health interpretation.
Mental Health Interpreting Experience
When asked if they’d ever interpreted for a mental health interpreting encounter, the vast majority of respondents (92%) responded yes. One respondent was unsure as to whether or not they had interpreted for a mental health encounter, whereas the remaining 7% said they had not.
I asked those surveyed how many hours per month (on average) they engaged in both medical and mental health interpretation. With this data, I calculated a percentage (per respondent) per each type of interpretation. The pie chart displayed here shows the average of these percentages: 78% medical interpretation and 22% mental health interpretation, which I believe represents the average division of interpretation duties of the interpreters surveyed (strictly limited to medical and mental health interpretation, not including legal, community, conference interpreting.
Biases
Do interpreters have biases that could impact their ability to provide mental health interpretation services? Unfortunately, there’s no real way to operationally define and quantify biases, but I thought it would be interesting to see what interpreters thought about their own biases, as well as how those potential biases related to mental health interpretation and interpretation in general.
Do feel you have biases that could interfere with your provision of interpretation services in a mental/behavioral health care setting?
I asked interpreters whether they felt they had any biases that could interfere with their provision of interpretation services in mental/behavioral health care settings.
There was only a slight majority response: 33.6% of interpreters surveyed admitted that they have biases, but that those biases would not interfere with their ability to interpret. The rest of the responses are outlined in the pie chart above and the table below.
| Response | % |
|---|---|
| Yes, I have biases, and I know they could affect my ability to interpret. | 11.8% |
| Yes, I have biases, but they would not interfere with my ability to interpret. | 33.6% |
| No, I don’t have biases. | 29.4% |
| Biases have nothing to do with interpreting. | 16.8% |
| I don’t know. | 6.7% |
| Other | 1.7% |
Some of the “other” responses included that the interpreter avoids biases altogether because they are unnecessary, and another interpreter stated that they are prohibited from having biases in an encounter by their code of ethics.
Safety
It was important to me to ask about interpreter safety in mental health settings, as this is a common concern voiced by interpreters. It’s important to point out (as is mentioned in part 2 of the mental health interpretation training series I produced with AALB) that patients in mental health settings are not inherently more dangerous or threatening.
The following question was asked, once about medical settings, and once about mental/behavioral health settings:
While interpreting in a _______ setting, how many times have you felt that you were in danger or at risk of being physically harmed?
This is another one of those instances where the results show a notable difference between the two settings.
Of the times interpreters mentioned they felt they were in danger, 63% of those incidents were in mental health settings, whereas 37% of those instances occurred in medical settings. Keep in mind that the survey only asked when interpreters felt in danger and did not ask them how many times they were in danger (or physically harmed).
Skills & Vocabulary
Mental health interpretation requires not only a special set of skills, including simultaneous interpretation, but also a working knowledge of mental health terms and topics.
The average self-reported skill level of simultaneous interpreting, from 1 (beginner) to 5 (expert) was 3.3. Keep in mind this is only based on the interpreters’ perception of their own skill level, not a standardized test. The majority of respondents reported 3’s (32.5%) and 4’s (35.9%).
When it comes to vocabulary, I asked about two mental health terms related to trauma, as well as two LGBTQ+ terms related to gender. My reasoning for choosing the terms are as follows:
- Trauma-informed care is an increasingly popular treatment framework in human service fields, including mental health (and even general medical) care. I have not seen any trainings being offered on trauma-informed care for interpreters, so I wanted to get an idea of how familiar interpreters were with it, as a later installation of the mental health training series delves into trauma-informed interpreting.
- Vicarious trauma is a topic getting a lot of attention in the interpreting world right now and there is no shortage of trainings on vicarious trauma as it presents in interpreters. I was interested to gauge respondents’ familiarity with this term for which there is a wealth of trainings available.
- Non-binary is a gender identity that causes a lot of controversy in the linguistic world when it comes to historically gendered languages. Many discussions I’ve had with fellow interpreters of historically gendered languages surrounding non-binary pronouns have shown me that many interpreters are entirely unfamiliar with the concept, or inflexible with language usage in a way that is non-gender-affirming. The LGBTQ+ population experiences increased rates of mental health issues stemming from being a marginalized group, and we can make or break the provision of gender-affirming services in the rendering of our interpretations.
- Transgender is a gender identity that I have seen many folks define incorrectly in a way that can possibly be harmful or offensive. Understanding is a big component of being able to not only interpret accurately, but also to assist mental healthcare professionals in providing gender-affirming services to this marginalized population.
Overall, respondents reported being more familiar and capable of defining these often-controversial gender-related terms than the mental health terms they were asked about.
Interested in seeing the conclusions I was able to draw from these data?
I recently wrote an article summarizing the important points of this survey and how they pertain to mental health interpretation and medical interpretation training. Click below to read it!
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