Medical and Mental Health Interpreting: Two Distinct Disciplines

Mental health interpretation is not usually considered a specialty apart, but rather incorporated into medical interpreting as a whole. I believe that this isn’t a wise way to go about providing mental health interpreting services to patients, as many medical interpreters starting out are often blindsided by mental health interpreting assignments with little to no preparation. Most 40-hour medical interpreting training courses do not go over the skills necessary for mental health interpretation. Furthermore, aside from technical interpreting skills, mental health interpreting requires a certain level of emotional intelligence and control, as well as a working knowledge of mental health topics.

A Key Component: Simultaneous Interpretation

Most 40-hour medical interpretation training programs do not work on building simultaneous interpretation skills. Consecutive interpretation is the standard for medical interpretation, in which there are pauses in between utterances for an interpreter to interpret (and take notes, if necessary). This is generally considered to be a more accurate form of interpretation, although it is significantly slower than simultaneous interpreting. Simultaneous interpretation occurs when an interpreter actually speaks over the person they are interpreting for, with enough of a lag for them to listen and process what it is that they are hearing. Most of us are familiar with this form of interpreting as a result of depictions of United Nations conferences in the media.

Simultaneous interpretation is a necessary skill for mental health interpreting. We cannot (and should not) put a patient’s emotional outpourings on pause in order for us to interpret. Imagine speaking to a therapist about a traumatic even that occurred in your life, only to have to stop every three sentences and put your emotions on hold until you are able to speak again. What might you even hold back or omit to make communication easier? It would be highly frustrating, possibly even isolating, in what is supposed to be a therapeutic, healing environment.

Knowing The Difference

The complex mental processes required for mental health interpretation don’t simply stop at the mental gymnastics that is simultaneous interpretation. You not only have to know how to interpret simultaneously, but when to interpret simultaneously versus consecutively. For instance, if you are accompanying a patient that is admitted to an inpatient psychiatric unit to their daily meeting with their doctor, you will likely want to switch to consecutive in order to maximize the accuracy with which medications and dosages are being discussed.

Emotional Intelligence and Emotional Regulation

Perhaps the most difficult skill when interpreting in mental health settings has to deal with an interpreter’s own emotions and how their demeanor or interactions can affect others. Oftentimes in inpatient psychiatric facilities, especially in acute care units, patients (not just your own!) can be prone to outbursts due being especially emotionally vulnerable. It’s arguable as to whether or not the ability to manage and navigate those situations is innate or can be taught/learned, but what is not arguable is the importance of that ability.

I was once with my patient when another patient nearby began showing subtle cues of emotional distress. Their eyes began darting, their feet began lightly tapping, and I could tell they were trembling ever-so-slightly. Furthermore, their respiratory rate was increasing, which I could tell from their nostrils rapidly flaring. What would you do in this situation?

Ultimately in this situation, I decided to move away from the irate patient. I announced in the third person that we were going to move into the hallway, and I used some excuse (I don’t recall at this point exactly what it was). My plan was to announce to the therapist once we were away that the other patient was becoming irate and I felt unsafe, but before I had a chance to do this, the patient actually became violent and threw a chair at the wall. Had we not vacated that room, one of us would have likely been hit.

Maintaining composure, especially in the previously mentioned example situation is key. Knowing your own limitations as an interpreter plays into this, because if for instance you yourself are a survivor of domestic abuse, interpreting for a domestic abuse survivor may not be possible for you. That isn’t to say survivors can’t interpret for survivors, but rather you have to really know yourself and where you are at in your own recovery. This also doesn’t mean if you’ve lived a relatively trauma-free life that you are good to go interpreting in mental health settings, either! We all have our own hangups, and you really do have to know yourself intimately to be able to anticipate these situations.

Mental Health Vocabulary & Concepts

Needless to say, mental health interpreting carries its own specific lexicon. Furthermore, certain groups are unfortunately predisposed to suffering from mental health conditions. Transgender individuals who are not in treatment (ie: cross-sex hormone treatment or CHT) are at increased risk for depressive disorders. While it is important in medical settings to know how to interpret trans-specific vocabulary and pronouns, I would argue this is far more important in a mental health setting. Not knowing how to interpret, “My preferred pronoun is they,” could have disastrous consequences for someone who could be seeking care because other’s lack of acceptance of their gender identity contributes to their depression or anxiety.

Certain concepts such as trauma-informed care are beginning to permeate the medical community outside of the discipline of mental/behavioral health, but not all medical interpreters are familiar with these concepts. Person-first language is another that comes to mind. While it is not an interpreter’s job to filter and modify the utterances they interpret, being familiar with these concepts can certainly make us aware of the importance of the specifics of the language used and how essential it is to preserve its essence. As an example, imagine a provider says to their patient, “As a person with schizophrenia, you are…” The provider made a conscious choice to say “a person with schizophrenia” and not “a schizophrenic” in keeping with the concept of person-first language, so it’s essential for an interpreter to interpret this accurately and completely.

Furthermore, it is within an interpreter’s scope of practice to occasionally step up and advocate for their patient. If a provider is not being sensitive to a transgender patient’s personal pronouns or is visibly upsetting a patient by referring to them as “a schizophrenic,” I might as an interpreter step outside of my role as an interpreter and take on the role of an advocate for my patient. This can be a learning opportunity for the provider, as well as an opportunity to build rapport, while simultaneously making sure my patient is being respected in a sensitive situation.

Medical Interpretation ≠ Mental Health Interpretation

So, as you can see, mental/behavioral health and medical interpretation are two realms of interpreting that may have overlap, but are not the same. Just because you have training for one does not mean you are cut out for the other. An all-too-common fallacy in the interpreting world is using medical interpreters for mental health interpreting, but this does a huge disservice to our patients if we do not have the proper training. Either mental health interpreting training must be a part of medical interpreter training for medical interpreters to effectively interpret in the world of mental health, or the two disciplines should be kept separate.

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