Culturally and linguistically diverse clients

Culturally and linguistically diverse clients

On occasion, language difficulties and cultural misunderstandings may contribute to a person being made subject to compulsory treatment. 

Use an interpreter if necessary and seek your client’s instructions on whether or not there have been interpreters used during their initial assessment and subsequent mental state examinations. 

If a phone interpreter is to be used, ask the staff for a private room with a telephone so that your conversations with the client remain confidential. 

Ask that the service ensure there is an interpreter available at the hearing.

Go through the clinical file and report on compulsory treatment and check for beliefs or behaviours which may have a cultural, rather than a clinical basis. 

Practice tips for working with interpreters:

  • Ask the interpreter to translate exactly what was said, if the interpreter appears to be paraphrasing or editing what your client is saying, ask them to repeat it using the client’s exact words.
  • Be aware that some concepts may have no direct translation into English and the interpreter may need to use more words to express what was said. 
  • Remember the interpreter may not be familiar with medical terminology. Use plain language and avoid acronyms
  • Ensure the Tribunal is aware that an interpreter is to be used and that extra time is allowed for the hearing as a result
  • Hearings sometimes start later than expected. Ensure that the interpreter is booked for enough time to allow for this.
  • Your client may prefer an interpreter of their own gender. Take instructions on this point and book an interpreter accordingly
  • Your client may be from a small migrant community where there is stigma around mental illness. They may be reluctant to use an interpreter, especially if they know the person. Reinforce to the client and the interpreter that your meeting is confidential, and the interpreter is bound by professional rules of confidentiality. If the client is still uncomfortable, it may be necessary to use a phone interpreter and ask for someone from another state. Alternatively, your client may be fluent in another language and it may be possible to use a different interpreter in that language. 

For more information, see Approaching work with interpreters in mental health settings. This free two-part workshop explores advanced skills for practitioners working with interpreters in mental health settings. 

Case examples

Cultural misunderstandings

In XIJ [2017] VMHT 58 (31 October 2017) the tribunal found that XIJ’s admission was a result of a traumatic event coupled with cultural misunderstandings. XIJ had been dismissed from her employment without an explanation. When she became distressed, police were called, and she was forcibly removed from her place of employment and injected with sedatives before being taken to hospital. Key to this finding was the fact that XIJ was able to produce her GP’s contemporaneous notes that contradicted the evidence of the treating team and showed that she had displayed no psychotic symptoms when assessed in her own language.

Paranoia and cultural experience of racism; cultural practices; lack of interpreter

In NTW [2016] VMHT 86 (3 November 2016) the tribunal found that concerns about personal safety considered to be paranoid by the treating team were based in reasonable concerns that NTW had developed as a result being subjected to workplace bullying, racist abuse and having had her home broken into. The tribunal accepted NTW’s submission that spreading flour around a doorway to detect an intruder’s footprint was a cultural practice but did not consider it to be disturbed behaviour in any case. The tribunal observed that interpreters had not been used in NTW’s admission or early case management and once she had been seen by a psychiatrist with an interpreter she was varied to a community temporary treatment order.

More information

 

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